Dental Considerations In The Esthetic Treatment Of The Adult Orthodontic Patient Drs. Vince Kokich Jr. and Gregg Kinzer Summary by: Philip Markin The concept of improving dental esthetics BEFORE doing restorative dentistry. There are four esthetic factors to be considered. However, how severe do they have to be before being recognized by both dentists and lay people? A. Esthetic factor #1-crown width (lateral incisors) Best way to determine proper width of teeth is to do a wax set-up put the canines in the best functional position put the central incisors in their best position the remaining space is the proper space for the lateral incisor How large does the discrepancy have to be before it is noticeable? small lateral incisors - 3 to 4 mm. too small- was noticeable unilateral small lateral incisors 2mm. was noticeable Position of small teeth, example- lateral incisor-for restoration- the size and shape of tooth determine the type of restoration veneer - position more palatal on the ridge, lingual surface in occlusion with more space to the distal crown- center of the ridge, out of occlusion and more space to the distal Treatment sequence for undersized lateral incisor open the space place composite on tooth (determine size by wax set-up) B. Esthetic factor #2 tooth proportion (length vs width) ideal is 65% to 85% (75%) maxillary central incisors 78% lateral incisor 73% C. Esthetic factor #3 gingival levels lay people notice a 2mm. discrepancy must diagnose between altered active and passive eruption altered active eruption deep sulcus, erupt out of the alveolus (1-2mm from CEJ) altered passive eruption diagnostic factors (tooth didn't erupt out of the alveolus enough) crown length incisor wear sulcus depth CEJ Timing for treatment - do the periodontal treatment with orthodontic brackets still in place. D. Esthetic factor #4 - Crown length Factors to consider width to length proportion (approximately 75%) incisal/occlusal plane esthetics - be familiar with thresholds for being noticed by dentists and lay people. lip level - is it noticeable during a smile? Orthodontic intrusion when restorative dentistry is involved - depends on type of tooth preparation. 1. ferrule preparation-need 1.5 mm. below the build-up for the crown 2. preparation length- 3mm. of tooth is proper length The key factor is COMMUNICATION between the orthodontist , periodontist, oral surgeon, and restorative dentist.