## 4 Discussion
These outcomes are in accordance with the findings of the study conducted by [PERSON] et al., [34]. According to which, gingival response after lumineer placement was satisfactory with GI and PPD scores remaining within normal range. A possible explanation for this finding is the biocompatibility of ceramics and its ability to minimize toxic and inflammatory cellular effects with minimal bacterial growth around the cervical margin [35]. [PERSON] et al., in their study reported that ceramic restorations accumulated less plaque around the restoration margins along with the reduced bacterial viability. In addition, oral hygiene instructions and plaque control are pivotal for a healthy perio-restorative interface [36]. As oral hygiene instructions were reinforced at regular review appointments, it is the author's opinion that plaque control and therefore BOP considerably improved with consequent follow-up examinations at 12 and 24 weeks in patients [37]. [PERSON], in her study, found that regular oral hygiene instructions improved the periodontal parameters and plaque control in patients with dental veneers [38]. It is also suggested that education level and socioeconomic status have a positive indirect influence on oral health and plaque control of individuals [39]. As a majority of participants (87.4%) enrolled in the present study were well educated and belonged to good socio-economic background, this might have contributed to the results of the study. Furthermore, it is reported in previous studies that females exhibit better behavior and attitude towards oral hygiene practices than males [40; 41]. Incidentally, the majority (59.25%) of patients in the present study were females, therefore gender distribution and their behavior towards oral hygiene practices positively influenced the study findings. GCF flow rate is an indicator of increased tissue permeability which represents early stages of inflammation. This outflow removes the non-adherent microbes and their toxins from dento-gingival space. The findings of the present study showed that GCF volume and GCF levels of IL-6 and TNF-\(\alpha\) at week 4 was significantly higher compared to baseline. IL-6 and TNF-\(\alpha\) cytokines in GCF are pro-inflammatory biomarkers, suggestive of deterioration and clinical inflammatory response in periodontium [18; 42]. Subgingival margin, biological width violation, overzealous cord placement before lumineers placement margin adaptation, lumineer gingival contour, and cementation might be the reasons for the greater volume of GCF and cytokine level derangement [29; 43]. This result is in line with the outcomes of the study conducted by [PERSON] et al., according to which GCF flow rate increases to 5.5-fold during 0-21 days in gingivitis experiment study [44]. However, GCF flow rate and proinflammatory cytokines levels returned to baseline at week 12 and 24. This result is in accordance with the findings of clinical studies which suggested that highly glazed porcelain retains less plaque than tooth enamel [35]. It is well known, that individuals with periodontal infections and ongoing or previous periodontal disease may respond poorly to dental restorative treatments relative to healthy people. In addition, habitual tobacco smokers, diabetics, pregnant women and elderly patients are susceptible to periodontal disease [45; 46; 47]. In the present study, patientswith chronic periodontitis, systemic disease, and smokers were excluded that affects the periodontal response in such patients as a result of Lumineer treatment. Therefore, further studies assessing the clinical periodontal parameters and GCF cytokine profile of diabetics and smokers treated with esthetic lumineer restorations are recommended.