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ePaper created 2015-03-06, 09:14:48 | version 1.33.01
I 11 review _ minimally invasive dentistry practice I cosmeticdentistry 1_2015 _MiCD treatment protocol and clinical technique Minimally invasive dentistry was developed over a decade ago by restorative experts and founded on soundevidence-basedprinciples.15–24 Indentistry,ithas focused mainly on prevention, remineralisation and minimal dental intervention in caries management and not given sufficient attention to other oral health problems.Forthisreason,IdevelopedtheMiCDconcept and its treatment protocol in 2009, which integrates theevidence-basedminimallyinvasivephilosophyinto aesthetic dentistry in the hope that it will help practi- tioners achieve optimum results in terms of health, function and aesthetics with minimum treatment in- terventionandoptimumpatientsatisfaction.TheMiCD concept and treatment protocol are explained in an article titled “Minimally invasive cosmetic dentistry— Concept and treatment protocol”;25 hence, in the current article, I only discuss the MiCD core principles (Table 2), MiCD treatment protocol and clinical tech- niquebriefly(Fig.2). MiCDclinicaltechnique: Rejuvenation,restoration,rehabilitationandrepair TheMiCDclinicaltechniquefocusesontheaesthetic pyramid of the Smile Design Wheel1 (Fig. 3). Aesthetic components in dentistry are divided in to three broad groups: 1.macro-aesthetics, 2.mini-aesthetics;and 3.micro-aesthetics. Each aesthetic group deals with different smile aes- theticcomponents(Table3)andeachcomponentmust beharmonisedattheendoftreatment.Accordingtothe smiledefectandpatient’sdesire,therearefourdifferent techniquesinMiCDtoenhancesmileaesthetics: 1.Rejuvenation: to rejuvenate in MiCD is to enhance smile aesthetics with minor modifications in tooth position, colour and form, also known as the MiCD ABC principles, namely align, brighten and contour (Figs.4–9): _Align: minor discrepancies between the facial and dental midlines are acceptable in many instances.26 However,acantedmidlinewouldbemoreobvious27 and therefore less acceptable in cosmetic dentistry. Similarly, the disharmony in natural progression of axial inclination or the degree of tipping of anterior teeth affects the aesthetic outcome of a smile. The correction to the midline and axial inclination pro- gression, and necessary changes to anterior tooth position are carried out using cosmetic orthodontic procedures with fixed or removable aligners. Once the anterior teeth are in an aesthetically acceptable position, the aesthetic concerns of the patient gen- erally shift towards the colour enhancement of the dentition. It is to be noted that a well-aligned tooth generally requires no or less tooth preparation duringtoothcontour(shapeandsize)modification. This helps the clinician to achieve aesthetic smiles with micro- or minimally invasive procedures with averylowbiologicalcost. _Brighten: tooth bleaching or colour modification in MiCD is carried out once teeth are in acceptable alignment but before the tooth form is modified. The level of tooth colour modification depends on the quality of the existing colour of the dentition and the patient’s desire. Home and office bleaching are popular methods for modifying tooth colour. However, in some cases, procedures such as re- mineralisation, micro-abrasion, walking bleach and thinenamelveneersareused. _Contour:acontourisanoutlineoftheshapeorform of something.28 In dentistry, cosmetic contouring entails reshaping teeth or gingivae to an aesthetic form.Cosmeticcontouringcanbeperformedintwo ways, additive and subtractive. Additive cosmetic contouring entails changing the tooth form using tooth-colouredrestorativematerials,suchasaresin Table II_MiCD core principles. Table III_Aesthetic components and smile design parameters. Sooner is better Follow early diagnosis, prevention and intervention approach Smile Design Wheel approach Understand psychology, establish health, restore function and enhance aesthetics (PHFA—sequences of Smile Design Wheel) Do no harm Select the most conservative treatment options and procedures to minimise the possible biological cost Evidence-based selection Select materials, tools, techniques and protocols based on scientific evidence Keep in touch Encourage regular follow-up and maintenance Table II Aesthetic components Smile design parameters Macro-aesthetics: deals with the overall structure _Facial midline of the face and its relation to the smile. In order _Facial thirds to establish the macro-aesthetic components _Interpupillary line of any smile, the visual macro-aesthetic _Nasolabial angle distance should be more than 1.5 m. _Rickett’s E-plane Mini-aesthetics: deals with the aesthetic correlation In M-position: of the lips, teeth and gingivae at rest and in smile position. _Commissure height The aesthetic correlation can be established properly _Philtrum height when viewed at a closer distance than the visual _Visibility of the maxillary incisors macro-aesthetic distance. The visual mini-aesthetic distance is similar to the across-the-table distance, In E-position: which is normally within 60 cm to 1.5 m. _Smile arc (line) _Dental midline _Smile symmetry _Buccal corridor _Display zone and tooth visibility _Smile index _Lip line Micro-aesthetics: deals with the fine structure of dental _Maxillary central incisors (tooth size ratio) and gingival aesthetics (Fig. 8). Micro-aesthetics can _Principle of golden ratio be established at a visual micro-aesthetic distance _Axial inclination of less than 60 cm or within normal make-up distance. _Incisal embrasures _Contact point progression _Connector progression _Shade progression _Surface micro-texture Table III CDE0115_06-12_Koirala 26.02.15 10:27 Seite 6 CDE0115_06-12_Koirala 26.02.1510:27 Seite 6