Preoccupation with personal appearance has become one of the major forces shaping society today. There is no doubt the public’s concern with appearance has fuelled a paradigm shift in terms of the dental professional’s roll in society.
With the rapid growth of cosmetic dentistry over the last decade, traditional ‘text book methods’ with their more rigid format for aesthetic dental restorations have failed to meet the cosmetic demand of the 21st century. Because traditional methods have resulted in a template of mass-produced ‘uniform dentition’, the need for a new concept based on evolving fashion within cosmetic dentistry is required and is inevitable. This concept should apply to the demands of every individual and regard the sex, race,
colour, facial and body features, cultural background and
the variable perception of beauty in different societies.
The series of articles (The role of fashion in aesthetic Dentistry)[1,2] analysed this problem and presenting a new cconcept, based on a classification system, citing five different types of appearance. This classification refers to every individual’s own ‘general concept’ and ‘individual concept’ and focuses on the criteria the clinician must consider both theoretically and clinically [1,2], in order to manage failure, achieve dento-facial harmony and an ‘individual natural look’.[1,2] The cases in this article are based on the content of the series of articles [1,2], presenting clinical examples, where the emphasis has been placed on this new concept, and discuss how technically this theory/concept can be used in practice.
The following illustrated clinical cases present an analysis of two different types of appearance, then relate it to the appropriate dental design into the right face.
Patient A is a middle-aged lady. Her skin colour is light as is her hair colour. She has thin lips, nose and cheeks. Her colour collection and very fine narrow facial features give her a very soft traditional north European look. Patient A has an old dental restoration (anterior bridge, and large visible amalgam filling), which is disturbing the elegance and softness in her face.
Considering her delicate natural facial structure in general and the mouth and her thin lips in particular, there is a very limited space buccaly to be built up. This is one of the main points to be considered, as the dental restoration should fit into the lip frame and appear in correct proportion with its surrounding elements. To take maximum advantage of the available space buccaly, the teeth are shaped so that the different levels on buccal and proximal surfaces are clearly observed. The buccal surface is significantly prominent and creates a extreme contrast with the proximal part. The buccal surface reflects the light, and the contrast of different levels produces an optical illusion which make the dentition appear prominent.
By using this technique the dentition appears with rather narrow and prominent teeth.
The size and the shape of the teeth are designed so that the dentition is within the natural anatomical frames. The incisal embrasures form the lower part of the frame and have a clear gap with the lower lip in retracted smile. The buccal corridors are remained and not filled completely by extended buccaly premolars and molars. The gingival line is enhanced carefully so that it forms the upper part of the frame. This frame is clearly visible as usually appears in natural attractive smiles.
The shade no lighter than B1 is chosen, as this shade appears natural with her fair skin and light blond hair tones. The ultimate result should be in harmony with the facial features in general, and follow the natural softness in her face, in particular.
Patient B is in her early 20s. She has thick lips with very delicate cheeks and nose. Her hairstyle, light hair tones and skin colour, with her outstanding dark eyes and eyebrows, create a contrast among her facial features. This gives her an attractive contemporary look. She is missing tooth 11, and has extreme discolouration of 21. As the result of sucking the tomb over considerable number of years, her open bite and a sharp (V) shape of the maxilla have created a disharmony in her face and is therefore out of context with her whole concept.
Two issues for consideration in this case were that the restoration of 11 and 21 should match with her contemporary young look and blend in with her existing dentition, while rectifying the open bite. The challenge in this case was that the correction of open bite and closing the diastema would create a space which would be too large for 11 and 21. This could cause disharmony with the existing dentition. This is compensated partly by her thick lips, which is an advantage as the larger size of the centrals would match with their surrounding elements, and partly corrected by shaping the teeth so that the light reflection on buccal surfaces, produces an optical reduction of this surfaces. This phenomenon has been used in order to reduce tooth width of 11 and 21. Also shaping clear definition and steps of incisal embrasures and creating irregularity in dentition generally, will blend the dental restoration with the existing dentition and maintain her natural, young and contemporary look.
The temporary restoration is a IPS Empress bridge with 12 lingual retainer, 11 pontic and 21 retainer, which will be replaced by 11 implant and 21 crown, after the healing process of the bone graft placed for 11.
1. Molavi D (2005). The role of fashion in aesthetic dentistry. Dentistry Today. Feb; 24: 86-90
2. Molavi D (2007). The role of fashion in aesthetic dentistry. Dentistry Today. Sept; 26(9)
Vincenzo Iannone dental technician (New Smile Lab – www.newsmilelab.co.uk).
Ken Hamlett DDS (www.drhamlett.com)
Dr Donna Molavi is speaking for Independent Seminars at this summer’s World Aesthetic Congress (WAC). To book your place, call 0800 371652, email [email protected] or visit www.independentseminars.com/wac
World Aesthetic Congress (WAC)
Dates: 6 & 7 June 2008
Venue: The Queen Elizabeth II Conference Centre, London
Verifiable CPD: 14 hours
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