cosmetic dentistry_ beauty & science

10 I I case report _ periodontal surgery _In today’s new information age, patients want abetterqualityoflife.Theywanttokeeptheiryouth- ful, bright smile more than ever; keep their natural teeth; have their teeth feel and look better; and have a glowing smile. In recent years, dentistry ap- pearstohaveconcentratedalmostexclusively onaccomplishingthissmilebyfocusingonthe crownportionofthetooth.Restorativemate- rials are being made available to help dentists create the crown’s natural colouring, whiten- ing,andhues.Thecrownhasbeenlengthened, squared,madeovoid,roundedandshortened. Reproduction of the crown’s original shape and colour has also been attempted. Aesthetic dentistry must now turn its fo- cus towards achieving an aesthetic totality, not just the perfect crown or restoration. Many materials have been developed to help achieve an artistic tooth colour, but the desired aesthetic result still depends on the background accentuating the desired im- age—something great painters have long known and created in fine oil paintings. This background must both drape around and emphasisetheobject.Itcanmakeorbreakthe object that clinicians wish people to see. If thebackgroundisdistracting,theobjectloses its importance. 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 samecrownisplacedagainstanunhealthy,inflamed, reddish gingiva, the eye’s focus will be towards the unaestheticarea.Aporcelainlaminateplacedagainst a natural pink gingiva is simply more pleasing and compatible with its background. As mentioned in Part I of this series, achieving consistently successful 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 healthy periodontia is the prerequi- site and basis for sustaining this illustration of oral health. It is essential for restorative aesthetics, as wellasnaturaldentition,enablingclinicianstobetter their chances of achieving successful restorative re- sults and maintaining the results. By incorporating the use of tissue colours, hues, forms and symmet- rical appearances one can achieve and maintain the desired aesthetic goal. Asinotherformsofart,asymmetricalappearance tends to focus the observing eye on the overall illu- sion. Assuming there is no pathology, symmetry of colour zones and hue is vital to gain the desired illu- sion and distract attention from a defective area. The gingival layer of keratinised tissue is at the margin of natural teeth and around the crowns. The muco-gingival junction separates the outstanding colour demarcation of the pinkish keratinised at- tached gingival from the mobile alveolar mucosa, which is a reddish-blue zone. Nature’s colourations of these zones in symmetrical form are what clini- cians must strive for to achieve and maintain health and aesthetics. If, for example, an adequate zone of attached gingivalwereunevenlydistributedinthesamequad- rant, the reddish-blue alveolar mucosa would be out of place and draw negative attention. In contrast, if the attached gingiva locally were to encroach on the alveolar mucosa, a colour reversal would occur, re- sultinginalarge,unevenpinkzoneagainstanuneven reddish-blue background. Inthepast,oversizedfreegingivalgraftshavefre- quently been used to replace absent or inadequate zones of attached gingival. Those large donor grafts were protective but had an unaesthetic appearance; anencroachmentofcoloursintothealveolarmucosa cosmeticdentistry 4_2011 Fig. 2 Fig. 1 Cosmetic periodontal surgery: Multiple gingival graft techniques (Part II) Author_ Dr David L. Hoexter, USA