Orthotown October 2023 - 47

Learn about perfecting the soft-tissue side, too!
Drs. Trevor Nichols and Stuart Frost discussed their postorthodontic
soft-tissue sculpting process in a previous article for Orthotown.
To check it out, head to orthotown.com/laser-gums.
Clinical process and tools
Th e clinical procedure for hard-tissue
contouring can be done all at once
or in several stages, depending on
the severity, need, sensitivity and
desire of the patient. I learned the
techniques in this article from my
longtime mentor, Dr. Stuart Frost,
who taught and demonstrated them
in our offi ce. He truly is the king of
tooth shaping!
In our practice, we perform most
of the hard-tissue shaping midtreatment
and posttreatment. Although we
might prefer for a large amount of the
reshaping to be done at the beginning
of treatment, before brackets are
placed or before a scan is obtained,
it's often best to earn a patient's
trust over time before completing an
irreversible procedure.
In our discussions during consultation
and treatment visits,
we show patients photographs of
other cases and photographs of
their case to discuss options for
reshaping and, if necessary, discuss
a multidisciplinary approach for
posttreatment cosmetic dentistry.
If possible, our goal is to create a natural,
maintenance-free smile.
For most cases, the enameloplasty
will begin with incisal-edge contouring
for major discrepancies on both
upper and lower arches, from molar
to molar. Th is is done at the pano
reposition visit or before the patient is
scanned for refi nement. Th is is truly
important: If incisal-edge shaping is
completed only at the end of treatment,
the smile arch will be fl attened.
However, if the shaping is done at the
reposition or refi nement, smile arch
can be re-created if necessary with
adjusted incisal edges. Th e major
incisal-edge contouring is done using
the fl at fi ne diamond bur, as
well as at a slow speed with
a coarse disc.
Interproximal shaping
Product ordering list
*
Fine diamond wheel bur
* Straight fine diamond chamfer bur
*
Rubber-point polishing bur
* Coarse soft-flex disc
*
Fine diamond soft-flex disc
is completed during the
fi nal-quarter stages of treatment-typically,
during
fi nal wire adjustments or
during the fi nal refi nement.
Most interproximal adjustments
are done via IPR to
reduce black triangles and
to fl atten contacts for more
ovoid-shaped teeth (Fig. 3).
Th is is done sequentially
during visits until the shaping
of the teeth is ideal.
We use diamond discs,
OCTOBER 2023 | 47 | ORTHOTOWN.COM
which come in a variety of options
(single-sided, double-sided and a
variety of thicknesses). After the diamond
disc, we use an Intensiv Swingle
IPR system to round contacts and
sharp edges.
We were all taught in dental school
that to avoid black triangle formation,
the contact point should be no more
than 5 mm from the crest of the bone.
Many times, these contact points need
to be moved more gingival via IPR to
decrease the distance between the
contact point and the crest of the bone
and to elongate the contact. We also
know there's a limit to the amount of
IPR that should be performed, so if a
patient has moderate to severe recession
or attachment loss, a referral to a
periodontist might be best.
Now that most of the incisal edges
are clean and contoured, interproximal
contacts are elongated and black
triangles eliminated, the case can be
completed and we can move on to the
fi nal stage of tooth shaping. Th is is
typically done at the time of gingivectomy,
if needed; otherwise, at the time
of bracket or attachment removal. Th is
allows for full shaping and polishing of
the entire clinical crown.
Th e fi nal shaping of the teeth proceeds
as follows:
1. Th e fl at, red fi ne diamond wheel
bur is used to smooth lingual
incisal and incisal edges of lower
anteriors and round lower cuspids
and bicuspids as needed (Fig. 4).
Th is is done dry, and at a stall-out
speed to not heat up the tooth or
cause excess sensitivity.
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Orthotown October 2023

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