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A Predictable Procedure Guide
Let’s discuss the restorative periodontal interface and its significance. In essence, it involves the harmonious interplay of pink aesthetics (the gum tissue) and white aesthetics (the teeth). To achieve an optimal smile design, we need to address these components individually and in conjunction.
Summary
The patient in question initially considered Invisalign to close the gaps between her teeth. However, upon closer examination, it became clear that the issue wasn’t solely about tooth positioning but also tooth shape. As such, we had to assess whether it was one or both of these aspects that needed attention.
The patient presented with overall healthy teeth, but some discrepancies were noted. For instance, the axial inclination of tooth number eight appeared somewhat unusual. Additionally, the gaps and undersized laterals, coupled with the centrals appearing a bit short, contributed to the aesthetic concern. To address this, we considered extending the length of these teeth through composite addition, which I presented to the patient as a “gum lift” to make the idea more approachable and less invasive.
We aimed to enhance her smile by not only addressing tooth shape but also ensuring gum symmetry, which plays a crucial role in smile aesthetics. Achieving symmetry is paramount, even to non-dentists, as they instinctively recognize asymmetry. We began by mimicking a gum lift with composite material, a non-invasive approach. The patient loved the results, and we proceeded.
To optimize the outcome, we examined various lip dynamics and assessed the patient’s risk level for gum exposure when smiling. This information guided our decision-making. If excessive gum display was due to either the lip’s movement range or the gum tissue itself, we could tailor our approach accordingly, potentially using Botox to limit lip motion or conducting a “gum lift.”
A crucial aspect of this treatment journey is the upfront communication with the patient. Claire was informed that, as the teeth were moved to achieve a more ideal alignment, spaces would emerge between them. The extent of these spaces could be tailored to the patient's preferences and budget. This pre-treatment discussion ensures alignment between the patient's expectations and the treatment plan.
This process aligns with the “smile triad” method, which involves considering incisal edge position, lip dynamics, and gingival architecture. In this case, we needed to refine the gingival architecture, align the tissue scallops, and adjust the vertical heights.
Next, we focused on reshaping the gingival architecture, seeking symmetry and positioning that complemented the patient’s smile. For instance, we noticed variations in the scallop shapes of teeth number 8 and 10. We aimed to standardize these scallops to enhance the overall aesthetic appeal.
The initial step involved trimming the tissue to create symmetry and alignment. Then, to ensure that the tissue would stay in its new position, we performed crown lengthening by sculpting the bone and removing a bit of it, maintaining a three-millimeter distance from the free gingival margin to the facial crest of the bone. This enabled us to secure the tissue in place.
Finally, we carried out the composite bonding procedure for the four teeth (7-10) and the bone adjustment, all in the same session. This approach allowed for a simple, cost-effective, and minimally invasive solution for the patient, enhancing both the pink and white aesthetics of her smile.
Conclusion
In conclusion, this case demonstrates the power of providing patients with straightforward, affordable, and non-invasive solutions for smile enhancement, addressing both aesthetic and functional concerns in one appointment—a part of what I refer to as the “magic four.” I hope you found this lesson insightful.