Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2018-03-23, 14:27:11 | version 1.38.0
13Dental Tribune Middle East & Africa Edition | November-December 2014 Aesthetics Tooth (#) Length (mm) Width (mm) Spaces Notes 13 9.1 7.4 13 - 11: 7.1mm 12 6 4 Peg Shaped 11 8.5 8.2 Overerruption 1.4mm incisally Ging. zenith 3.3mm incisally to 21 21 9.8 8.5 Dental midline 4mm right 22 Missing 23 9 7.5 23 - 21: 2.7mm 23 - 24: 2mm Table 1. Teeth and spaces between them were measured. The proportions of the teeth (length to width ratio) and the arrangement of the spaces are crucial information in treatment planning, especially in patients with a high lip line. Figure 1 - 3: The unaesthetic smile of the patient before treatment. Figure 4 - 6: Retracted view of the teeth before treatment. Note the peg shaped #12, the missing #22 and the asymmetry of the spaces between teeth #11-13 and 21-23. ByKostisGiannakopoulos,Greece T he aesthetic performance of dental restorations has always been a factor of utmost importance in the suc- cess or failure of the treatment. Lately, as aesthetic awareness of the population increases and the evolvement of dental mate- rials have made new techniques possible, optimal aesthetics can be achieved following less in- vasive restorative procedures. In many cases, multidiscipli- nary treatment is necessary so that the best possible outcome is achieved with a minimum degree of compromise between invasiveness and aesthetics. Every complex case should be treatment planned by a team of specialists, so that every detail and limitation from each point of view is taken into account. The restorative dentist usually designs the smile and oversees each phase of the treatment by all other specialists. Congenitally missing lateral incisors are a common dental problem that can be esthetically dealt in three different ways1 : 1. canine substitution, 2. tooth supported restoration, and 3. implant supported restoration. Tooth auto transplantation (usu- ally premolar) and removable partial dentures are other, less commonly applied treatment options. In the case of only one lateral incisor missing, an ad- ditional problem of symmetry between the right and left side usually exists and needs to be addressed. Peg shaped lateral incisors pose another aesthetic problem2 that is usually restored with as fol- lows: 1. all ceramic crowns, 2. por- celain veneers, and 3. direct or indirect composite veneers. Ad- ditional to the inadequate width and length of the peg shaped lat- eral, many times there is also a gingival aesthetic problem that can lead to a square looking restoration and too much gingi- val tissue display if not properly treatment planned with either orthodontic intrusion or gingi- voplasty/gingivectomy before the restoration is fabricated. In this article, a case is report- ed of a young patient with one congenitally missing and one peg shaped lateral incisor. The patient was treated with a com- bination of orthodontics, peri- odontal surgery and aesthetic – restorative dentistry interven- tions. Case report A 22 year old Caucasian female presented to the clinic asking for aesthetic improvement of her smile. The patient was sin- gle and a student of law school. The medical history was unre- markable with no pathologies and no known allergic reactions reported to any kind of medica- tion. No medications were taken on a systematic basis by the pa- tient. The dental history was also unremarkable with only preven- tive and minor operative dentist- ry interventions and prophylaxis in the past. The patient men- tioned a history of congenitally missing teeth in her family. The chief complaint of the pa- tient was spaces between the teeth and specifically the miss- ing upper left lateral incisor tooth, the irregularly shaped upper right lateral incisor, and the diastema between teeth #11 and 21. Also, she was concerned about asymmetries in her smile and misalignment of her teeth. Finally, the patient stated she would like to have a brighter smile (Figures 1-3). The dental examination re- vealed no pathological findings or signs of dental disease. The DMFT was low and the compre- hensive periodontal examina- tion was within normal limits; soft tissue examination resulted in no pathological findings; radi- ographic bitewing examination revealed no pathological find- ings as well. The aesthetic evaluation of her smile resulted in the following issues that would need to be ad- dressed in the treatment plan: 1. peg shaped lateral incisor #12, 2. congenitally missing lateral inci- sor #22 with diastema between #11 and 21, 3. dental midline transmitted to the right by 4mm, 4. asymmetry between the left and right side, especially in the space between 11-13 and 21-23, 5. gummy smile, especially on the area of #12 and the missing tooth #22, and 6. the gingival ze- nith was asymmetrical between #11 and 21 (Figures 4-6, Table 1). The occlusion was Class I. The base shade of the teeth was A3 on the upper central incisors and A3,5 on the upper canines with the Vita Classic shade guide (Vita Zahnfabrik, Bad Sacking- en, Germany). Photographs and alginate im- pressions were taken in the exam appointment to fabricate study models. Then the team of aesthetic/restorative dentist, orthodontist and periodontist treatment planned the case. The recommended treatment plan was accepted by the patient in favor of the alternative treat- ment plans. Orthodontic phase The orthodontic treatment goals were as follows: 1. intrude #11 to align the incisal edges of the centrals, 2. equalize the spaces between #11-13 and #21-23, 3. transfer the dental midline to the left, and 4. correct misalign- ments and minor rotations in different areas. Some composite resin was bonded on the facial surface of tooth #12 to facilitate bracket placement. The com- posite was white in shade to Conservative approach to multidisciplinary aesthetic dental treatment > Page 16 Figure 7 - 9: Photographs of the patient during the orthodontic phase of the treatment.