A smile is a curve that sets everything straight. When the curve is not right, it needs to be set right.
Till recently, one of the popular myths was that Orthodontic Braces is the best solution for this. However, this costs more time and money and offers lower guarantee of results.
Aesthetic dentistry is a good alternative to design the curve as against Orthodontics when one would like to achieve the desired result in a short time and by spending less money. Aesthetics dentistry is gaining importance now increasingly focusing on the shape, shade, size, and alignment of teeth.
Smile designing is itself a specialty that has gained tremendous popularity in recent years, and offers a variety of options. The preference for cosmetic treatment without Orthodontics has also increased with time. The teeth are designed to have set proportions and the Golden proportion of Ratio is 1:1.618 is the most important protocol to be followed in smile designing, to achieve the desired result.
A 22-year old female patient reported with a complaint of spaces in the upper anterior teeth, which were also larger than required, causing difficulty in closing the lips, leading to potentially incompetent lips, everted lips and puckering of chin. This resulted in keeping her mouth tight-lipped without a smile. Clinical examination revealed other findings like crowding of the lower anterior teeth and a deep bite, i.e., lower anterior teeth occluding posterior to the upper anterior teeth, and almost touching the incisive papilla. Things were not quite easy as she had a missing lateral incisor. Diagnostic models were made and an analysis was carried out on these as to which treatment option would work out the best.
Orthodontics was the first option. The expected result out of Orthodontic treatment was to correct the deep bite and crowding of the lower anteriors, and to consolidate the spaces in between the upper anteriors, which would lead to a single space for the lateral incisor. This space is to be replaced with a bridge or an implant. The drawbacks of doing orthodontic treatment for this patient was the time required and that doctors may end up having a large space for the lateral incisor to be replaced. A deviation of the midline also was expected.
Second option was to perform root canal treatment of the upper anterior teeth, followed by crowns which can be designed according to our requirement. The expected result of this treatment is short upper anterior teeth, with proper alignment and no spacing. The drawbacks of this treatment are that 5 normal teeth will be made non vital intentionally, and that deep bite and crowding of lower anterior teeth won't be corrected. The advantages are that the desired result will be achieved in a matter of few days, and all the teeth will be as per the Golden proportion.
Option 2 won over Orthodontic treatment in this case, as time and the size of the upper anterior teeth were given more priority.
Root canal treatment was performed on 5 upper anterior teeth in 2 sittings.
An impression was made to serve as a mould for fabrication of temporary intermediate crowns.
The teeth were reduced (Crown preparation) giving 2 mm clearance on all sides of the teeth giving adequate space for the metal capping and the ceramic, as the choice of material for crowns was Porcelain fused to metal.
More preparation was done on the labial surface to provide adequate thickness for the ceramic which will help in achieving the desired shade.
Temporary crowns were fabricated intraorally using a self-cure resin material that was fixed on the reduced teeth using a mixture of Zinc oxide and Eugenol.
The permanent ceramic crowns were fixed after 3 days using Glass Ionomer luting cement.
This treatment helped boost the patient's confidence level in just a few days' time. The patient was able to close her lips normally, smile with confidence, and also carry out her regular activities without any change.
"Indeed, we often underestimate what a simple smile can do in our lives."
Article by Dr. Rakesh Dorai, BDS
Dental Surgeon, Kauvery Hospital, Chennai