No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Interdisciplinary management of anterior dental esthetics
Abstract
Dental esthetics has become a popular topic among all disciplines in dentistry. When a makeover is planned for the esthetic appearance of a patient's teeth, the clinician must have a logical diagnostic approach that results in the appropriate treatment plan. With some patients, the restorative dentist cannot accomplish the correction alone but may require the assistance of other dental disciplines.
This article describes an interdisciplinary approach to the diagnosis and management of anterior dental esthetics. The authors practice different disciplines in dentistry: restorative care, orthodontics and periodontics. However, for more than 20 years, this team has participated in an interdisciplinary dental study group that focuses on a wide variety of dental problems. One such area has been the analysis of anterior dental esthetic problems requiring interdisciplinary correction. This article will describe a unique approach to interdisciplinary dental diagnosis, beginning with esthetics but encompassing structure, function and biology to achieve an optimal result.
If a clinician uses an esthetically based approach to the diagnosis of anterior dental problems, then the outcome of the esthetic treatment plan will be enhanced without sacrificing the structural, functional and biological aspects of the patient's dentition.
... 3 In today's interdisciplinary dental world, treatment planning must begin with well-defined esthetic objectives. 4 One of the most relevant is to establish anterior guidance. 2 Many adults with skeletal Class III malocclusion have additional dental and periodontal problems that require interdisciplinary treatment approaches. ...
... The key factors that determine the most correct approach to correct crown length differences are the sulcus depth, the location of the cementoenamel junction relative to bone level, the amount of existing tooth structure, the root-to-crown ratio, and the shape of the root. 4 Bracketing and alignment must often be accomplished to improve the esthetic restorability of the abraded teeth. 2 Determination of the tooth position is guided by the gingival margin levels and not by the incisal edges. Therefore, to determine the ideal gingival levels, it is necessary to establish the correct length-to-width ratio of the central incisors and correct the symmetry between the maxillary right and left central incisors and the desired amount of gingival display. ...
... Therefore, to determine the ideal gingival levels, it is necessary to establish the correct length-to-width ratio of the central incisors and correct the symmetry between the maxillary right and left central incisors and the desired amount of gingival display. 4 Alignment of the gingival margins in cases of abraded teeth increases the discrepancy of the incisal edges. Prosthetic compensation can be achieved with veneers or full crowns. ...
The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.
... This assessment was created by one of the authors (Raman Aulakh) and used in other case reports [13,14] in order to encompass orthodontics and restorative dentistry. It had to synchronize with Facially Generated Treatment Planning (FGTP) [15,16]. The analysis for each case is reported in a dedicated table. ...
... The patient evaluation in any complex rehabilitation should follow a pattern, a systematic approach which helps clinicians to elaborate the treatment plan [18][19][20][21]. Spear and Kokich elaborated the so called Facially Generated Treatment Planning (FGTP): the key reference point is an upper central incisor, and his position should be planned first in relation to face and lips [15,16]. ...
... In case 1 the correction of cross bite avoided any restorative intervention on tooth 1.2. In case 2 the Clin Check allowed to measure and create exactly the correct space for tooth 1.2, based on the Bolton analysis (15). An additive restoration was performed to conform the tooth to the contralateral and the correction of the cross bite prevented from occlusal stress and restore function. ...
Background
Esthetic dentistry has become a very important aspect of every dental treatment from the patient perspective, whether it is orthodontics or implant therapy. The aim of this article is to describe the advantages of a newly developed branch of five-to-five clear aligner therapy (CAT) (Invisalign Go, Align Technology, San Jose, Calif) in interdisciplinary treatments especially in terms of minimally invasive interventions.
Case presentation
Two case reports are presented together with a comprehensive analysis using the SAFE (Safety, Assessment, Function, Ethics) assessment. This paper aims to introduce a new systematic in CAT. Invisalign Go (Align Technology, Santa Clara, California, USA) allows orthodontic treatment from second premolar and second premolar in both arches. It is specially designed for general practitioners devoted to restorative dentistry for a better planning of a multidisciplinary and mini-invasive treatment plan.
Discussion and conclusion
The clinical results demonstrate how CAT is extremely useful in multidisciplinary treatment plan in order to straighten teeth especially in a pre-restorative phase to allow minimally invasive and adhesive restorations.
... Understanding these interdisciplinary concepts opens up many treatment options and outcomes. In today's dental world, every practitioner must understand how different dental disciplines work together to create an aesthetic makeover based on conservatism and biological soundness [2]. ...
... Dental diseases like caries, periodontal disease, and oral cancer can cause pain, functional limitations, and lower quality of life. Healthy oral health outcomes often result from interprofessional collaboration between healthcare providers, patient families, and caregivers [2]. ...
... The teeth and periodontal tissues that are visible when people smile have been described as the esthetic area [1]. When complex cases oral issues arise in the esthetic area, the main challenge is how to properly treatment periodontal soft and hard tissues, which requires adequate acquisition of morphological parameters in this area [2]. ...
... Many different methods for measurement of gingival thickness have been proposed, including direct visual inspection [2], dental probe transparency [7], transgingival probing [8], the use of an ultrasonic transducer [9], and cone-beam computed tomography (CBCT) [10,11]. Among these methods, direct visual inspection and dental probe transparency are qualitative methods for determining whether the gingiva is "thin" or "thick". ...
Purpose:
This study investigated and tested a novel cone-beam computed tomography (CBCT) scanning technique capable of obtaining clear contours of soft tissues in the esthetic area.
Methods:
Twenty-three periodontally healthy participants underwent this novel CBCT scanning technique. Soft tissue morphological parameters were measured on the CBCT images obtained. Intraoral clinical data were also collected at the same locations, and the accuracy of the CBCT method was tested.
Results:
The median (interquartile range [IQR]) of the supracrestal gingival tissue thickness as 0.91 (0.73-1.13) mm, and the thickness of the central incisors was significantly greater than that of the canines (P < 0.05). The median (IQR) of keratinized tissue thickness was 0.73 (0.55-0.91) mm, which also showed a significantly greater thickness in the central incisors than in the canines (P < 0.05). Bland-Altman analysis suggested that CBCT could be accurate for measuring soft tissues in the esthetic area.
Conclusion:
The novel CBCT technique described yields clear contours of soft tissues in the esthetic area without the need for auxiliary tools. Moreover, measurements of soft tissue morphological parameters on CBCT appear to be accurate.
... 6,7 The diagnosis and treatment plan involving different dental specialties, mainly its treatment sequence, could be overwhelming. [8][9][10][11][12][13] In addition, treating undersized teeth may be specially challenging for the orthodontist due to the lack of gingival and/or incisal references. [14][15][16][17] As a consequence, the orthodontic treatment may become arduous and the orthodontist may be misguided. ...
... 13,16 Particularly, in these cases involving several specialist miscommunication may increase considerably treatment duration and worsen the final treatment outcome. 9 In patients with undersized teeth caused by wear, the treatment usually includes tooth reconstruction. 5,12 Additionally, when undersized teeth are due to altered passive eruption, patients often require a surgical procedure. ...
Objective:
The aim of this case report is to present a novel digital approach of guiding orthodontics and periodontal surgery by creating interim restorations that represent the final shape of the teeth before starting the treatment.
Clinical considerations:
The patient presented with worn dentition, super-erupted maxillary and mandibular anterior teeth, and altered passive eruption, all this creating a gummy smile. Following a digital wax-up design, a digital orthodontic set-up, and the digital bracket bonding, temporary restorations, and bracket indirect bonding trays were fabricated. Restorations' cementation, bracket bonding, and periodontal surgery were performed the same day. After 14 months of orthodontic treatment, teeth were restored with final ceramic restorations. One year and 6 months was the total treatment duration.
Conclusion:
Prosthetically guided orthodontic concept allows the use of digital technology to simulate the final outcome of the patient treatment before starting dental therapy. This technique not only improves the communication between specialists, it also reduces treatment time and increases precision and predictability.
Clinical significance:
The prosthetically guided orthodontics (PGO) concept has the goal to start interdisciplinary therapy with a simulation of the final outcome. Giving the worn teeth their proper size through interim restorations prior to orthodontic therapy will guide the orthodontist from the beginning of the treatment and will improve communications between all the specialists. Through a digital approach, a digital wax-up and an orthodontic digital set-up the objectives of treatment can be established early on.
... Their impact on professional life is also felt by the people and that is one of the reasons of the utilization of dental services by a number of people to correct the esthetic aspect of their dental appearance. [13][14][15][16] The proportion of patients utilizing dental services for esthetic and cosmetic purposes has increased substantially with increasing awareness, availability of specialized dental facilities, and growing willingness to pay. [17,18] The role of media in influencing the self-perception of individuals and recognizing their esthetic needs for dental procedures can also be not ruled out. ...
A BSTRACT
Introduction
Esthetics is often an essential yet ignored aspect of dental treatment. In the present study, an attempt was made to evaluate patient satisfaction in terms of esthetic outcome of dental treatment.
MaterialS and Methods
For this purpose, a systematic review was carried out by searching, MEDLINE, PubMed, and Scopus databases using the keywords “esthetics,” “orthodontic treatment need,” “dental treatment need,” “satisfaction,” and “determinants.” A total of 1075 studies were shortlisted, out of which a total of 927 were excluded in the preliminary assessment itself. A further 779 were excluded during the process of identification of themes and concepts and another 73 were out of sampling frame/inappropriate methodology. Of the remaining 75, a total of 44 studies were related with expectation and perceptions and thus only 31 (2.9%) studies were left that had evaluated esthetics as the treatment outcome. Among these, 9 studies each were related with orthodontic and prosthodontic/implantology treatment, respectively, while 6 studies were related with general dental treatment, and the remaining 7 were related with specialized/esthetic procedures.
Results
The overall patient satisfaction rate was 67.3%. It was highest in the prosthodontics and dental implantology group (75.1%) and lowest in patients availing of generalized dental (32.4%).
Conclusion
Patient satisfaction was affected by gender, pretreatment appearance, patient personality characteristics, type of disorder, patient education, previous bad experience, treatment time, cost of treatment, use of appliance/treatment modality/material, practice location and environment, dentist personality, quality of treatment, patient’s esthetic perception, negligence/regularity, smoking, and oral health factors.
CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY
The article targets to describe the patient expectations with respect to esthetic dental treatment and how patient’s satisfaction is affected by different esthetic dental treatments availed by them for various purposes. The article also highlights the various dental treatment options availed by the patients and their esthetic outcome.
... 32 This joint planning becomes even more critical in tooth wear patients who present with aesthetics as their main concern to achieve a satisfactory outcome for the patient. 33,34 Formulating a rigorous maintenance stage as part of the treatment plan ensures long-term success of the overall treatment, especially in patients with extensive restorative work. 35 Communicating and emphasizing this life-long need for monitoring, and the possible need for future intervention, is essential and forms part of the valid consent process. ...
There is increased evidence supporting the different management modalities of tooth wear, be it direct or indirect resin composite through an additive approach, or ceramics through a subtractive one. However, there remains a cohort of patients with complex clinical case presentations that require careful assessment, formulation of a multidisciplinary treatment plan, and the delivery of a restorative-led systematic intervention involving additional oral surgery or orthodontic specialties. This case series presents the multidisciplinary management of advanced complexity tooth wear cases, with treatment needs extending beyond the scope of direct and indirect restorative management, through a systematic treatment planning approach.
CPD/Clinical Relevance: To highlight the potential multidisciplinary management options of tooth wear.
... Especially, extraorally harvested bone grafts are associated with clinically significant morbidity and risk of complication. 10 Nowadays the most frequently applied bone augmentation techniques related to implant dentistry are guided bone regeneration (GBR) procedures. In GBR procedures, a barrier membrane is utilized to allow bone to form without the interference of fibrous and epithelial tissues. ...
... Spear et al organized the analysis of complex dental problems by prioritizing the incisal edge position of the maxillary central incisors for correct phonetics and esthetics. 2 Robbins and Rouse presented a diagnostic algorithm for anterior esthetic problems, called Global Diagnosis. 3 The system is based on 5 criteria designated as ideal conditions: (1) a 1:1 proportion of the middle to lower facial thirds; (2) a maxillary lip length of 20 to 22 mm for women and 22 to 24 mm for men, with mobility of 6 to 8 mm for both men and women; (3) a straight maxillary gingival line from canine to canine; (4) a maxillary central incisor length of 10 mm; and (5) a cementoenamel junction palpable in the sulcus. ...
Patients with a complex problem set involving multiple levels of altered structure challenge the clinician to develop an individualized, appropriate treatment plan. Dentofacial deficiency, occlusal problems, and loss of tooth structure require intervention to establish stability and regain function, speech, esthetics, and masticatory muscle comfort. The comprehensive examination must quantify each problem to specify the diagnosis for realistic treatment planning. The clinical case of a patient with Costello syndrome is presented to illustrate essential concepts in diagnosis and treatment of complex cases, including (1) Global Diagnosis of anterior esthetic relationships, (2) occlusal analysis with diagnostic casts verified in centric relation, (3) comprehensive restoration previewed with a diagnostic wax-up and removable acrylic resin overlay, (4) adhesive monobody composite resin onlays that preserve tooth structure, and (5) programmed occlusion, quantified with digital occlusal analysis, to ensure stability and comfort. Costello syndrome is a neurodevelopmental syndrome causing multisystem effects, including a distinctive craniofacial phenotype, cardiovascular disease, intellectual disability, growth hormone deficiency, and dental abnormalities such as delayed dental development, bruxism, and demineralized enamel lesions. In the present case, quantification of the patient's problem set allowed precise treatment planning that resulted in predictable restoration.
... These units are connected through lines of symmetry, proportions, and colors (Bukhary et al., 2007;David et al., 2015;Manipal et al., 2014). In this articulated balance, the anatomy of the gingival margins is crucial (Giancotti et al., 2011;Spear et al., 2006). ...
Objectives:
To evaluate the influence of the gingival contour on the smile esthetics. The influence of size, symmetry, teeth involved in apically shifted gingival margins, and the distance and clinical training of the observer were investigated.
Materials and methods:
Two groups were identified: 33 first-year dental students (inexperienced) and 40 last-year students (trained). Each observer expressed four evaluations on four different images assigning a score from 0 to 10. Using a picture of an "ideal" female smile, 10 variants were virtually created by shifting (2 and 4 mm) the gingival contour apically at different sites of the upper incisors and canines. A total of 292 evaluations were collected.
Results:
Considering a score >6 for a "pleasant smile," only one 4 mm single alteration at the canine gingival contour obtained an insufficient score. "Observational distance" and "clinical training" did not influence the final score, while size and symmetry of alterations displayed a significant role.
Conclusions:
The dental training of the observer and a close interpersonal distance seemed to be irrelevant in the esthetic perception of gingival margin alterations.
... 4 The increase in demand for aesthetic restorations by patients has challenged dentists to propose their treatment plan and deliver it in a more organized and systematic manner. 5 The value of a captivating smile is undeniable. 6 This report describes modifying the labially erupted mesiodens into a primary central incisor. ...
The management of supernumerary teeth, especially mesiodens, consists of a wide range of treatment options. Constant monitoring of supernumerary teeth is mandatory to decide whether to retain it in case of its favourable positioning in the arch by reshaping or endodontically or orthodontically treating it. If its position is unfavourable, surgical removal may be followed. This case report consists of treating labially erupted mesiodens, resulting in early exfoliation of primary maxillary incisor in a five-year-old and modifying the mesiodens into primary incisor until its successor erupts.
... All patients signed an informed consent. The patient sample included 18 women and 12 men between 20 and 50 years of age, none of whom presented ideal esthetic proportions of dental elements, as described by many authors (Belser, 1982;Magne et al., 2003;Richard, 1973;Spear et al., 2006). ...
Objectives:
This study aimed to evaluate the production of customized composite veneers starting from a two-dimensional (2D) digital preview using the Digital Smile System (DSS). MATERIAL AND METHODS: A photographic examination of 30 patients was performed by taking two digital pictures of the face and a digital preview through the DSS. Moreover, optical scans of the dental arches were obtained and the data were entered into a three-dimensional (3D) software to prepare a virtual preview. The standard tessellation language files were sent for production using CAD-CAM technology. The Friedman test, Bonferroni, and Dunn post hoc tests were used, comparing the linear measurements of the 2D and 3D plans and the final veneers (α = .05).
Results:
Significant differences emerged between the pictures and digital scans on the mesial-distal widths of the lateral incisors and canine. Linear measurements in the 2D plan were significantly different from those of the 3D plan, except for the height measures of incisors. No significant changes were found on comparing the parameters of the 2D and 3D plans with those of the final pieces.
Conclusions:
The customized veneers were clinically adequate and similar to 2D and 3D plans, although significant differences emerged between the picture and digital scans as well as between the 2D and 3D plans.
... 2,3 In particular, determining the position, inclination, and gingival levels of maxillary anterior teeth should be some of the first steps of comprehensive treatment planning, because the esthetic outcome could be compromised or even disastrous if a treatment plan does not begin with a clear view of its esthetic impact. 4,5 Various types of computeraided design (CAD) systems are available for virtual smile design. Virtual smile design helps clinicians make a treatment plan with higher predictability by allowing them to visualize the esthetic impact of restorative and surgical treatments before they begin the treatment procedures. ...
Various types of digital dental technologies have been successfully implemented as a part of dental treatment to improve predictability and efficiency of dental procedures. Virtual smile design can be used to enhance predictability from an esthetic perspective, and the virtual articulator can be a useful tool to create a desired occlusal scheme. This case series describes a fully digital workflow that can predictably achieve desired esthetic and functional outcomes. The proposed protocol also includes other currently available digital technologies, such as intraoral scanning, computer-aided design, milling, and 3D printing. Three clinical cases are presented to describe the workflow in detail.
... In addition, the position of maxillary central incisors will dictate the positions of lateral incisors, canine, and premolars. [20] In general, an attractive smile is one where the incisal edges of the upper anterior teeth follow the curvature of the lower lip while smiling. [21,22] According to the McLaughlin Bennett Trevisi system, the tip of the canines should be at the level of the central incisor edge. ...
There is a gap in research about the differences in smile attractiveness. The problem the study addresses is how the vertical canine and incisor position affect smile attractiveness. The aim of this study was to assess the perception of the smile attractiveness between Saudi laypersons, orthodontists, non-orthodontist, and various dental students levels, and to determine how the canine and incisor vertical positions affect the attractiveness of smile. The study is a cross-sectional survey and was conducted at King Abdulaziz University, Jeddah, Saudi Arabia. Six groups of subjects participated in the study: Orthodontic residents (n = 31), prosthodontic, restorative, periodontics specialties residents specialties residents (n = 30), interns (n = 31), fifth year students (n = 41), 6th year students (n = 39), and laypeople (n = 39). Participants were asked to rate the attractiveness of a smile of a female subject photographed using a Minolta DiMage 7i digital camera. The image had been manipulated to produce 2 sets of images; 1 to modify the incisors and 1 to change the canines. The subjects were asked to choose the most and least attractive picture. For the best incisor positions, only the laypeople and prosthodontics liked the original picture, the rest liked +0.5 mm which accentuate the smile curve and make it follow the lower lip line. For the worst incisor position, all groups did not prefer the minus 1.5 reversed smile. For the best canine vertical position, all groups preferred the original position where canine was at the level of the incisal plane. For the worst canine position, they all disliked the minus 1.5 reversed smile. Results confirmed past findings that orthodontists are in general more critical about smile attractiveness than laypersons, but just like other dental specialists. The findings can be used in the esthetic dentistry field, but further research on the study population based on other dental design parameters remain necessary.
... Orthodontic treatment remains the best method for aligning the malposed teeth, as the tooth movement is similar to physiologic tooth movement with bone remodelling taking place. However, for those patients not willing for orthodontic treatment due to time constraints, economic reasons, needing immediate estheticsrestorative treatment can be saught as an alternative 2 modifying the access cavity preparation during root canal treatment followed by tooth preparation appropriately to receive a crown. But this may lead to undue loss the natural tooth structure, especially on the labial sidenecessitating placement of post and core restoration. ...
Aim: To evaluate and compare the stress distribution pattern of simulated endodontically treated maxillary central incisors restored with cast post and cores with different core angulations. Materials and Methods: An intact maxillary central incisor was decoronated 3mm above the CEJ, endodontically treated and restored using cast post and core and metal ceramic crown. The sample was scanned using 3D white light scanner and FEM models were generated by angulating the cast core to the post and were divided into 4 models : cast post restored central incisor with 0 0 core angulation , 10 0 angulation , 20 0 angulation , 30 0 angulation. A force of 75N was applied at an angle of 135 degrees to the long axis of crown on palatal side and stress distribution was analysed. Results: • At 30 degrees, highest stress concentration was seen at cervical region of the tooth • Upto 20 degree change in core angulation, there was not much of increase in stress distribution under normal loading conditions Conclusion: Upto 20 degrees, the cast post and cores had no much detrimental effects and beyond that the stress levels increased drastically and stresses accumulated at the cervical 3 rd of the tooth.
... Das Gesicht besitzt klar die Stellung eines Schlüsselmerkmals im Rahmen der physischen (Gesamt)Attraktivität[31]. Zahnästhetik scheint in der heutigen Zeit -auch unter dem Modewort «Smile Design»[32] -fast unentbehrlich geworden zu sein. Ein perfektes und strahlendes Lächeln verursacht zudem eine große Nachfrage in der ästhetischen Zahnheilkunde, ist ein Spiegelbild der modernen Gesellschaft und wurde längst auch zum zahnmedizinischen Marketing-Tool[33].Allerdings variiert die subjektive Perzeption der Ästhetik zwischen Zahnarzt und Patient und ist auch interindividuell sehr verschieden[34]. Vor allem die Farbe und Form spielen bei der Einschätzung einer Restauration eine wichtige Rolle[35]. ...
... In the context of architectural education it can be scientific methods of analysis and conclusions from the cycle of General subjects, from the basic disciplines of the development of compositional and artistic skills and spatial imagination, imaginative and intuitive thinking, etc. The forthcoming digital modernization of the design and construction production process forms new professional competencies for the practical development of information types of design in educational programs on architectural and construction specialties (Spear et al., 2006;Imahori & Lanigan, 1989). ...
This article analyzes modern requirements for professional education of student architects. New educational documents and the trajectory of their further development are examined. Special attention is paid to innovative interdisciplinary principles of the educational process, as well as methodological requirements. The experience of a separate school on formation of the concept of interdisciplinary methods of teaching of the main discipline is considered. As well as promising directions of development of the specialty in this school.
... The evaluation and execution of all these concepts will allow having a predictable treatment in the future, but above all, the comfort of the patient with proper function, aesthetics and better self-esteem. [9][10][11][12][13] Within the rehabilitation of total edentulous patients who will be restored with an implant-supported prosthesis, the use of prototypes is of utmost importance before thinking about a definitive material. The prototype will allow us to assess for a long, yet considerable amount time all the aforementioned elements, while enabling the clinician to make any type of modification during this prototype stage. ...
Purpose of Review
This article describes the clinical management of a patient who had a severely damaged dentition due to periodontal disease for several years.
Recent Findings
The following clinical case is developed from the integral and global aspect, including surgical conditioning, implant placement and the elaboration of a prosthetic prototype that can give a successful outcome for the definitive restoration. A full series of a diagnostic workup was made, and a treatment plan specific to the needs of the patient was laid out, with an emphasis on the difficulty of the management of these types of patients in which a dental practice is familiar with.
Summary
There are complications on these rehabilitations due to the severe damage of the dentition with extensive osseous atrophies that make a challenging situation in order to provide a comfortable, esthetic and functional rehabilitation. Implant-supported fixed dental prosthesis is a well-accepted treatment option for edentulism. Loss of teeth due to extensive caries or severe periodontitis presents a challenge to the clinicians.
... Uma abordagem interdisciplinar entre o dentista restaurador, periodontista e outras especialistas, pode levar à bons resultados de terapia e motivação aos pacientes (Spear et. al., 2006. Zahra et. al., 2016e 2019. ...
Novos desafios surgem a cada dia na área de saúde, os quais vem demonstrando que somente a partir da confluência de saberes e fazeres das diversas áreas do conhecimento os sistemas de saúde estarão fortalecidos para o enfrentamento deles, tendo em vista a complexidade das ações que se fazem necessárias em todos os níveis de atenção: primário, secundário e terciário. As rápidas mudanças epidemiológicas e demográficas, concomitante ao surgimento de pandemias e recrudescimento de doenças transmissíveis e não transmissíveis no mundo, evocam novos olhares e fazeres que requerem transformações desde a formação dos profissionais, produção de conhecimentos com vistas à processos de trabalhos colaborativos nos serviços de saúde, nos quais ocorram uma compreensão quanto a complementariedade dos diversos saberes e fazeres que compõem a equipe de saúde, desconstruindo a cultura das ações sobrepostas ou, a falácia que algumas profissões são mais importantes e portanto, hegemônicas frente as outras. O mundo é complexo e dinâmico, logo, os seres humanos que nele existem também o são em suas dimensões existenciais considerando que estão imbricados no mundo e, por esta característica fenomenológica, o saber / fazer de uma única profissão jamais será capaz de compreender e atender as complexas necessidades factuais destes seres em todo o seu ciclo vital, tendo em vista a imprevisibilidades e incertezas oriundas delas. Com base nas afirmações supracitadas e partindo do princípio de que o trabalho em saúde não tem um produto concreto final, sendo seu resultado consequência das relações profissionais e interpessoais que subjazem suas ações de cuidado e não apenas resultante do saber/fazer de um único profissional, é importante enfatizar que toda a centralidade do processo de trabalho em saúde deve ser o usuário e suas complexas necessidades, as quais só poderão ser realmente atendidas com um cuidado interprofissional / colaborativo. Portanto, mudanças no modus operandi e modus faciendi na formação dos profissionais de saúde e no processo de trabalho suscitam o desenvolvimento de novas competências e habilidades que devem permear a arte de ensinar, pesquisar e extensionar, reverberando no verdadeiro trabalho em equipe nos serviços de saúde, algo somente alcançável através da implementação de uma educação interprofissional nas universidades e cursos técnicos, assim como, a criação de políticas indutoras para o trabalho colaborativo, no qual os diversos saberes e fazeres profissionais sejam valorizados e reconhecidos quanto sua importante complementariedade, visando decisões terapêuticas compartilhadas no atendimento às necessidades de saúde no contexto mundial vigente frente a pandemia de COVID-19 e outras demandas biopsicossociais de cuidado humano. Nesta perspectiva, pensar em ciências da saúde é refletir sobre novos aprendizados, novas metodologias de ensino e novas formas de pesquisar em um cenário contemporâneo que desvela um mix de processos antigos que recrudescem e novos que surgem, apontando a urgência de novas tomadas de decisões, as quais sejam rápidas e eficazes em responder às complexas necessidades dos usuários do sistema de saúde, contribuindo para o resgate e manutenção da qualidade de vida. Desejamos a todos uma profícua leitura desta obra, a qual pela diversidade de temáticas abordadas, permitirá ao leitor não somente uma leitura do mundo sob o prisma dos autores ao socializarem os resultados alcançados em seus estudos, mas, sobretudo, poderá instigá-lo de certa forma à “reescrevê-lo”, no sentido de transformálo a partir da apreensão e ressignificação de conhecimentos contidos nas diferentes pesquisas que corporificam este e-book, permitindo um movimento de cruzamento e interdependência entre variadas competências.
... Uma abordagem interdisciplinar entre o dentista restaurador, periodontista e outras especialistas, pode levar à bons resultados de terapia e motivação aos pacientes (Spear et. al., 2006. Zahra et. al., 2016e 2019. ...
Novos desafios surgem a cada dia na área de saúde, os quais vem demonstrando que somente a partir da confluência de saberes e fazeres das diversas áreas do conhecimento os sistemas de saúde estarão fortalecidos para o enfrentamento deles, tendo em vista a complexidade das ações que se fazem necessárias em todos os níveis de atenção: primário, secundário e terciário. As rápidas mudanças epidemiológicas e demográficas, concomitante ao surgimento de pandemias e recrudescimento de doenças transmissíveis e não transmissíveis no mundo, evocam novos olhares e fazeres que requerem transformações desde a formação dos profissionais, produção de conhecimentos com vistas à processos de trabalhos colaborativos nos serviços de saúde, nos quais ocorram uma compreensão quanto a complementariedade dos diversos saberes e fazeres que compõem a equipe de saúde, desconstruindo a cultura das ações sobrepostas ou, a falácia que algumas profissões são mais importantes e portanto, hegemônicas frente as outras. O mundo é complexo e dinâmico, logo, os seres humanos que nele existem também o são em suas dimensões existenciais considerando que estão imbricados no mundo e, por esta característica fenomenológica, o saber / fazer de uma única profissão jamais será capaz de compreender e atender as complexas necessidades factuais destes seres em todo o seu ciclo vital, tendo em vista a imprevisibilidades e incertezas oriundas delas. Com base nas afirmações supracitadas e partindo do princípio de que o trabalho em saúde não tem um produto concreto final, sendo seu resultado consequência das relações profissionais e interpessoais que subjazem suas ações de cuidado e não apenas resultante do saber/fazer de um único profissional, é importante enfatizar que toda a centralidade do processo de trabalho em saúde deve ser o usuário e suas complexas necessidades, as quais só poderão ser realmente atendidas com um cuidado interprofissional / colaborativo. Portanto, mudanças no modus operandi e modus faciendi na formação dos profissionais de saúde e no processo de trabalho suscitam o desenvolvimento de novas competências e habilidades que devem permear a arte de ensinar, pesquisar e extensionar, reverberando no verdadeiro trabalho em equipe nos serviços de saúde, algo somente alcançável através da implementação de uma educação interprofissional nas universidades e cursos técnicos, assim como, a criação de políticas indutoras para o trabalho colaborativo, no qual os diversos saberes e fazeres profissionais sejam valorizados e reconhecidos quanto sua importante complementariedade, visando decisões terapêuticas compartilhadas no atendimento às necessidades de saúde no contexto mundial vigente frente a pandemia de COVID-19 e outras demandas biopsicossociais de cuidado humano. Nesta perspectiva, pensar em ciências da saúde é refletir sobre novos aprendizados, novas metodologias de ensino e novas formas de pesquisar em um cenário contemporâneo que desvela um mix de processos antigos que recrudescem e novos que surgem, apontando a urgência de novas tomadas de decisões, as quais sejam rápidas e eficazes em responder às complexas necessidades dos usuários do sistema de saúde, contribuindo para o resgate e manutenção da qualidade de vida. Desejamos a todos uma profícua leitura desta obra, a qual pela diversidade de temáticas abordadas, permitirá ao leitor não somente uma leitura do mundo sob o prisma dos autores ao socializarem os resultados alcançados em seus estudos, mas, sobretudo, poderá instigá-lo de certa forma à “reescrevê-lo”, no sentido de transformálo a partir da apreensão e ressignificação de conhecimentos contidos nas diferentes pesquisas que corporificam este e-book, permitindo um movimento de cruzamento e interdependência entre variadas competências.
... Uma abordagem interdisciplinar entre o dentista restaurador, periodontista e outras especialistas, pode levar à bons resultados de terapia e motivação aos pacientes (Spear et. al., 2006. Zahra et. al., 2016e 2019. ...
mundo é complexo e dinâmico, logo, os seres humanos que nele existem também o são em suas dimensões existenciais considerando que estão imbricados no mundo e, por esta característica fenomenológica, o saber / fazer de uma única profissão jamais será capaz de compreender e atender as complexas necessidades factuais destes seres em todo o seu ciclo vital, tendo em vista a imprevisibilidades e incertezas oriundas delas. Com base nas afirmações supracitadas e partindo do princípio de que o trabalho em saúde não tem um produto concreto final, sendo seu resultado consequência das relações profissionais e interpessoais que subjazem suas ações de cuidado e não apenas resultante do saber/fazer de um único profissional, é importante enfatizar que toda a centralidade do processo de trabalho em saúde deve ser o usuário e suas complexas necessidades, as quais só poderão ser realmente atendidas com um cuidado interprofissional / colaborativo.
... However with the time aesthetic has become one of the major concern and the treatment plan, without including aesthetic view of patient, may bring disastrous outcome. 18 The concept of aesthetics and perception towards the dental aesthetics vary from population to population and among the individuals in the population. 8 In this study 52.15% of the participants were satisfi ed with their general teeth appearance, among them 29.51% were male and 22.64% were female. ...
Introduction: Oral health not only comprises of mere absence of oral disease and dysfunction but also includes dental appearance for overall facial beauty as it has influence on person’s self confidence and social life. Dental aesthetic comprises of tooth color, shape, alignment and position of the teeth in the dental arches. For the rewarding outcome of the treatment, clinician need to understand the root of dissatisfaction with present aesthetic and desired treatment to enhance the aesthetic that will assist in development of treatment plan. Materials and Methods: Pre-tested structured questionnaire was used in 349 subjects from previous studies with slight modification for data collection. The questionnaire was divided into three parts, first part recorded the demographic data, second part consisted of the patients’ view regarding satisfaction of the dental appearance and third part consist of the Likert scale where participants will rate the satisfaction level regarding their general appearance. Results: A relationship between gender (P<0.05), education (P=0.006) and overall satisfaction of the general appearance of the teeth was seen. Males were found to be more satisfied than females and people with higher education were more satisfied with their general dental appearance. For majority of the participants, choice of treatment to improve the aesthetic was teeth whitening (37.25%) followed by orthodontic treatment (29.80%), then dental crown, veneers (27.29%). The least favoured treatment by the participants is denture (5.16%) to improve the aesthetic. Conclusions: Dissatisfaction with the color, alignment, teeth appearance and condition are the main reasons for the patients to seek aesthetic treatment.
... An interdisciplinary approach between periodontists and prosthodontists is required to achieve successful esthetic rehabilitation for the short clinical crown and excessive gingival display [27]. Esthetic consideration is the first step in the treatment plan for the maxillary anterior region [28]. In the case of crown lengthening is needed to be performed, the surgeon should receive all information on optimal gingival contours and tooth esthetics when. ...
... Cada trabalho artístico requer uma visualização inicial, de modo que, na arquitetura, escultura ou pintura, é necessário fazer uso de projetos, esboços ou protótipos, os quais são representações bi ou tridimensionais do resultado final e, depois de terem sido desenvolvidas, irão guiar os processos de construção, desenho e modelagem. Da mesma forma, na Odontologia, todas as necessidades, expectativas, questões funcionais e biológicas dos pacientes devem ser cientificamente incorporadas no desenho estético do tratamento, que deve servir como referência para todo o resto do procedimento [8][9][10][11][12] . ...
OBJECTIVE: To review the literature on the digital planning and diagnosis protocol known as "Digital Smile Design", highlighting its main advantages concerning aesthetic rehabilitation in restorative dentistry. MATERIAL AND METHOD: 60 articles were searched in Pubmed, Scielo, and Bireme databases, using the search terms Dental photography, cosmetic dentistry, treatment protocols. Inclusion criteria were: In vivo studies, systematic reviews and meta-analysis, literature addressing variables under study, language in Portuguese and English, and articles published from 1990 to 2020. Exclusion criteria were: letter to the editor, literature review, and clinical case. RESULTS: DSD is a treatment planning tool used in interdisciplinary aesthetic dentistry to strengthen the diagnostic vision, improve communication between specialists and patient guidance. Smile design refers to the many scientific and artistic principles that, collectively, can create a beautiful smile. These principles are established through data collected from patients as diagnostic models, anamnesis, and measurement of facial proportions. In turn, the aesthetic composition of the smile depends on many points of reference and anatomical parameters for the formation of a harmonious and beautiful set. FINAL CONSIDERATIONS: the DSD is an important tool to be used for aesthetics rehabilitations in restorative dentistry, since it is an instrument that facilitates the diagnosis, improves communication between the multidisciplinary team and assists in the orientation and motivation of the patient, increasing the predictability of treatments.
... Discolored teeth are among the biggest hurdle of a beautiful smile. Therefore tooth colored restoration are in vogue and their demand is increasing day by day [3] . The possibility for innovative use of esthetic material are multiple [4] . ...
Tooth discoloration is one of the most common findings now a days. Several factors have been found to be responsible for this. A variety of procedures are available now a days for tooth discoloration from microabrasion to veneers. The main focus should be on as conservative as possible treatment so maintain the natural tooth structure.
Objective
This article presents technical guidelines for perio‐restorative esthetic crown lengthening, along with a discussion of the biologic rationale. A classification system is proposed to assist in treatment planning and sequencing the surgical and restorative phases.
Clinical Considerations
When esthetic crown lengthening is performed as an adjunct to restorative therapy, the surgical approach must be determined by the anticipated position of the restorative margins. The removal of sufficient bone to achieve the desired clinical crown length and preserve the supracrestal gingival tissue dimensions is facilitated by the use of a surgical guide fabricated according to the design of the restorations. A staged approach allows sequencing the provisional restoration to minimize unesthetic sequelae during the healing period. Inadequate bone resection and/or alteration of the soft tissue dimensions results in delayed healing, leading to coronal gingival rebound and biologic width impingement.
Conclusion
The identification and preservation of appropriate restorative and biologic landmarks is essential for success in pre‐prosthetic esthetic crown lengthening treatment. A staged approach improves the esthetic management during the postsurgical healing and maturation period.
Clinical Significance
A restorative driven classification system for sequencing and staging adjunctive esthetic crown lengthening procedures is presented. Technical guidelines to enhance gingival margin predictability are suggested, accompanied by relevant evidence. In addition, wound healing timelines following gingival and osseous resection are provided.
The aesthetic management of tooth size discrepancies is an essential component when dealing with simple and complex dental rehabilitation. Tooth size and shape is a crucial factor that strongly influences both the smile and the face in the treatment outcome. From an orthodontic perspective, evaluation of the ideal mesiodistal widths relating to both maxillary and mandibular arches is required to plan the correct occlusal, aesthetic, and functional result.
The aim of this paper is to propose a safe and repeatable method to evaluate and correct tooth size discrepancy through the presentation of two case reports. Both cases were managed using a combination of clear aligner therapy and minimally invasive restorative procedures, as well as the use of digital tools.
The treatment of edentulous or soon-to-be edentulous jaws requires surgical and prosthetic skill to achieve a functional outcome. These interventions have a profound impact on facial aesthetics with respect to support for the perioral tissues and lower face. Patients may present with significant loss of supporting tissue necessitating prosthetic replacement. Ideally, this intervention should be determined in the diagnostic phases to more predictably achieve the desired result and patient approval. Change in position of teeth and prosthetic contour can detrimentally affect speech. This chapter aims to provide a background to the effects of prosthesis contour and techniques to enhance aesthetics and maximise phonetic adaptation.KeywordsSpeechRestorative contoursPrototype
Three-dimensional imaging is superior to conventional 2D radiographic imaging for the assessment of airway, jaws, temporomandibular joints (TMJ), teeth, and the alveolus that houses the teeth. The diagnostic modality becomes even more important if the orthodontic therapy is surgically facilitated (SFOT). Three-dimensional radiographic analysis gives detailed information on the anatomy, suspected areas with potential complications, anticipation of the path of tooth movement to identify areas in need of bone grafting among other benefits. SFOT performed under 3D imaging guidance enables improved esthetics, stable occlusion and function, and long-term success. CBCT imaging is also helpful to rule out pathology from the alveoli, jaws, TMJ, skull base, and neck. A methodical evaluation of CBCT via multiplanar and panoramic reconstructions, as well as 3D reconstructions paves way for better surgical planning and successful outcomes. This chapter deals with CBCT evaluation of mandible, maxilla as part of the facial skeleton as a preoperative evaluation prior to SFOT.KeywordsCone Beam Computed TomographyTemporomandibular jointsMultiplanar reconstructionThree-dimensional reconstructionMaxillary sinusSkull baseAlveolar processAirway analysisMaxillaMandible
Though the ideal position of the central incisor has not been clearly identified in dental literature for esthetics, function, and airway, several practitioners have devised systems to evaluate the face. The three systems are facially generated treatment planning, CORE esthetic evaluation, and Digital Smile Design (DSD). Together, these systems help determine the ideal position of the central incisor, though they are not perfect. However, when used in combination, a reasonable position may be determined with respect to facial esthetics, function, and airway.
Treatment planning of complex cases involves a combined effort from different specialists. Hence, it is of utmost importance for the various specialists involved in the treatment to understand and collaborate closely. In these situations, Surgically Facilitated Orthodontic Therapy (SFOT) plays an important role in achieving challenging movements and reducing time of treatment. This chapter reviews an interdisciplinary treatment approaches involving periodontics, orthodontics, dental implant placement, and prosthodontics with a fully digital dentistry workflow. These new approaches have the objective to minimize miscommunication between specialists, improve precision, and reduce treatment time. Additionally, it describes critical parameters to perform a correct diagnosis and a successful treatment plan.
Statement of problem:
One of the major challenges in restorative dentistry is to provide optimal esthetics in a minimally invasive way. The optimization of dental esthetics and function is directly related to the position and alignment of the anterior teeth, but whether prerestorative clear aligner therapy will enhance esthetics and minimize restorative needs is unclear.
Purpose:
The purpose of this clinical study was to evaluate the effect of prerestorative maxillary and mandibular second premolar to second premolar clear aligner therapy in minimizing the need for restorative treatment.
Material and methods:
Fifty adult patients treated with clear aligners (Invisalign Go; Align Technology) were included in this study. Previously generated 3-dimensional orthodontic simulations and clinical photographs in the ClinCheck/6.0 software program were used. Three restorative treatment plans for each participant were generated for initial (no aligners), Express (after using 7 aligners), and Lite Packages (after using 20 aligners) by 2 blinded restorative dentistry instructors. The maxillary and mandibular teeth in the smile-line (to the second premolars) were included. Assessment criteria were the estimated number of restorations, restoration surfaces and preparations and incisal edge inclusion, and the need for gingival leveling. The Friedman test and Cochran Q test were used for statistical analyses (α=.05).
Results:
A strong positive correlation was found between the 2 instructors (P<.001). Estimated number of restorations (10 [3 to 16]a) decreased significantly for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The estimated number of restoration surfaces (28.5 [9 to 48]a) decreased significantly for Express (15 [0 to 42]b) and Lite Packages (9.5 [0 to 24]c) (P<.001). While the estimated number of teeth to be prepared for recontouring (7 [0 to 16]a) was significantly less for Express (3 [0 to 10]b) and Lite Packages (0 [0 to 4]c) (P<.001), the incisal edge inclusion (10 [3 to 16]a) was significantly less for Express (6 [0 to 14]b) and Lite Packages (4 [0 to 8]c) (P<.001). The need for gingival leveling (26 [52%]a) decreased significantly for Express (20 [40%]a) and Lite Packages (7 [14%]b) (P<.001).
Conclusions:
Prerestorative short-term clear aligner therapy might conserve tooth structure and reduce the number of restorations. The application of the Invisalign Lite Package was more effective than the Invisalign Express Package for second premolar to second premolar alignment.
Background:
Virtual planning has revolutionized orthognathic surgery. This study presents a computer-assisted method for constructing average three-dimensional (3D) skeletofacial models that can be applied as a template for surgical planning for maxillomandibular repositioning.
Methods:
We used the images of 60 individuals (30 women and 30 men) who had never undergone orthognathic surgery to construct an average 3D skeletofacial model for male participants and one for female participants. We validated the accuracy of the newly developed skeletofacial models by comparing their images with 30 surgical simulation images (i.e., skulls) that had been created using 3D cephalometric normative data. The comparison was conducted by superimposing surgical simulation images created using our models with the previously created images to analyze their differences, particularly differences in the jawbone position.
Results:
For all participants, we compared the jaw position in the surgical simulation images created using our average 3D skeletofacial models with that in the images created using 3D cephalometric normative data. The results revealed that the planned maxillary and mandibular positions were similar in both images and that the differences between all facial landmarks were <1 mm, except for one dental position. Most studies have reported <2 mm to be the success criterion for the distance difference between planned and outcome images; thus, our data indicate high consistency between the images in terms of jawbone position.
Conclusions:
Our average 3D skeletofacial models provide an innovative template-assisted orthognathic surgery planning modality that can enhance the fully digital workflow for virtual orthognathic surgical planning.
Risk studies/level of evidence:
Therapeutic, II.
The foundational principles of esthetic smiles reveal the direct influence of individual tooth alignment on dentofacial relationships. The use of clinical photography is an essential means to identify esthetic problems. Smile design provides an opportunity for effective communication to discuss treatment alternatives with the patient in the consultation process. The scope of treatment can be determined, and treatment limitations can be explained. Smile design findings influence preparation design, material selection, and laboratory communication for enhanced predictability and improved treatment success.
Contemporary Aesthetic Crown Lengthening: An Interesting Orthodontic/Periodontics Case Utilizing Digital Design, Digital Planning and 3D Printing Technology to Aid in Patient Management
Les cas de réhabilitation et d'orthodontie nécessitent une communication précise avant et pendant le traitement. Le défi fréquemment rencontré dans bon nombre de ces cas est de trouver une méthode fiable et facile à interpréter pour communiquer les objectifs et les recommandations. Les avantages visuels de l'outil Digital Smile Design (DSD) peuvent rationaliser le processus de communication et aider à assurer la compréhension entre les cliniciens et les patients.
ARTICLE INFO ABSTRACT Careful attention and meticulous treatment planning are the most rehabilitation. It is a biggest challenge to treatment planning order to optimize comfort and satisfaction. With early loss of loss of report is of full mouth rehabilitation of a 55 years old loss of posterior teeth with loss chewing improved appearance, we used a removable appliance to test an the provisional stage, the patient related symptoms chewing function, and a satisfying smiling appearance Copyright©2017, Ashok. This is an open access article distributed under the Creative and reproduction in any medium, provided the original work is properly cited.
Smile design is defined as the process of creating an esthetic smile based on scientific and artistic guidelines established through studies, perception, and cultural and racial standards that have been recognized over time. Smile design is a dynamic field with evolving trends that take into consideration: facial esthetics, lip dynamics, pink and white esthetics, and personality. Traditional smile design focused on the orodental complex. Modern smile designers must have a global understanding of the entire patient to design the perfect smile.
The ideal definition of "Minimal Invasive (MI) Dentistry" is the use of a biological method rather than a typical (surgical) operational dentistry strategy to treat dental caries. When operational dentistry is necessary, it is now done in the most conservative way possible, with the least amount of tooth structure being harmed. This novel method of caries cares shifts the focus from detecting carious lesions as cavities (and a recurring cycle of restorations) to diagnosing the oral ecological imbalance and affecting biological changes in the biofilm. After stopping the disease process, MI aims to restore lost tooth structure and function, while optimizing the tooth's healing capacity. “Caries treatment has evolved from G.V. Black's extension for prevention to minimally intrusive owing to advancements in dental adhesives and restorative materials, increased knowledge of the caries process and remineralization, and changes in the incidence of caries. A decrease in cariogenic bacteria, new classifications of caries based on the location and size of lesion remineralization, and procedures and materials for minimally invasive cavity preparation are some of the topics covered in this book.”
Background
: The interarch space is defined as the vertical space between the edentulous ridge and the occlusal or incisal aspect of the opposing arch. Measuring the interarch space in a patient requiring an implant-supported fixed prosthesis is crucial for determining the prostheses to be used in each clinical situation. Depending on the measurements and other factors, such as the need for lip support or pink esthetics issues, decisions about the most convenient type of implant-supported prosthesis can be taken. Analogic workflow to measure the interarch space can represent a time-consuming and costly procedure that may lead to inaccuracies.
Objective
: It is aimed to describe a step-by-step protocol to measure the upper and lower interarch space with open-access software from the digital scan of the patient's complete dentures obtained with an intraoral scanner.
Methods
: An extraoral scan (using an intraoral scanner) of the existing complete removable prosthesis is required to assess the interarch space for making an implant-supported prosthesis treatment planning. If the existing complete denture does not fulfill the required functional and esthetic parameters, a complete interim denture, a wax trial denture, or a printed denture prototype should be previously fabricated. The antagonist arch and the intermaxillary record scan also need to be obtained. Finally, all STL files are imported into an open-access software for measuring the interarch space.
Results
: Open-source software can be used to measure the upper and lower interarch space from existing complete dentures following the step-by-step protocol outlined in this paper
Conclusion
: Interarch space of edentulous patients rehabilitated with complete dentures can be measured with a 360 degrees scanning of the existing complete dentures and open-access software by applying the protocol outlined in this paper.
Clinical relevance
: The clinician can assess and digitally measure the interarch space of edentulous patients requiring an implant-supported fixed prosthesis using free software by following the step-by-step protocol outlined in this paper.
Objective:
The conventional anterior esthetic treatment protocol is limited as it's time consuming and unreliable. A predictable digital workflow for minimally invasive anterior esthetic tooth rehabilitation with global diagnosis principle has been introduced in this report.
Clinical considerations:
A 23-year-old female patient with the chief complaint of unsatisfied shape and color of her anterior teeth visited our hospital for restorative consultation. Three-dimensional Digital Smile Design was used to integrate into a virtual patient model to provide rehabilitative esthetic planning with global diagnostic principle. 3D printer was used for communication and guidance preparation. Digital impression and computer-aided design/computer-aided manufacturing technologies were adopted for making the morphology of designed restorations that can precisely transfer to definitive prostheses. The esthetics, functional occlusion, and gingival tissues remained stable for over a follow-up period of 3 years. No signs of fractures within the restorations were observed.
Conclusions:
Minimally invasive anterior esthetic tooth rehabilitation can be readily achieved using a predictable digital workflow with global diagnosis principle.
Clinical significance:
This digital approach might promote diagnosis, enhance communication, reduce processing time, and increase the predictability of final outcomes with high comfort and esthetic effect.
The anterior maxilla or premaxilla is part of the upper jaw and the most significant content of this region, from the aspect of orthodontic therapy, are the incisor teeth. The frequency of complications during orthodontic movement of the upper incisors refers to a more detailed evaluation of the anatomical structures of the premaxilla. The aim of this study was to investigate morphological and morphometric characteristics of the anterior maxilla by cone beam computed tomography, which could be of interest for planning orthodontic teeth movement. By reviewing the available literature, we compared the values of the alveolar bone height, the distance between the alveolar crest and enamel – cement boundary, total alveolar bone width, the thickness of the buccal, and palatal plate, nasopalatine canal, and accessory canals of the anterior maxilla. The results of our study show changes in the labial and palatal aspects of the alveolar bone height during orthodontic interventions. Different results of the alveolar bone width are in correlation with gender, age, and type of orthodontic tooth movement. Distance between the nasopalatine canal and maxillary central incisors was estimated at the value from 4 to 6 mm, which is below the recommended value for maximum incisal retraction by Proffit. Research results show variations in shape, length, and diameter of the nasopalatine canal, which indicates individual varieties detected on cone beam computed tomography. Other anatomical structures and measures show an insignificant correlation with orthodontic teeth movement. According to the contradictory results of the available articles, it is required to achieve an individual approach to orthodontic interventions in the area of the anterior maxilla.
ARTICLE INFO ABSTRACT Careful attention and meticulous treatment planning are the most rehabilitation. It is a biggest challenge to treatment planning order to optimize comfort and satisfaction. With early loss of loss of report is of full mouth rehabilitation of a 55 years old loss of posterior teeth with loss chewing improved appearance, we used a removable appliance to test an the provisional stage, the patient related symptoms chewing function, and a satisfying smiling appearance Copyright©2017, Ashok. This is an open access article distributed under the Creative and reproduction in any medium, provided the original work is properly cited.
A phase of periodontal therapy may be required before commencing implant therapy to ensure a predictable result and ensure patient compliance with maintenance protocols. Occlusal assessment and the use of splints, occlusal equilibration, or selective tooth build‐ups to optimise occlusion may be necessary for a stable long‐term periodontal result. A thick biotype and 3‐5 mm of attached mucosa are optimal for long‐term implant health. A cone beam computed tomography scan can determine the bucco‐lingual, vertical, and mesio‐distal bone volume of an implant site, along with identifying structures such as adjacent teeth and their root angulations, bone levels, and apical pathologies. The pathogenic flora associated with endodontic lesions can be very detrimental to implant placement and can result in implant failure and bone loss if an infection spreads to the adjacent implant site. Orthodontics is a discipline often overlooked in the planning of dental implants.
Objective
This case will illustrate the interdisciplinary management of an adolescent female patient with amelogenesis imperfecta (AI). It will contrast this approach and compare it to the previous “multidisciplinary” treatment rendered before the patient was referred for a second opinion.
Clinical considerations
The patient had a family history of AI affecting all of her permanent teeth. There were many impacted teeth. The majority of her family and relatives afflicted by this opted for dentures. The patient had undergone 2 years of treatment and was told that her “braces would be removed next week.” Her new dentist was concerned because the case was not ready to restore.
Conclusion
He recommended referral to another orthodontist for a second opinion and formulation of an interdisciplinary treatment plan that would include a periodontist, endodontist, and restorative dentist. The patient's family accepted the second opinion referral and restarted treatment with an interdisciplinary team. The restorative dentist was the quarterback for this integrated and sequenced approach. The case was ultimately restored. A 35 year follow-up shows stability with a caries free, periodontally healthy, esthetic result.
The maxillary midline diastema is, indisputably, one of the dentoalveolar disorders that cause special concern to parents and patients,[1] specifically given its position. [2]It is most commonly seen dento-alveolar anomaly in maxillary arch than mandibular arch.[3] Maxillary midline diastema seen in deciduous dentition is a transcient condition, while those seen in adoscelent and adult have different etiological factors. On the basis of controverting data, [4,5]it may be concluded that multiple factors are involved in the etiology of maxillary midline diastema, a fact suggesting that further research is required.[1-5]
Statement of problem
Different technologies have been used to fabricate trial restorations. However, studies investigating the accuracy of trial restorations fabricated with different techniques in comparison with the initial 3-dimensional virtual design are lacking.
Purpose
The purpose of this clinical study was to evaluate completely digital workflows for managing the esthetic outcome through the production of trial restorations with 2 different technologies: stereolithography apparatus (SLA 3D) and computer-aided design and computer-aided manufacturing (CAD-CAM). The aim was to determine which of them provided trial restorations more similar to those of the 3D virtual design.
Material and methods
Thirty participants who did not meet ideal esthetic proportions for the anterior maxillary teeth were enrolled. For each, 2 intraoral and extraoral frontal photographs and intraoral digital scans were made. The digital images were processed by using the Digital Smile System (DSS) software program to have a smile preview after the treatment. Virtual designs were matched with the surface tessellation language (STL) files from the intraoral scans and edited by exocad DentalCAD to create custom trial restorations using SLA 3D and CAD-CAM technologies. Two independent examiners measured the virtual restorations by using virtual calipers in the software program and then the trial restorations by using digital calipers. The measurements were carried out from the incisal edge to the gingival margin, mesial-distal widths of the central incisors, and the distance from the distal margins of maxillary right and left canines. The trial restorations were evaluated intraorally for fit. The participants approved the definitive treatment outcome after the evaluation. The normality of data was verified with the Shapiro-Wilk test, and the Friedman test for matched groups with the Bonferroni and Dunn tests for multiple comparisons were used (α=.05).
Results
Comparing the 3D designs with the printed trial restorations, a significant increase was only found in the mesial-distal width of central incisors ( P<.05), while the milled trial restorations showed a significant increase ( P<.05) of all measurements except for the maxillary right and left canines. Comparing printed trial restorations with the milled ones, the only significant difference was found in height measures of maxillary right central incisor, with the milled trial restorations exhibiting higher values than the printed ones ( P<.05). The printed trial restorations showed good clinical fit, and the milled restorations had poor clinical adaptation.
Conclusions
The accuracy of printed trial restorations was higher than that of milled trial restorations, except for the canine to canine width of maxillary anterior teeth. However, this difference did not compromise the fit of the printed trial restorations. The milled trial restorations had increased dimensions in comparison with the measurements made in 3D designs, and consequently, their clinical fit was compromised. SLA 3D- printing technology provided the best fit.
This retrospective study was conducted to measure lip-tooth characteristics of adolescents. Pretreatment video clips of 1242 consecutive patients were screened for Class-I skeletal and dental patterns. After all inclusion criteria were applied, the final sample consisted of 50 patients (27 boys, 23 girls) with a mean age of 12.5 years. The raw digital video stream of each patient was edited to select a single image frame representing the patient saying the syllable "chee" and a second single image representing the patient's posed social smile and saved as part of a 12-frame image sequence. Each animation image was analyzed using a SmileMesh computer application to measure the smile index (the ratio of the intercommissure width divided by the interlabial gap), intercommissure width (mm), interlabial gap (mm), percent incisor below the intercommissure line, and maximum incisor exposure (mm). The data were analyzed using SAS (version 8.1). All recorded differences in linear measures had to be > or = 2 mm. The results suggest that anterior tooth display at speech and smile should be recorded independently but evaluated as part of a dynamic range. Asking patients to say "cheese" and then smile is no longer a valid method to elicit the parameters of anterior tooth display. When planning the vertical positions of incisors during orthodontic treatment, the orthodontist should view the dynamics of anterior tooth display as a continuum delineated by the time points of rest, speech, posed social smile, and a Duchenne smile.
Orthodontic forced eruption may be a suitable approach without risking the esthetic appearance in tooth fracture below the gingival attachment or alveolar bone crest. Extrusion of such teeth allows elevating the fracture line above the epithelial attachment and so the proper finishing margins can be prepared. Restoration after orthodontic eruption may present a more conservative treatment choice in young patients compared with the prosthetic restoration after extraction. This case describes a multidisciplinary approach using the orthodontic forced eruption facilitating the composite restoration of a fractured upper permanent central incisor.
Purpose: This study was designed to determine the perceptions of lay people and dental professionals with respect to minor variations in anterior tooth size and alignment and their relation to the surrounding soft tissues.
Materials and Methods: Smiling photographs were intentionally altered with one of eight common anterior esthetic discrepancies in varying degrees of deviation, including variations in crown length, crown width, incisor crown angulation, midline, open gingival embrasure, gingival margin, incisal plane, and gingiva-to-lip distance. Forty images were randomized in a questionnaire and rated according to attractiveness by three groups: orthodontists, general dentists, and lay people; 300 questionnaires were distributed.
Results: The response rate was 88.2% for orthodontists, 51.8% for general dentists, and 60.6% for lay people. The results demonstrated threshold levels of noticeable difference between the varying levels of discrepancy. A maxillary midline deviation of 4 mm was necessary before orthodontists rated it significantly less esthetic than the others. However, general dentists and lay people were unable to detect even a 4-mm midline deviation. All three groups were able to distinguish a 2-mm discrepancy in incisor crown angulation. An incisal plane cant of 1 mm as well as a 3-mm narrowing in maxillary lateral incisor crown width were required by orthodontists and general dentists to be rated significantly less esthetic. Lay people were unable to detect an incisal plane asymmetry until it was 3 mm, or a lateral incisor narrowing until it reached 4 mm. Threshold levels for open gingival embrasure and gingiva-to-lip distance were both at 2 mm for the orthodontic group. Open gingival embrasure became detectable by the general dentists and lay people at 3 mm, whereas gingiva-to-lip distance was classified by these groups as noticeably unattractive at 4 mm.
This article discusses the vertical position of the maxillary incisors and its relationship to esthetics. Two situations are discussed. The first, a discrepancy between the incisal plane and the interpupillary line, is corrected by maxillary surgery, orthodontic intrusion/extrusion, or orthodontics and restorative dentistry. The correct decision depends on the interrelationship of the posterior occlusal plane, incisal plane, interpupillary line, and the crown length of the incisors.
The second discrepancy in the vertical position of the maxillary incisors is the “gummy” smile. This problem, due to either overdevelopment of the entire maxilla or over-eruption of the maxillary incisors, is solved by maxillary surgery, orthodontic intrusion of the over-erupted teeth, or orthodontics and restorative dentistry. The proper choice of treatment depends on the interrelationship of the posterior occlusal plane, incisal plane, crown length of the maxillary incisors, and the level of the gingival margins of the maxillary anterior teeth.
This article has discussed the medio-lateral relationship of the maxillary anterior teeth relative to esthetics. In this dimension, common problems include asymmetric crown widths, inadequate pontic width, midline deviation, and improper angulation of the maxillary incisors. In all four of these situations, the proper solution depends on a coordinated, interdisciplinary approach involving well-planned and well-choreographed orthodontics and restorative dentistry.
The purpose of this investigation was to analyze the clinical crown of the 3 tooth groups of the maxillary anterior sextant of the permanent dentition of normal subjects with respect to (i) width, length and the width/length ratios and (ii) determine if there is a correlation between tooth dimensions or tooth group ratios and subject height. Subjects (≥20 y.o.) were recruited for this study if (i) the free gingival margin on the facial surface of teeth in the maxillary sextant was positioned apical to the cervical bulge, (ii) there was no evidence of attachment loss; as determined by lack of a detectable CEJ and (iii) the marginal tissue was knife edged in form, firm in consistency and coral pink in color. Teeth were excluded if (i) there was evidence of gingival alteration, i.e., gingival overgrowth/hyperplasia, inflammation, altered passive eruption, attachment loss, gingival recession or history of periodontal surgery, or (ii) there was evidence or history of incisal edge/proximal tooth alteration as in, i.e., restorative intervention, traumatic injury or occlusal wear into dentin. At least 1 suitable tooth from each tooth group of the maxillary anterior dentition had to be present. A maxillary impression was taken and poured in yellow die stone. The widest mesial-distal portion and the longest apical-coronal portion of the test teeth were measured. Gender, ethnicity and subject height (SH) were recorded for each participant. Due to a limited ethnic diversity only data from the Caucasian group were analyzed. The mean coronal tooth width (mm) of males versus females was CI: 8.59 versus 8.06, LI: 6.59 versus 6.13 and CA: 7.64 versus 07.15. The mean coronal tooth length (mm) of males versus females was CI: 10.19 versus 9.39, LI: 8.70 versus 7.79 and CA: 10.06 versus 8.89. All width and length measures were significantly greater for males than for females. The mean coronal tooth width/length ratios for males versus females was CI: 0.85 versus 0.86, LI: 0.76 versus 0.79 and CA: 0.77 versus 0.81. A comparison between genders of the width/length ratios of the CI and LI were found not to differ, however the CA ratio for females was significantly greater than for males. A statistically significant difference was found to exist between the mean (cm) SH for males versus females: 181.2 versus 164.0. A positive correlation (p≤0.0001 to 0.0691) was found to exist between tooth group width/height ratios within genders. No significant correlation was found between any of the tooth dimensions or tooth group ratios and SH. The results of this study indicate that within male and female Caucasians, the mean width/length ratio of the maxillary 3 anterior tooth groups is 0.81. As well, within both genders there is a positive correlation between tooth group width/length ratios. The significance of these findings with respect to periodontal mucogingival plastic surgical procedures is discussed.
A survey has been presented that correlates measurements of upper lip type, sex, race, and age of dentulous patients with the amount of exposure of the maxillary and mandibular anterior teeth with the lips gently parted and in the resting position. Perhaps the most interesting finding was the gradual reduction in the amount of maxillary central incisor exposure with an increase in age, accompanied by a gradual increase in the mandibular tooth exposure. The importance of the amount of mandibular teeth seen in complete dentures has not been sufficiently emphasized in previous literature.
Lateral cephalometric radiographs were evaluated to determine the posttreatment stability of 66 patients treated with LeFort I osteotomies to reposition their maxillae superiorly. The sample was divided into three groups based on the degree of pretreatment overbite: openbite subsample--no incisal overlap; overlap subsample--incisal overlap and no incisal contact; contact subsample--incisal overlap with incisal contact. The cephalograms were superimposed and linear measurements were made at each interval (pretreatment, posttreatment, and at least one year posttreatment). The results clearly show that the three subsamples reacted differently during the posttreatment interval. 42.9 percent of the subsample with pretreatment openbite showed a significant increase in facial height, significant eruption of maxillary molars, and a significant decrease in overbite. 28.6 percent of the openbite subsample and 16.7 percent of the overlap subsample showed a significant increase in facial height, significant eruption of maxillary incisors, and no change in overbite. The contact subsample had no significant posttreatment changes. Possible reasons for the posttreatment instability in the openbite subsample are proposed.
Long-term response of the anterior open-bite malocclusion was evaluated in forty-one white subjects who had undergone orthodontic treatment and were out of retention a minimum of 9 years 6 months. The purpose of the study was threefold: (1) to make cephalometric comparisons between a sample of open-bite patients and a sample with normal cephalometric standards, (2) to evaluate treatment and posttreatment changes that occurred in treated open-bite patients, and (3) to search for predictors and associations of value. Changes occurring across time in the open-bite patients were analyzed by computer means using pretreatment, posttreatment, and long-term cephalometric radiographs and dental casts. An analysis of subgroups was reviewed to compare dentoalveolar and skeletal relationships of both stable and relapse groups. More than 35% of the treated open-bite patients demonstrated a postretention open bite of 3 mm or more, with the relapse subgroup demonstrating across-time, less mandibular anterior dental height, less upper anterior facial height, greater lower anterior facial height, and less posterior facial height. Neither the magnitude of pretreatment open bite, mandibular plane angle, nor any other single parameter of dentofacial form proved to be a reliable predictor of posttreatment stability.
This study was conducted to determine the average dimensions of the six maxillary anterior teeth in a targeted population and to evaluate the relationships between intertooth and intratooth dimensions. Casts were obtained from 54 patients ranging in age from 18 to 35. Measurements of length and width were made on the casts using a digital caliper. Using these measurements, ratios were calculated: length to width, width to width, and length to length. Although the tooth dimensions varied somewhat by race and gender, the ratios were quite consistent. In addition, the golden proportion was not found to correlate with any of the calculated ratios.
In 25 patients with vertical maxillary deficiency, selected for a group of 410 Le Fort I osteotomies, the anterior part of the maxilla was repositioned inferiorly. Four groups could be distinguished. A group (n = 6) with downgrafting of the maxilla alone, fixed with wire osteosynthesis, a group (n = 6) treated with Le Fort I and sagittal split osteotomy with a wire-fixed maxilla, a group (n = 8) with a Le Fort I and vertical ramus osteotomy where the maxilla was fixed with wire and group (n = 5) treated by Le Fort I and vertical ramus osteotomy in which the maxilla had been fixed with miniplate osteosynthesis. In the group of single maxilla repositioning and in bimaxillary group with a plate-fixed maxilla, the range of relapse was -0.3 mm to +1.0 mm (mean + 0.4 mm) and 0 mm to + 1.0 mm (mean + 0.5 mm) respectively, which was not correlated to the distance of inferior repositioning. The bimaxillary cases, in which the maxilla had wire osteosynthesis, showed postoperative relapse ranging from - 1.4 mm to + 3.4 mm (mean + 1.3 mm) (sagittal split osteotomy) and - 1.1 mm to + 3.7 mm (mean + 1.2 mm) (vertical ramus osteotomy). In these cases the outcome of surgical intervention appeared completely unpredictable. If these figures are presented as percentages as is done in the literature in the majority of publications, a misleading impression appears. Likewise information about operation technique, fixation methods and linear measurements of movement and relapse (instead of percentages) are essential in comparing different studies.
This article compares the long-term outcomes of rigid internal fixation with wire fixation.
In this retrospective study, nine cases of vertical midface augmentation in which rigid fixation was used were compared with 11 cases with wire fixation. One surgeon completed all cases for the rigid fixation group, and another surgeon completed the cases in the wire fixation group.
Follow-up was 16 +/- 11 months for the rigid fixation group and 20 +/- 12 months for the wire fixation group. Inferior movement at the anterior portion of the maxilla was 7.0 +/- 2.9 mm with rigid fixation and 4.5 +/- 3.6 mm with wire fixation (P < .05). Postsurgical superior movement (relapse) was 0.4 +/- 0.4 mm with rigid fixation and 2.4 +/- 2.4 mm with wire fixation (P < .01). Inferior movement at the posterior maxilla was 3.1 +/- 0.2 mm with rigid fixation and 2.8 +/- 2.3 mm with wire fixation. Postsurgical superior movement (relapse) was 0.8 +/- 0.4 mm with rigid fixation and 0.5 +/- 2.3 mm with wire fixation, which was not significantly different.
This comparison showed downgrafting of the maxilla using autogenous bone harvested from the iliac crest and rigid internal fixation to be a predictable and stable procedure.
Deep overbite is one of the most common features of adult malocclusions. Treatment of deep overbites involves a careful diagnosis, treatment plan, and mechanics plan. Pure intrusion of upper or lower incisors alone or in combination with flaring and extrusion of posterior teeth are common methods to correct deep overbites. This article describes appliance systems and biomechanical considerations necessary for intrusion of incisors.
As we complete the 20th and progress into the 21st century, orthodontists worldwide are experiencing a gradual but significant change in their practices. The number of adult patients has increased substantially. Although adults cooperate better than adolescents, they present a different set of challenges for the orthodontist. Adults may have worn or abraded teeth, uneven gingival margins, missing papillae, and periodontal bone loss, all of which can jeopardize the esthetic appearance of the teeth after bracket removal. This article will discuss the solutions for managing these challenging orthodontic-periodontic-restorative situations to produce a more ideal esthetic result.
Occasionally, patients require restorative treatment during or after orthodontic therapy. Patients with worn or abraded teeth, peg-shaped lateral incisors, fractured teeth, multiple edentulous spaces, or other restorative needs may require tooth positioning that is slightly different from a nonrestored, nonabraded, completely dentulous adolescent. Generally, orthodontists are not accustomed to dealing with patients who require restorative intervention. Should the objectives of orthodontic treatment differ for the restorative patient compared with the nonrestorative patient? How should the teeth be positioned during orthodontic therapy to facilitate specific restorations? Should teeth be restored before, during, or perhaps after orthodontics? The answers to these and other important questions are vital to the successful treatment of some orthodontic patients. This article will provide a series of eight guidelines to help the interdisciplinary team manage treatment for the orthodontic-restorative patient.
Throughout the 1990s, esthetic dentistry has become a prominent part of the treatment protocol of most dentists. Patients have become more conscious of the benefits of a beautiful smile and are willing to invest time and money to improve the appearance of their teeth. Many of these patients can be treated with routine restorative procedures (crowns, composites, laminates) to achieve the desired results. However, some patients have problems with tooth position that create significant discrepancies in gingival levels which can compromise the esthetic result of restorative dentistry. Prerestorative orthodontic therapy can often resolve these tooth position problems and enhance the esthetic restoration. This article describes the indication, methods, and results achieved when orthodontics preceded restorative dentistry in the treatment of various esthetic challenges.
Maxillary midline position relative to the facial midline is stressed as an important diagnostic feature in orthodontic treatment planning. Depending on the patient, however, movement of the dental midline to be coincident with the facial midline may be difficult to achieve. In addition, evaluation of dental midline position may be complicated if other midline facial structures are not well aligned. The two objectives of the current study were to determine how far the maxillary dental midline could deviate from the facial midline and still be considered aesthetically acceptable, and to determine how the position of various midline facial landmarks affect overall facial aesthetics. One hundred twenty individuals, including orthodontists, general dentists, orthodontic patients, and parents of patients, evaluated digitally altered images of two patient-subjects to rate the acceptability of dental midline deviations and to prioritize the importance of location of various midline facial structures. The mean threshold for acceptable dental midline deviation was 2.2 +/- 1.5 mm. There was a significant difference in deviation thresholds between the two patient-subjects (P < .05). Orthodontists and dentists were significantly less tolerant of midline deviations than were patients (P < .001), with the tolerance of parents in between. When deviations of various midline facial structures were evaluated, photographs with maxillary midline and/or nose deviations were considered less aesthetic (P < .001). There were no apparent differences noted among orthodontists, dentists, patients, and parents in this part of the study.
The purpose of this investigation was to analyze the clinical crown of the 3 tooth groups of the maxillary anterior sextant of the permanent dentition of normal subjects with respect to (i) width, length and the width/length ratios and (ii) determine if there is a correlation between tooth dimensions or tooth group ratios and subject height. Subjects (> or = 20 y.o.) were recruited for this study if (i) the free gingival margin on the facial surface of teeth in the maxillary sextant was positioned apical to the cervical bulge, (ii) there was no evidence of attachment loss; as determined by lack of a detectable CEJ and (iii) the marginal tissue was knife edged in form, firm in consistency and coral pink in color. Teeth were excluded if (i) there was evidence of gingival alteration, i.e., gingival overgrowth/hyperplasia, inflammation, altered passive eruption, attachment loss, gingival recession or history of periodontal surgery, or (ii) there was evidence or history of incisal edge/proximal tooth alteration as in, i.e., restorative intervention, traumatic injury or occlusal wear into dentin. At least 1 suitable tooth from each tooth group of the maxillary anterior dentition had to be present. A maxillary impression was taken and poured in yellow die stone. The widest mesial-distal portion and the longest apical-coronal portion of the test teeth were measured. Gender, ethnicity and subject height (SH) were recorded for each participant. Due to a limited ethnic diversity only data from the Caucasian group were analyzed. The mean coronal tooth width (mm) of males versus females was CI: 8.59 versus 8.06, LI: 6.59 versus 6.13 and CA: 7.64 versus 07.15. The mean coronal tooth length (mm) of males versus females was CI: 10.19 versus 9.39, LI: 8.70 versus 7.79 and CA: 10.06 versus 8.89. All width and length measures were significantly greater for males than for females. The mean coronal tooth width/length ratios for males versus females was CI: 0.85 versus 0.86, LI: 0.76 versus 0.79 and CA: 0.77 versus 0.81. A comparison between genders of the width/length ratios of the CI and LI were found not to differ, however the CA ratio for females was significantly greater than for males. A statistically significant difference was found to exist between the mean (cm) SH for males versus females: 181.2 versus 164.0. A positive correlation (p < or = 0.0001 to 0.0691) was found to exist between tooth group width/height ratios within genders. No significant correlation was found between any of the tooth dimensions or tooth group ratios and SH. The results of this study indicate that within male and female Caucasians, the mean width/length ratio of the maxillary 3 anterior tooth groups is 0.81. As well, within both genders there is a positive correlation between tooth group width/length ratios. The significance of these findings with respect to periodontal mucogingival plastic surgical procedures is discussed.
Soft and hard tissue recession following the removal of an anterior tooth presents a unique restorative challenge for the treatment team. The dental literature has examined postextraction tissue loss and proposed multiple solutions for this aesthetic complication. The majority of these techniques have focused on the prevention of buccolingual recession of the residual ridge, while the maintenance of the interdental papilla following extraction has received less attention. The purpose of this article is to present a clinical technique for maintaining papillary height and form following single anterior tooth removal.
Skeletal changes greater than those observed in untreated adults have been noted beyond 1 year post-surgery in adult patients who had surgical correction of a long face deformity. The stability of skeletal landmarks and dental relationships from 1 to >3 years post-surgery was examined in 28 patients who had undergone surgery of the maxilla only, and in 26 patients who had undergone 2-jaw surgery to correct >2 mm anterior open bite. Although the average changes in almost all landmark positions and skeletal dimensions were less than 1 mm, point B moved down >2 mm and face height increased >2 mm in one-third of the maxilla-only group and in 40% of the 2-jaw group (>4 mm in 10% and 22% respectively). Overbite decreased 2-4 mm in only 7% of the maxilla-only and 12% of the 2 groups, with no changes >4 mm, because in three-fourths of the patients with an increase in anterior face height, further eruption of the incisors maintained the overbite relationship. In the maxilla-only group, mandibular length (Co-Pg) showed >2 mm long-term change in 45% of the patients, two-thirds of whom showed an increase rather than a decrease in length. In the 2-jaw group, no patients showed a decrease in Co-Pg length and one-third had an increase. For both groups, changes in overjet were smaller and less frequent than changes in mandibular length.
The purposes of this study were to determine the prevalence of posttreatment open gingival embrasures in adult orthodontic patients and to examine the association of pretreatment maxillary incisor malalignment, posttreatment alveolar bone height, interproximal contact position, root angulation, crown shape, and embrasure area with open gingival embrasures. Posttreatment intraoral photographs of 337 adult orthodontic patients were evaluated to determine the prevalence of open gingival embrasures. A subsample of 119 patients was identified for measurement and divided into 2 groups: normal gingival embrasures and open gingival embrasures. Digital images of the pretreatment maxillary models and posttreatment maxillary central incisor periapical radiographs were made to measure the pretreatment and posttreatment variables. The prevalence of posttreatment open gingival embrasures in adult orthodontic patients was 38%. Pretreatment maxillary central incisor rotation and overlap were not statistically associated with posttreatment open gingival embrasures. A posttreatment alveolar bone-interproximal contact distance greater than 5.5 mm was associated with open gingival embrasures. Short and more incisally positioned posttreatment interproximal contacts were associated with open gingival embrasures. Open gingival embrasures were found to have more divergent root angulations and more divergent or triangular-shaped crown forms than normal gingival embrasures. Embrasure areas larger than 5.09 mm(2) were also correlated with open gingival embrasures. Increased alveolar bone-interproximal contact distance and increased root angulation demonstrated the greatest increase in the odds of an association with an open gingival embrasure. This investigation indicates that open gingival embrasures are common in adults who have undergone orthodontic treatment and that posttreatment variables are significant factors in open gingival embrasures.
It is sometimes difficult to identify esthetic problems let alone pre-visualize an esthetic end-result. The Esthetic Grid Analysis is a system for analyzing the basic problems that detract from the concept of an attractive smile. A photograph is taken of the anterior teeth with the lips retracted. The upper and lower frame of the photograph is aligned parallel with the interpupillary line, assuming that the interpupillary line is parallel with the horizon. Where this is not the case, the vertical margins of the photograph are aligned parallel with the facial midline. Through orienting the photograph to the facial guidelines and incorporating the idealized positions of the incisal plane, highest Upline, midline axis, and proportionate contact areas, a grid is formed. The grid built from these components provides a method of demonstrating deviations from an esthetic arrangement of anterior teeth.
CLINICAL SIGNIFICANCE
Integrating facial guidelines with the dental composition using a grid highlights deviations from the ideal. It thereby assists in the treatment planning process by communicating esthetic problems to the patient, laboratory personnel, and other specialists.
The lessons from managing a successful study club are learned over a life-time of practice, just a dentistry is. The author, who has taught numerous participation continuing education courses using the study club model and mentored many study clubs identifies these criteria for success: a respected mentor, open feedback, multiple points, of view, a clear mission and structure, and attention to the changing needs of the participants over time. A study club that has renewed itself effectively over a twenty-year period is described as a possible model.
The purpose of this study was to analyze the effect of various degrees of axial midline angulation on the attractiveness of a smile. We explored the influence of age, race, sex, direction of midline deviation, education, occupation, and dominant hand on each evaluator's perception of dental esthetics. Photographs of smiling subjects--one man and one woman--were altered to produce both left and right axial midline angulations in 5 degree increments. Fifty orthodontists and 50 laypeople evaluated these altered photographs by assigning both a numerical attractiveness rating and an acceptable or unacceptable rating to each. The results showed that attractiveness scores and acceptability ratings declined consistently as axial midline angulation increased. Statistical analysis showed that both sex of the subject and occupation of the judge were significant variables (P < .05) in the evaluation of the subjects. Age, race, sex of the judge, education level, direction of midline deviation, and dominant hand were not statistically significant. The mean acceptable midline angulation for the male subject was 6.6 +/- 4.5 degrees for orthodontists and 10.7 +/- 6.2 degrees for laypeople. For the female subject, the mean acceptable threshold was 6.4 +/- 4.0 degrees for orthodontists and 10.0 +/- 6.1 degrees for laypeople (P < .001). Discrepancies of 10 degrees were unacceptable by 68% of orthodontists and 41% of laypeople.
Beautiful teeth, visible when smiling, are in line with the present ideal of beauty. The display of teeth when smiling is determined by the smile line: the projection of the lower border of the upper lip on the maxillary teeth when smiling. On the basis of a literature search the determining methods of the smile line are discussed, demographic data of the position of the smile line are given, and factors of influence are examined. There is no unequivocal method for determining the position of the smile line. A rough distinction can be made between qualitative and (semi)-quantitative methods. The (semi)-quantitative methods have clear advantages for research purposes, but their reliability is unknown. It was demonstrated that among minimally 40% of subjects the maxillary gingiva was not visible when smiling. The mandibular gingiva was not visible when smiling among more than 90% of subjects. Furthermore, it appeared that among women the smile line was on average higher situated than among men and that it has not yet been proven that the smile line will be situated lower when growing older.
This study aimed to evaluate the assessment of attractiveness of standardized changes in incisor proportions. Two original photographs, showing the maxillary anterior teeth in the frame of a smile, were computer-manipulated. From the so-produced symmetrical 'golden standard' images, two sets were constructed. Each set contained one golden standard image and seven images with different standardized changes concerning (i) width-to-length ratios of the central incisors (60-96%) and (ii) tooth-to-tooth proportions between the widths of lateral and central incisors (43-87%). The judges, consisting of three groups of individuals (24 dentists, 24 medical students, and 179 patients), ranked each photo set for attractiveness on a visual analogue scale. The width-to-length ratios were assessed as most attractive within a range of 75-85% (medical students, patients) or 75-80% (dentists), respectively. The tooth-to-tooth proportions showed the best results concerning attractive appearance within a range of 50-74% (medical students, patients) or 56-68% (dentists), respectively. No significant differences between the participant groups were found except for some extreme variations. It was concluded that a most attractive 'golden range' could be identified for both the width-to-length ratios and the tooth-to-tooth proportions of the maxillary incisors.
Forced eruption offers a method of treatment of teeth fractured close to the alveolar crest. We introduce a modification of this common technique. The fractured fragment of a patient's crown is bonded to the adjacent teeth and used as anchorage, permitting the root extrusion while offering acceptable aesthetics. The bonded crown does not impede the eruption of the root so that the frequent occlusal adjustment of other methods is not required. The final result is acceptable and a low cost alternative to common techniques.
Inferior repositioning of the maxilla to correct vertical maxillary deficiency has been one of the more unstable orthognathic procedures performed. Different surgical techniques have been proposed to stabilize downward movement of the maxilla. The aim of this study was to evaluate the skeletal stability of maxillary anterior downgrafting using bone biological plates in association to bone plates and bone graft for skeletal stabilization.
The records of 6 patients were evaluated cephalometrically, analyzing the presurgical, immediate postsurgical and long-term follow-up radiographs. All patients had one-piece Le Fort I osteotomy with anterior downgraft of at least 2 mm at point A. Any horizontal movement of the maxilla concomitant with the downgraft was no more than 5 mm. Rigid fixation with titanium miniplates and screws and with bone biological plate was used to stabilize the maxilla. In the sample of 6 patients, 3 underwent one-jaw (maxilla only) surgery and 3 two-jaw surgery.
The mean surgical inferior downgrafting at point A was 5+/-1.4 mm (P<0.001) with a relapse of 0.16+/-1. 63 mm (3.2% of surgical movement). The mean surgical inferior downgrafting at the anterior nasal spine (ANS) was 5.66+/-1.36 mm (P<0.001) with a relapse of 0.41+/-1.56 mm (7.32% of surgical movement). Relapse in the vertical dimension failed to reach any statistical significance for all maxillary landmarks.
Anterior downgrafting of the maxilla with this fixation method seems to be a stable and predictable procedure. The use of bone biological plates seems to substantially improve skeletal stability even if further investigations with a more consistent sample of patients is required.
This article has discussed six guidelines for managing adolescent orthodontic patients who are missing their maxillary lateral incisors and will require implants to replace these teeth. The space for the crown and implant, the space between the apices of the roots of the central incisor and canine, the possibility of implant site development, the effect of space opening on the integrity of the adjacent papillae, the impact of altered passive eruption, and the method for determining the age of implant placement have been discussed in detail. The intent of this article has been to emphasize the importance of interdisciplinary decision-making when planning implants in young adolescent patients who are congenitally missing their maxillary lateral incisors.
Creating a flow sheet may assist in the decision whether to use conventional orthodontics and what the limitations of treating the patient will be if treatment is performed without any orthodontics. The decision process can be viewed as a series of questions, and depending upon the answer to the questions, the practitioner and patient can decide on whether to involve orthodontics or not. Questions can create a framework to help separate the patients who would benefit from orthodontic intervention from those we all enjoy treating who can be managed with purely restorative care.
A review of the literature of selected cephalometric analyses
- K Littlefield
Littlefield K. A review of the literature of selected cephalometric analyses. St. Louis: University Press; 1992.
An interdisciplinary case report
- F Spear
- Vg Kokich
- Mathews
Spear F, Kokich VG, Mathews D. An interdisciplinary case report. Esthet Interdisc Dent 2005;1(2):12-8.
Fundamentals of esthetics. Carol Stream, Ill.: Quin-tessence
- C Rufenacht
Rufenacht C. Fundamentals of esthetics. Carol Stream, Ill.: Quin-tessence; 1990.
Maximizing anterior esthetics: an interdisciplinary approach
- Kokich Vg
- Spear Fm
- Kokich
- Vo
Kokich VG, Spear FM, Kokich VO. Maximizing anterior esthetics: an interdisciplinary approach. In: McNamara JA Jr, ed. Frontiers in dental and facial esthetics. Ann Arbor, Mich.: Needham Press; 2001: 1-18.
Diagnosis and treatment planning of esthetic problems
- Chiche G V Kokich
- Caudill
Chiche G, Kokich V, Caudill R. Diagnosis and treatment planning of esthetic problems. In: Pinault A, Chiche G, eds. Esthetics in fixed prosthodontics. Chicago: Quintessence; 1994.
Diagnosis and treatment planning of esthetic problems
- Chiche
When to restore, when to remove
- Spear
An interdisciplinary case report
- Spear
Maximizing anterior esthetics: an interdisciplinary approach
- Kokich
Orthodontic therapy for the periodontal-restorative patient
- Kokich
Anterior dental esthetics: an orthodontic perspective I: crown length
- Kokich
Managing orthodontic-restorative treatment for the adolescent patient
- Kokich
Occlusion in the new millennium: the controversy continues
- Spear
A conversation with Dr. Frank Spear
- Spear