Predictably Achieving Esthetics

Long gone are days when the results of cosmetic dentistry were unpredictable and stressful. By using a proper systematic approach to treatment planning, one can eliminate guesswork and achieve a predictable aesthetic makeover. Smile enhancement is the forefront of treatment planning in the present era of dentistry. It is not necessary to spend countless hours on a patient in order to achieve that pretty smile. What is required is following the key steps to achieve that aesthetic and functional harmony. The goal of aesthetic dentistry is to develop a peaceful and stable masticatory system, where the teeth, tissues, muscles, skeletal structures, and joints all function in harmony. ( Peter Dawson). Step 1: A proper patient interview: It is vital to develop a good rapport with the patient to understand his personality type. A proper detailed interview will help to communicate with the patient in a better way and guide in adequate treatment planning. It will help know the expectations of the patient which will lay the foundation of the aesthetic treatment. But it is also essential to keep in mind that through patient’s primary concern may be a “pretty smile” but we should not forget the dentofacial harmony along with the aesthetic rehabilitation. Step 2:Diagnostic analysis of the case: Following are the required diagnostic records for proper interpretation of the case:

• Medical history
• Dental examination
• Occlusion check
• Tmj examination
• Periodontal condition of the teeth
• Complete radiographic series
• Complete photographic series
• Models

Components of an aesthetic smile The following points are to be kept in mind for a symmetrical, well balanced and functional aesthetic restoration before jumping on to the further treatment: There are three basic components of a smile:

1. The teeth
2. The gingival scaffold and
3. The lips.

Table: Desirable traits of an attractive smile.

• Teeth
• Colour
• Position
• Silhouette Shape
• Gingiva
• Health
• Harmony and continuity of form
• Lips
• Form of lipline: high, medium or low
• The gingival line follows upper lip contour
• Incisal edge line follows lower lip contour

A smile design should always include the evaluation and analysis of both facial and dental composition.

1. Facial composition.

The two critical facial features that play an essential role in smile design are:

1. Interpupillary line

It should be perpendicular to the midline of the face and parallel to the occlusal plane.

1. Lips
2. Dental composition

It is further subdivided into:

1. Tooth components
2. Soft tissue components.

Tooth components:

1. Dental midline

It refers to the vertical contact interface between two maxillary centrals. Evaluation of midline should be done using the philtrum of lip whose centre should match the papilla between the centrals. A discrepancy of around 2 mm is acceptable. Midline should be:

1. a) Parallel to the long axis of the face
2. b) Perpendicular to the incisal plane
3. c) Should drop straight down from papilla.
4. Incisal edge positions

It is determined by:

• Degree of tooth display

When the mouth is relaxed and slightly open, 3.5 mm of the incisal third of maxillary central incisor should be visible in a young individual.

• Proper phonetics.

1. Tooth dimensions

• Maxillary central incisors:

They are the focal point of an aesthetic smile. The length to width ratio of centrals should be approximately 4:5. Proper guidelines for achieving correct proportions in an aesthetic smile can be determined using following formulas:

• Golden proportion
• Recurring aesthetic dental proportion
• M proportions
• Chu’s aesthetic gauges.

However strictly sticking to these formulas are not as important as the visual judgment of a clinician.

• Maxillary lateral incisors:

They should never be symmetrical and are influenced by gender.

• Maxillary canine:

They play a critical role in smile designing as they support the frontal muscles and they also depict the personality of a person ( vigorous and aggressive in masculine and delicate and soft in the feminine)

• Maxillary bicuspids:

They play an essential role in the arch design. They should fill the buccal corridor. Tooth inclinations From central to canine, there should be a natural, progressive increase of mesial inclination of each subsequent anterior tooth.

• Maxillary central incisor- Positioned vertically or slightly labial.
• Maxillary lateral incisor- cervical is tucked in, incisal edge inclined slightly labially
• Maxillary canine- Cervical area positioned labially, cusp tip lingually angulated.

1. Interdental contact area and point.

Interdental contact area follows the 50:40:30 rule in reference to maxillary central incisor. Interdental contact point should move apically as we move posteriorly from the midline.

1. Incisal embrasures