Orthotown September 2022 - 58

Fig. 3: " Short teeth " corrected by negative gingivoplasty.
Figs. 2a and 2b: Short teeth corrected by positive coronoplasty.
Figs. 4a and 4b: White and pink tissue relationships in aesthetic smiles.
(Images courtesy of Dr. Tom Pitts)
Fig. 5: Aesthetic bonding to improve color uniformity.
patient in Fig. 3, negative gingivoplasty by
diode laser gingival recontouring was the
best choice because both VIP and SA were
adequate.
In both cases, the tooth positions after
orthodontics were acceptable, but failing to
create beautiful teeth through optimizing
white and pink aesthetics would not have
satisfied the patient's aesthetic need-and
could be perceived as an aesthetic failure.
The first step in the treatment process
should involve gaining an understanding
of the patient's aesthetic need as requiring:
* Alteration in tooth position
(VID/VIP, gingival display,
smile arc).
* Changes in white (tooth)
aesthetic contours.
* Changes in pink (gingival)
aesthetic contours.
For clinicians
early in this journey,
there is value in creating visual aesthetic
objectives using digital simulator software.
Good apps for this purpose include Smilecloud,
SmileFy and DSD Direct HandsOn.
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SEPTEMBER 2022 // orthotown.com
Given the constraints of space, this article
will be limited to developing whitetissue
aesthetics.
The white-tissue factor
Orthodontists have paid lip service to
white-tissue aesthetics for decades. Most
doctors incorporate the principles in only
very specific cases, including peg laterals
and canine substitution, while others expand
it further by manicuring incisal edges
at the end of some treatments, using mostly
" revision through reduction. " By expanding
our vision through a lens of tooth
contour similar to that of a cosmetic dentist,
we can deliver more attractive smiles
by creating beautiful teeth.
Basic principles of
aesthetic teeth
No single tooth shape or contour is
universally ideal and applicable to all patients.
Research has shown that the golden
proportion, recurring aesthetic proportion
and golden percentage methods are all inadequate
at describing aesthetic contours
of anterior teeth in aesthetic smiles.5
Similarly,
the concept of visagism, frequently
employed in digital smile design proponents
to correlate tooth shape with personality
type and smile projection, has not
held up well under research scrutiny.6
Contour principle: Height/width ratio
of 75%-85%, with length of the upper incisor
less than 11.5 mm.
Shape principle: Avoid overly square
or triangular incisors, with more rounded,
softer shapes for female patients.
Virtually every orthodontist is familiar
with Fig. 4a, which illustrates the white
and pink aesthetic principles of SA, gingival
arc (GA), papillary arc (PA), incisal embrasures,
gingival embrasures and contact
point lengths. However, fewer are familiar
with Fig. 4b, which illustrates the relationships
among reflective surfaces on the anterior
teeth, gingival zeniths and long axis,
incisal edge curvature, emergence profile
and contact point escapements. These relationships,
which are well known to our
cosmetic dental colleagues, are integral factors
in aesthetic tooth shape.
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Orthotown September 2022

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