Distinguishing between art and craft
Beautiful smiles are created not by chance, but by an understanding of craft and art. The materials, techniques and procedures blended with the creative eye of an artist ultimately give us and the patients we treat the masterpiece we are proud of.
Aesthetic dentistry is comprised of two aspects, craft and art. Craft refers to the mechanics of its construction, and the art to how well it was put together. The mechanics of aesthetic/restorative dentistry can be learned.
A sequential list of photographs or explanations can be memorised for a technique and the technique can be shown and practiced on models and patients. Quality, however, is more difficult to learn as it cannot be reduced to a formula.
The attainment of quality, or the art within, is a process. It comes from understanding the variations of colour (the hue, chroma, value, etc), the characterisations inherent within (translucency, texture, craze lines, hypocalcification), and the anatomical shapes that all coincide to form what is unique to that individual or their smile. It comes from understanding preparation design and the effects that it will ultimately have on the aesthetic result.
The following case represents a common scenario. Often, the patient presents with a desire to have a more attractive smile without understanding why their smile is compromised. Our diagnosis should start as we listen and watch the patient speak to us about their desires.
Our silent questions should focus on things like:
• Why is there uneven wear displayed?
• Why can we not see adequate incisal edge display?
• Why is there variation in shade throughout the anterior teeth?
As we continue to listen and examine the patient, we come to the conclusion that function/support (or a lack thereof) is the reason for our aesthetic compromise. So, before we can address the artistic aspect of our case, we must first understand and address the functional mechanical aspect of it. This is to ensure the lasting artistic efforts we make in the design of our preparations and overlying ceramic restorations.
Aesthetic diagnosis of this case shows uneven incisal edge display, disproportion of the occlusal plane resulting in canting, faceting of the right side anterior teeth, asymmetric gingival tissue and, of course, the need for shade enhancement.
The adverse functional elements clearly contribute to the above aesthetic compromises. The loss of shared anterior guidance of both centrals due to incisal edge breakdown of the upper right central incisor, loss of cuspid guidance in right lateral movement resulting in destruction of incisal edges of the central incisor and upper right lateral incisor, no cuspid guidance in left lateral movement and lower anterior incisal edge destruction (Figure 1).
The craft of this case lies in our understanding of the functional problems and methods required to sort them out. The case’s artistic aspect is dependent on the eye of the dentist to design this patient’s smile to fit within the context of the patient’s face. He must also co-design the ceramic restoration and its internal/external characterisations with the ceramic technician.
The obvious artistic enhancements lie first in the issue of proportion. Proportion not only as it relates from one tooth to the other, but proportion as it relates to the teeth to the lips to the face (Figures 1 -8).
Gradation of colour from the gingival to the incisal, texture of the surface, internal variations of colour, translucency at the incisal edge, halo design on the incisal edge and incisal edge charactersations play a significant part in whether or not the art of aesthetic dentistry is understood by both the dentist and ceramist (Figure 9).
Figures contained in this article represent the art of proportion of the teeth to the face. As can be seen, the primary aesthetic offence is teeth which are too small for the lips and face which surround them. The post operative view significantly enhances the teeth to face proportion filling out buccal corridors and the anterior segment.
Figure 2 represents the art of proportion of the teeth to each other from the frontal 1:2 view, the ‘golden proportion’. This is evident in the lateral views and frontal post operative views (Figures 4 and 6). Disproportion of central, lateral incisors, cuspids and bicuspids to each other, and to their contra lateral counterparts, creates disharmony in the smile (Figures 1, 3 and 5).
Figure 9 shows the understanding of art in replicating the vitality and realness within a porcelain restoration to make it naturally appealing. The communication between the aesthetic dentist and the ceramist and their understanding of inherent quality (art) is depicted in the 1:1 view.
Note the amount of incisal characterisations designed within the incisal third: translucency, halo, craze lines, hypocalcification and chipping, all very real and artistically placed by the ceramist to replicate a natural tooth. Note the surface texturing to naturally reflect and deflect light along with the gradation of color from the gingival to the incisal).
A functionally aesthetic smile is the culmination of balance between craft and art, the mechanics of its construction and the quality of its construction. However, the art of a smile cannot sustain itself without the foundation of sound functional and mechanical principles. However, a functionally sound design can sustain itself in the presence of inferior aesthetics.
The goal of aesthetic and restorative dentists is to learn the craft (mechanics), and by using that as a foundation to begin the process of learning the art (quality). The art of aesthetic dentistry can be learned through associations with outstanding, aesthetically focused laboratories and high end aesthetic hands-on continuing education programs such as the Aesthetic Advantage in London.
If we are to claim to be ‘cosmetic dentists’ then maybe teeth whitening in some fashion needs to be our only tool. But if we claim ourselves to be artists of the smile and truly concerned with optimum aesthetic and functional results, then the title of ‘aesthetic/restorative dentist’ would be more appropriate and fair to those who are committed to this level of education.