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Too Much Tooth, Not Enough Tooth Making Decisions About Anterior Tooth Position – ARTICLE and CLINICAL PHOTOS by Frank Spear, DDS, MSD The restoration or creation of an esthetic smile is always the result of focused observation, thoughtful evaluation, and a systematic approach to planning and sequencing treatment. Restorative and esthetic dentistry approached through this process will incorporate the five critical elements that contribute to the beauty of a natural smile and result in a successful outcome for both patient and dentist. These five essential considerations are tooth position, gingival levels, arrangement, contour and color. Although each of these is important in the final result, the first step is the most important – and in the esthetic process, the starting point for tooth position always is the incisal edge of the maxillary central incisor. 1,2 As in denture prosthetics, this step is critical not only in the esthetic plan, but also in developing the functional treatment plan – because it determines the appropriate positions of all the maxillary teeth and subsequently, beginning with the lower incisors, determines the positions of the mandibular teeth. 18 www.chairsidemagazine.com
Lip mobility as a factor in tooth display Figure 1a: Average amount of central incisor display in a 30- to 40-year-old woman with correctly erupted central incisors. Figure 1b: High lip mobility of more than 10 mm combined with a resting display of 3 mm. In this article, I review the elements used in determining the correct position of the incisal edge of the maxillary central incisor, step No. 1 in the diagnostic and treatment planning sequence called Esthetics—Function—Structure—Biology, used in the Spear Education program. The practitioner must evaluate three aspects to ensure correct placement of that edge, and I will describe them here. ■ The Elements Of Determining Incisal Edge Placement The three factors the dentist must evaluate for correct placement of the maxillary central incisor’s incisal edge are tooth display and lip mobility; the position of the incisal edge relative to the position of the other teeth in the maxillary arch; and phonetic considerations. Tooth display and lip mobility. The first consideration is a combination of two elements: the amount of tooth displayed at rest and lip mobility. Lip mobility is the amount of lip movement that occurs as the patient smiles. 3 The majority of observers will select as an ideal esthetic smile one that displays the full central incisor and includes a slight amount of gingiva apical to the tooth. 4 The amount of tooth that shows at rest will vary depending on the amount of lip movement during the smile. As an example, if the patient’s central incisor is 10.5 mm long (an average length) and the lip moves 6 mm from rest to full smile, assuming a display of the gingival margin during full smile, 4.5 mm of tooth will be displayed at rest. If the same patient’s lip is less mobile, moving only 4 mm from rest to full smile, 6.5 mm of tooth will be displayed at rest to achieve the same esthetics. Conversely, if the patient has a highly mobile lip, with 10 mm of movement, only 0.5 mm of tooth will display at rest to meet the esthetic requirements of an ideal smile. “As a general rule in my practice, with the patient’s lip at rest, I always ensure that at least the edges of both central incisors are visible so that the patient does not appear to be edentulous.” The preceding example illustrates clearly that placement of the incisal edge will be influenced dramatically by the patient’s level of lip mobility and the desired appearance of the smile regarding tooth exposure and gingival display (Fig. 1a,1b). As a general rule, the more mobile the lip, the less tooth that can be displayed with the lip at rest to create a pleasing smile; the less mobile the lip, the more tooth Too Much Tooth, Not Enough Tooth: Making Decisions About Anterior Tooth Position 19
Page 1: Chairside® A Publication of Glidew
Page 4 and 5: Contents 45 Practice Management: So
Page 6 and 7: Letters to the Editor “Dear Dr. D
Page 8 and 9: Contributors Michael C. DiTolla, DD
Page 11 and 12: PRODUCT........ TrollFoil Dr. DiTol
Page 13 and 14: Dr. DiTolla’s CLINICAL TIPS PRODU
Page 15 and 16: Book Review “Aesthetic & Restorat
Page 17 and 18: Figure 5: The fractured ceramic sur
Page 22 and 23: Creating suitable incisal edge posi
Page 24: tion using “s” sounds as well;
Page 27 and 28: Interview with Dr. Paul Homoly 25 I
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Page 39: one; you’re a fantastic employee,
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Page 44: ■ Reasons for Biologic Shaping 1.
Page 48 and 49: Glenn Lombardi: Well, let me start
Page 50 and 51: Second, if you’re not comfortable
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Page 65 and 66: Dr. DiTolla’s Patient Product Rev
Page 67: The Chairside ® Caption Contest IN

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