Why you should send your next (or 1st) Gingival Mask to me.

I was managing the removables department in a small lab about 15 years ago when a Dentist requested a Gingival Mask.  At that time over 75% of the work I did involved implants, attachments, and the cases no one else wanted.  I had no idea how to make a mask, but I do love a challenge, so I called Tom Bormes over at Preat and he was more than happy to help me out. Tom must have taken at least a dozen phone calls from me as I learned how to make a mask. After learning the basics, I went and showed a very good friend of mine, Dr. Isaac Comfortes, what I was working on. Dr. Comfortes saw the potential the masks had for improving smiles, and with his help and that of his wonderful patients, I was able to fine tune my skills I became one of, if not the best, 'mask makers' around. In 1995 and again in 1996, I was fortunate enough to be invited to lecture with Dr. Comfortes and Dr. Ralph Leung at the CDA Fall Session on 'Smile Design' where a Gingival Mask was shown to be a very useful appliance in the practice of cosmetic dentistry.  At the time the average  mask was expected to last six to twelve months. 

Masks are not easy to make and surgical silicone is relatively expensive, so the lab fees can run about the same as a standard denture. Acrylics may be able to last for years but they can also irritate delicate tissues causing more recession and if they break, they are difficult, if not impossible, to repair. Because of this, they usually don't go much past the canines. Gingival Masks can go to the distils of the 1st molar and in some cases distil to the 2nd molar. While surgical silicones will not affect the tissue or break, they do tend to lose their flexibility and color over time. Candida is also a problem. It loves to grow on masks and it hardens the silicone.

Ten years ago I started experimenting. We learned that proper cleaning and storing the mask overnight in contact lens solution would help control Candita becouse of the disinfectant qualities in the solution. Although this helped make the masks last about six months longer, I still wanted more, I wanted to be able to produce a mask that would last two years. Thats when I really started to experiment.

I started working with different FDA approved dental silicones, discovering their individual qualities like opacity, translucently, color stability, and the longevity of those qualities. I now belive that I have come up with the best possible results using a combination of the best dental silicones available on the market today. I won't say what it is that I do that is different or what my special blend is, but I will tell you that half of of the materials I use I order from from Preat.

I want to say thank you to Tom for all his help, his time, and his generous gift of materials for the CDA seminars. I also have to give a big thank you to Tom's son Chris. Chris has not only helped and supported me with my masks, Chris has been my go to guy for attchments and help in figuring out which one to use for some of my most difficult cases.

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Care and Cleaning.

Advise your patient not use toothpaste, a toothbrush, or any denture cleaner or denture (or partial) effervescent soaking product. Any of the above can scrach the surface, bleach out the color, or cause the mask to harden.  Have your patient clean their mask like one would clean a contact lens, with their hands with a gentle soap like Ivory or Neutragena. Do not use an antibacterial soap, it can change the flexability of the mask. Do not use finger nails, they can scratch the mask. Have your patient store the mask in soft contact lens solution when not in use. Contact lens solution will not harden or discolor the silicone, and has the added benefit of being a safe disinfectant for the mask.  Contact lens solution is not made for the mouth, so rinsing after soaking is recomended.

Is a Gingival Mask right for your patient?  

If your patient has had perio surgery, they must resolve the issues that led to the surgery before making a mask for them, and if they are using a fluoride rinse, they must wait at least 30 minutes before inserting the mask. If your patient smokes and drinks more than  occasionally, it will probably be a waste of everybody's time and money. The mask could last less than four months.

Patients can expect to get as little as six months or as much as two or more years of use from their gingival mask. A lot depends on  hygiene,  personal habits, how often it is worn, and, how it is worn.  Rarely is it the patients own Ph that causes hardening of the silicone. Gingival masks will pick up staining just like an acrylic denture, therefore the same foods that stain a denture should be avoided. Women need to be careful not to get lipstick on their masks.

Food and drink that is high in ascorbic acid should also be avoided as these will bleach the color and reduce the flexibility of the mask. Rinsing the mouth and mask after eating or drinking will help with this, and although a thorough cleaning twice a day is recommended,  once a day is mandatory. It is suggested that two masks be made at  the same time, as patients have been known to lose them (toss in tissue, pets, etc.). A spare mask can be kept in the patients chart and you will be a hero when your patient loses their mask the day before their wedding, photo shoot, or family reunion.

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Gingival Mask impression technique.

A pristine impression is necessary and a prophylaxis appointment (or at least a good flossing) before taking an impression for a mask is recommended. Please use a disposable tray, as the impression is cut off the model. If the model is pulled and it breaks, it will be ruined, we will not get a chance to do a second pour. The impression technique is similar to the standard crown and bridge technique. You can use your regular crown and bridge material. Please do not use rubber base, alginate, or hydrocolloid. Syringe material into the interdental spaces and around the necks of the teeth, and then seat a loaded disposable tray. You want to go from first molar to first molar. The impression must include the entire vestibule area, the interproximal area, and facial tooth structure. We do not need the palette. If your patient has large spaces, unstable dentition, or spaces under bridges, you can place a little soft wax on the linguals, being careful not to push the wax past the height of contour of the interproximals. If some of the ‘tags’ between the teeth tear as you remove the impression, tease them out with a blunted instrument and please send with the impression, we will glue it back together. Please allow the lab to pour the impression, it must  be poured under vacuume.

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Seating the Mask.

Very little, if any, adjusting of the mask is needed during the seating appointment. At most the tags may need to be trimed if you have difficulty fitting then into the spaces. Do not use a handpiece to adjust the mask, it will be like trying to adjust a rubberband. Use sharp scissors or a scaple if you need to trim the tags. The smaller the space to fill, the thinner the tag will be, and these some times need a little extra help seating. A toothpick if used carefully, can help tease the tag into place.  Do not use any denture adhesive to help hold the mask in place.

Care and Cleaning.

Advise your patient not use toothpaste, a toothbrush, or any denture cleaner or denture (or partial) effervescent soaking product. Any of the above can scrach the surface, bleach out the color, or cause the mask to harden. Have your patient clean their mask like one would clean a contact lens, with their hands with a gentle soap like Ivory or Neutragena. Do not use an antibacterial soap, it can change the flexability of the mask. Do not use  finger nails, they can scratch the mask. Have your patient store the mask in soft contact lens solution when not in use. Contact lens solution will not harden or discolor the silicone, and has the added benefit of beeing a safe disinfectant for the mask.

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