Conservative orthodontic-prosthodontic approach for excessive gingival display: A clinical report

What comes first: teeth or face? Recommendations for an interdisciplinary collaboration between facial esthetic surgery and dentistry

OBJECTIVE

The aim of the present study was to provide recommendations in order to facilitate communication between dental professionals and surgeons who are collaborating in the field of dentofacial esthetics.

CLINICAL CONSIDERATIONS

Smile esthetics are beyond the scope, both of the surgeons who are collaborating with facial esthetics and of the dentists, as a wide range of treatment options from both sides is available. It can be difficult for the surgeon or the dentist that first comes in contact with the patient to conduct an individualized global treatment plan, in order to find out how the various phases of the treatment can be sequenced, as a workflow for an efficient interaction between facial surgery and dentistry still does not exist in the scientific literature.

CONCLUSIONS

Facial cosmetic procedures and dental treatment have to be planned as individual elements of the whole dentofacial esthetic rehabilitation. The treatment has to be initiated with the design of the smile and the intraoral mock-up, followed by the required surgical interventions, and to be finished with the delivery of the definitive dental restoration.

CLINICAL SIGNIFICANCE

Dentofacial esthetics require comprehensive communication between surgeons and dentists. Following the proposed recommendations, an individualized interdisciplinary treatment plan can be conducted, defining the role of each specialty.

Perception of dentists, dental students, and patients on dentogingival aesthetics

Abstract Introduction Patients’ demand for dentogingival aesthetics has increased significantly in recent years, and this is a complex concept due to numerous factors involved in obtaining patient/professional satisfaction. Some dentogingival features may alter smile harmony, such as excessive gingival display. Objective To evaluate whether the presence of gingival display has a negative influence on the perception of dentogingival aesthetics. Material and method 180 individuals (60 dentists, 60 dental students, and 60 patients) evaluated images of volunteer smiles. These images were digitally altered by the Adobe Photoshop™ software, creating different situations of gingival display (4 mm, 2 mm, 0 mm, -2 mm, -4 mm), and graded by the evaluators with the following scores: (01) very pleasant smile, (02) pleasant smile, and 03) unpleasant smile. The scores assigned were analyzed using ANOVA (α=0.05). Result Gingival displays between 0 and 2 mm were considered aesthetically pleasing. Changes of -4 and +4 mm were defined as the most disharmonious smiles. The 0-mm female smile was considered the most harmonious for dentists (1.51) and dental students (1.77), by Student's t test (p<0.05). In the opinion of patients, the smile of +2 mm was considered the most aesthetic. In the image evaluations of men, the 0-mm smile was considered the most aesthetic (p <0.05) for dentists (1.85) and dental students (1.62). The patients considered +2 mm of gingival display the most harmonious smile. Conclusion The aesthetic perception of dental students and dentists was different when compared to the group of patients.

A guide to minimally invasive crown lengthening and tooth preparation for rehabilitating pink and white aesthetics

The rehabilitation of anterior dental aesthetics involves a multitude of disciplines, each with its own methodologies for achieving a predefined goal. The literature is awash with different techniques for a given predicament, based on both scientific credence, as well as empirical clinical judgements. An example is crown lengthening for correcting uneven gingival zeniths, increasing clinical crown lengths, and therefore, reducing the amount of maxillary gingival display that detracts from pleasing pink aesthetics. Many procedures have been advocated for rectifying gingival anomalies depending on prevailing clinical scenarios and aetiology. This paper presents a minimally invasive technique for crown lengthening for short clinical crowns concurrent with excessive maxillary gingival display, which is expedient, maintaining the inter-proximal papilla, mitigating morbidity, reducing post-operative inflammation, and increasing patient comfort. In addition, with a similar ethos, a minimally invasive tooth preparation approach is presented for achieving optimal white aesthetics.