Multidiscipline Restoration of the "Esthetic Zone" Part 1June 26, 2019 by AACD Executive Office
Written by AACD Sustaining Member, John C. Calamia, DMD
As you know, modern-day esthetic dentistry is constantly changing. Understanding the extent of what goes into cosmetic cases in the modern day is an important part of executing procedures to the highest degree. Along with this, the idea of multidisciplinary restorations, specifically utilizing orthodontics, is massively important in helping perfect the smiles of patients. The design of the smile is one of the most important parts of determining how the final product will turn out. Let’s look at the components of the smile design.
The multi-disciplined restoration of the esthetic zone looks at the full gamut of what makes up the smile and the problems the patient has with their smile in order to make the result as esthetically pleasing and functional as possible. The piece that makes this all possible is the smile evaluation that looks at all aspects of the smile on the macro and micro level.
For the initial consultation of the patient, the first steps are to:
From here, the diagnostic cast will be made, and, if necessary, a diagnostic wax-up will be created. Then, oral hygiene instruction will be given to ensure the longevity of the restoration, as well as specialty consults in terms of other disciplines like orthodontics or periodontics.
When looking at the facial and maxillary midline of the patient, the problem is presented. The dental (Max.) midline and the facial midline do not coincide. The facial midline is set up on the mesial of tooth #9, where there is a large gap (diastema) between #8 and #9. Most of the discrepancy is to the right side of the patient. If the final restoration was lined up on the facial midline, #8 would end up very wide in comparison to the mesial-distal width of #9. The smile line is also looked at and compared with the lower lip. The Maxillary Axial Inclinations are then evaluated, as well as the gingival zeniths.
After the completion of the smile evaluation, a list of problems is organized. These periodontics, endodontics and orthodontics problems will be the ones addressed during the restoration. There will also be a list of preventative measures to be taken in order to make sure the same problems don’t happen after the restoration has been completed.
The treatment plan for this case will be completed in phases:
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