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cosmetic dentistry_ beauty & science International Edition

I CE article _ interdisciplinary approach _Introduction In today’s dentistry, for rendering the best comprehensive dental services to our aesthetically driven patients, the paradigm has shifted to an interdisciplinary team of specialists that work to- gethersteeredbyaclinicalco-ordinator.Thisperson should be either a multi-competence general den- tist or a specialist with additional training outside his or her specialty area. This gives him or her the abilitytobringthesurgical,orthodontic,restorative and technical teams together as a whole, following treatment sequences customised especially for the patients’ best interests and expectations. The challenge is making the correct diagnosis and selecting the appropriate treatment regimen. In order to achieve that, the clinician has to follow certain guidelines and understand the relations between teeth and the adjacent structures. Estab- lishing the correct position of the incisal edge of a maxillary central incisor in relation to the lower lip, the correct ratios between the tooth’s width and length, and the level of gingival margin when smiling are very powerful diagnostic tools. In order to aid memory, one may remember it as the 42.2 rule: (a) a maximum of 4 mm of maxillary central incisor display when the lips are at rest (a minimum of 2 mm; Fig. 1); (b) a maximum of 2 mm of gingival display during smiling; (c) a maximum of 2 mm from the incisal edge of the maxillary central incisor to the lower lip during smiling (Figs. 2 & 3); and (d) the middle third of the maxillary central incisor should be perpendicular to the occlusal plane and the incisal edge should touch the plane (± 0.5 mm; Fig. 4). The correct ratio between the width and length of a maxillary central incisor is 78 to 80 per cent. With the incisal edge position already determined, we can identify the position of the gingival margin (Figs. 5 & 6). Gingival margin positioning should be in accor- dance with the understanding of six conditions present in the oral cavity with different aetiologies and treatment regimens: 1. Altered passive eruption when the gingival mar- gin does not recede to a level near the cemento- enamel junction (CEJ) during tooth eruption. Diagnostically, the gingival margin is located 06 I cosmeticdentistry 1_2014 Fig.1_Thelevelofthemaxillarycentral incisors in the relaxed position (2–4mminwomenand1–2mminmen). Fig. 2_A maximum of 2 mm from the incisal edge to the lower lip during smiling, example 1. Fig. 3_A maximum of 2 mm from the incisal edge to the lower lip during smiling, example 2. Fig. 4_The middle third of the maxillary central incisor should be perpendicular to the occlusal plane. Fig. 5_Evaluating width to length ratios. Interdisciplinary approach in aesthetic dentistry Author_ Dr Sebastian Ercus, Belgium This article qualifies for continuingeducation(CE)credit. To take the CE quiz,log on to www.dtstudyclub.com. Click on“C.E.ARTICLES” and search for this article. If you have not registered on the site,youwillbeasked todosobefore taking the quiz. _ce credit cosmeticdentistry Fig. 6Fig. 5Fig. 4 Fig. 3Fig. 2Fig. 1 CDE0114_06-10_Ercus 11.06.14 14:02 Seite 1