ortho - the international C.E. magazine of orthodontics

ortho1_201318 I I clinical_ esthetics Authors_Julia Garcia Baeza, DMD, and David Garcia Baeza, DMD Orthodontics and esthetics: A multidisciplinary approach _These days, we are seeing a growing number of adult orthodontic patients. However, adult cases presentuniquechallengestotheorthodontist.Miss- ing teeth, root canals and periodontal problems are all common situations when dealing with adult patients. Unrealistic esthetic expectations are another challenge when dealing with adult patients. This is the patient who comes in with a request that his (or her)smilelooklikehisfavoritemoviestar.That’swhy it’s important to make sure the patient has a firm grasp of what is possible and what is not. The patient should know that we have the ability to level and align teeth, to coordinate arches and to improve occlusion, but we do not have the ability to change the texture of the enamel or the shape or form of teeth. With adult treatments on the rise, establishing a good multidisciplinary team is essential. This is a two-way street. Just as a secondary team of spe- cialists can be essential to achieving a successful orthodonticoutcome,orthodonticsisalsoavaluable toolforotherspecialtiestohaveattheirdisposal.This includesesthetics,butcanalsobeameanstoimprov- ing the health of the soft and hard tissues. We’re going to look at a case that will highlight the importance of the orthodontist in working with other specialties. _Case report: Part I In this case, the patient had a trauma and pre- sented the left central incisor apically displaced (Fig.1).Thepatientnotonlyshowedafractureofthe leftcentralincisor,butalsoanapicaldisplacementof theroot(Fig.2),takingthegingivalmargintoahigher situation (Fig. 3). This case could be approached in two different ways: extracting the damaged tooth and placing an implantorextractingthedamagedtoothandregen- eration (with the risks that regeneration entails). The risks associated with implantology include the loss of soft tissue and the loss of volume when implants are placed. This means that if the starting point of the gingival margin is higher than it should be after the implant placement, the gingival margin will be even more apically. This means a complete asymmetry of the soft tissues. With this aspect in mind, the vision of a prostho- dontist is to extract the damaged tooth while trying to increase the soft and hard tissues to avoid the gingival margin asymmetry between both central incisors. Thesetypesoftreatmentsaretechniquesensitive when mucogingival procedures are involved. Ortho- dontists must show their colleagues that they have the tools to help improve situations such as the one presented in this article. In this case, the orthodontist can make the situa- tion more favorable for the prosthodontist. The left central incisor was to be extruded in order to bring thegingivalmarginevenlowerthantherightcentral incisor.Aswesaidbefore,whattheprosthodontistis simply looking for is a favorable situation. When the gingival margin of the left central (Photos/Provided by Drs. Julia and David Garcia Baeza) Fig. 1 Fig. 2 Fig. 3