Dental Tribune U.S. Edition

In today’s new information age, patients want a better quality of life. They want to keep their youthful, brighter-appearing smile more than ever; keep their natural teeth; have their teeth feel and look better; and have a glowing smile. In recent years, dentistry seems to be concentrating almost exclusively on accomplish- ing this “smile” by focusing on the crown portion of the tooth. Restorative materials are creatively being made available to help dentists create the crown’s natural coloring, whitening, and hues. The crown has been length- ened, squared, made ovoid, rounded, and shortened. Reproduction of the crown’s original shape and color has also been attempted. Esthetic dentistry must now turn its focus toward achieving an aesthetic totality, not just the perfect crown or restoration. Many materials have been developed to help achieve an artistic tooth color, but the desired aesthetic result still depends on the background accentuating the desired image — something great painters have long known and created in fine oil paint- ings. This background must drape around and significantly contrast the object to be emphasized. It can make or break the object that clinicians wish people to see. If the background is distracting, the object loses its impor- tance. For example, cosmetically, if a crown is restored correctly against a healthy, pinkish-white gingiva, the patient’s illusionary smooth smile line can be successfully achieved and viewed. However, if that same crown is placed against an unhealthy, inflamed, reddish gingiva, the eye’s focus will be toward the unaesthetic area. A porce- lain laminate placed against a natural pink gingival is simply more pleasing and compatible to its background. As mentioned in part one of this series, achieving consistently suc- cessful dental aesthetics is mostly a function of creating desired illusions. The first step is ensuring that certain fundamental principles of health are preserved, respected and maintained. Achieving a healthy periodontia is the prerequisite and basis for sustain- ing this illustration of oral health. It is essential for restorative aesthetics, as well as natural dentition, enabling cli- nicians to better their chances for suc- cessful restorative results and mainte- nance of the results. By incorporating the use of tissue colors, hues, shapes, forms, and symmetrical appearances one can achieve and maintain the desired aesthetic goal. As in other forms of art, a sym- metrical appearance tends to focus the observing eye on the overall illusion. Assuming there is no pathology, sym- metry of color zones and hue are vital to gain the desired illusion and distract attention from a defective area. The gingival layer of keratinized tissue is at the margin of natural teeth and around the crowns. The mucogin- gival junction separates the outstand- ing color demarcation of the pinkish keratinized attached gingival from the mobile alveolar mucosa, which is a bluish-red zone. Nature’s colorations of these zones in symmetrical form are what clinicians must strive for to achieve and maintain health and aesthetics. If, for example, an adequate zone DENTAL TRIBUNE | November 2011 Clinical 5A AD Cosmetic periodontal surgery: Multiple gingival graft techniques (Part 2) By David L Hoexter, DMD, FACD, FICD Fig. 1 g DT page 6A Fig. 2