cosmetic dentistry_ beauty & science International Edition

incisal to the CEJ. Treatment options depend on the amount of attached gingiva and the position of the bone relative to the CEJ (as a general rule, the biologic width should be a minimum of 2 mm): (a) gingivectomy; (b) osseous resection (ostectomy) with or without flap surgery (without a flap, it is difficult to control the osseous contour driven by the new gingival margin); (c) apically repositioned flap. 2. Altered active eruption when the osseous crest does not resorb to a level 2 mm apical to the CEJ. The gingival margin is still located incisal to the CEJ. This is treated with periodontal surgery with osseous resection. 3. Compensatory eruption when the tooth sur- face is lost, with the reduction in facial height or verticaldimensionofocclusionunaffected(short tooth syndrome). Treatment is either restorative or, in the case of hypermobility of the lip, com- bined with a coronally positioned mucosal flap. 4. Delayed eruption followed by early loss of primary maxillary incisors, delayed eruption of maxillary permanent incisors or overeruption of mandibular incisors.Diagnosticfeaturesareshortmaxillaryin- cisors, over-erupted mandibular incisors or a Class IIImaxillomandibularrelation.Bearingthe42.2rule in mind, treatment should follow incisal reduction done selectively with crown lengthening only or crown lengthening combined with orthodontic intrusion of mandibular incisors and possible minimally invasive restoration of maxillary teeth. 5. Vertical maxillary excess described as a hyper- plastic growth of the maxillary skeletal base where teeth are positioned farther from the skeletal base, an increased facial lower third and excessive gingival display, which is classified according to three categories: (a) Category1:2–4mmofgingivaldisplay,treatedwith onlyorthodonticintrusion,orthodonticsandperi- odontics,orperiodonticswithrestorativetherapy; (b) Category 2: 4–8 mm of gingival display, treated with periodontics and restorative or ortho- gnathic surgery (Le Fort type I); and Fig. 6_Altered passive eruption. The enamel could be exposed by a gingivectomy in one appointment. Fig. 7_Lower third smile showing altered passive eruption. Fig. 8_Delayed eruption. Fig. 9_A hypermobile lip and a slight vertical maxillary excess. Fig. 10_Lower third full smile design. Fig.11_Relaxedposition(/m/sound–ahhh). Fig. 12_Superimposed photographs 10 & 11. The red arrow indicates the distance from the incisal edge to the upper lip in the relaxed position. The yellow arrow indicates the height of the upper lip in the relaxed position (~ 21 mm). The white arrow indicates mobility of the upper lip from the relaxed to smile position. Fig.13_Initiallowerthirdwhensmiling. Fig.14_Findingsinorderofimportance after establishing the incisal edge position on the full smile photograph. Fig. 15_The wax-up duplicated in a stone model. CE article _ interdisciplinary approach I I 07cosmeticdentistry 1_2014 Fig. 12Fig. 11Fig. 10 Fig. 9Fig. 8Fig. 7 Fig. 15Fig. 14Fig. 13 CDE0114_06-10_Ercus 11.06.14 14:02 Seite 2