As we come along this curve in understanding dental esthetics, we have been very focused on the white esthetics. We think about global, macro, micro elements, shades, contours, translucencies, textures, and all of the things that really are all about teeth.
I would like to share with you my observations and experiences with utilizing a tool that helps me to select shades for my direct and indirect restorations. As restorative dentists, we are given the task of either replacing or enhancing what is absent or deficient in nature. Innately, that solution is essentially simple.
Form follows function.
We've all heard the old adage everywhere, in all facets of life. And when it comes to anterior teeth we have to think of it as if we can get the function dialed in and honed in really well, the esthetics effortlessly fall into place.
How can the position of teeth affect function? I almost want to approach that backwards and say, "How can the position of teeth NOT affect function?"
The position of teeth is important for speaking and for enunciating sounds like our S sounds or F sounds.
The incisal edge determines how we enunciate. The incisal edge position dictates where the teeth hit on the lower lip so we can enunciate an F sound properly. If the teeth are too far apart or bumping into each other, you cannot make the F or S sounds properly, like the little kid who's lost his front teeth and wants them for Christmas. The position of the teeth affect not only our speaking, but it affects how we chew.
The position of teeth affects how we swallow and breathe.
The position of the teeth erupt into the mouth in the neutral zone, in the corridor that is dictated by the inward and outward functions of the muscles and the tongue.
When delivering a single crown, probably the toughest tooth we can prep for is the second molar.
There are a couple things to be aware of when prepping second molars:
1. Limited Opening
One, usually, there's a limited opening in that area, so when you are prepping the tooth, you have to give the patient breaks because you're going to have to ask them to open quite a bit.
2. Wear and Tight Neutral Zone
The second thing, which is more of a concern, is the wear in that area and also the tight neutral zone.
Here is how to cement a crown in 20 minutes or less every single time. Now, a lot of you may be doing this, but I'm not so sure you are because my first 17 years in practice, I didn't know if it was going to take 15 minutes to cement a crown or 30 to 40 minutes, because of all the unpredictability. So here's a few tips for you to make this happen every single time.
Any time that we're planning to work on multiple teeth on a patient, it's important to start with a complete exam and plan our treatment.
So as we begin to consider design as it relates to nature, it would be nice if there were some rules or formulas that would allow us to harness the power of what esthetics are all about. That would give us some predictability or a roadmap for our final design. I think it's been the Holy Grail, through mankind, to try to understand what those rules would be.
Fibonacci was a 13th-century mathematician, and he began to observe repeated patterns in nature. And what he tried to create were a series of mathematical logarithms that would give us a mathematical understanding of what esthetics was all about. The Fibonacci sequence was one of those formulas that look specifically at golden proportions.
It was a couple of centuries later that a guy by the name of Leonardo da Vinci came along. And he popularized a sketch called the Vitruvian Man. And it was based upon some work by another Italian engineer and architect, and his name was Vitruvius. And he felt as if the divine proportions seen in man ought to be what is replicated in architecture and design.
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So creating beautiful smiles is really about creating beautiful health.
Our vision when we're trying to create a great looking smile is to design something that's going to be a mirror of the relative health of the system. And I think, as we begin to consider enhancements or changes to someone's smile, we need to think of it in a perspective as a smile designer first, before we're beginning the treatment plan, what the results will be.
And when we begin to consider what components we're going to manipulate in order to try to optimize someone's smiles, we need to consider that with the end in mind, but obviously with an omnipresent understanding of the system at large and how the engineering will be.
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In our smile design process, we have learned from Dr. Dawson how to develop incisal embrasures. And also from Dr. Dawson and the American Academy of Cosmetic Dentistry, how to develop the apparent contact zone between teeth.
So between two centrals it should be 50%, a central and lateral, 40%, and a lateral and a canine, 30%.
There are times, though, where, depending on the restorative interfaces, say, for example, two implants, we cannot create an apparent contact zone that falls in those parameters. And if we want to keep the incisal embrasures developed, as Dr. Dawson's taught us, we need to have a long contact zone.