Orthotown September 2022 - 60

Fig. 8: Positive coronoplasty through aesthetic bonding and negative
gingivoplasty with a diode laser can be used to establish harmony.
The key is that tooth position was optimal, and correcting contours
and tooth shape provided an optimal aesthetic result.
Fig. 6: Upright teeth reflect light favorably for aesthetic perception.
(Images courtesy of Dr. Wassim Bouzid)
Fig. 7
Aesthetic tooth shape then is an artistic
choice, especially when it involves enhancing
tooth shape in patients who are considering
extensive restorative dentistry.
Color principle: Whiter teeth look
more youthful and are preferred, with
good uniformity of color (Fig. 5, p. 58)
and natural gradation.
The ability to alter tooth color has created
an additional opportunity for orthodontists
to deliver truly aesthetic results;
many practices now offer in-house whitening
as an adjunctive service. Given the
trend of orthodontic patients being older
and more discerning and demanding about
their aesthetic outcomes, we can expect
this trend to increase.7
A systematic approach to
" white tissue " recontouring
After a few years of trying to teach the
principles of microaesthetics, I realized
rules and guidelines alone weren't enough:
Most orthodontists are more effective
when following systematized techniques,
so they know when to start and stop.
60 SEPTEMBER 2022 // orthotown.com
Some attempts at establishing techniques
for aesthetic tooth contours have
been published in dental journals8
but
there have been few in orthodontic literature,
so I'm grateful for the opportunity to
address that.
The easiest, most reliable workflow was
adapted from cosmetic dentistry protocols
by Dr. Hicham Khayat. It involves seven
steps: frontal plane, vertical plane, transversal
line angles, embrasures, the three facial
planes, macrotexture and microtexture. By
adapting this technique to orthodontics, a
systematized approach is attained.
1: Frontal plane. Aesthetic orthodontic
alignment is designed to place the facial
surface of the incisor vertically, so reflected
light travels straight to the eye of the observer
instead of being refracted when teeth
are more proclined (Fig. 6). Prebonding
coronoplasty recontouring of the facial surfaces
makes the process more consistent.
Fine adjustments to shape of reflective
surfaces on the anterior teeth are easily accomplished
with fine diamonds, flexible
discs and polishing at bracket repositioning
appointments and debonding.
Remember that tooth color affects
aesthetic perception, too: Darker teeth appear
to be set lingually even if they are well
aligned, as seen in Fig. 7.
2: Vertical plane. Aligning the vertical
proportions of the teeth is the second step
in the protocol. In orthodontics, this step
is taken during treatment after correct VIP
is attained, and facilitated by tooth shape
optimization through positive or negative
coronoplasty (Fig. 8).
Optimizing aesthetic tooth proportions
after adjusting gingival display and
tooth length using interproximal reduction
(IPR) is accomplished with discs, followed
by flexible discs and polishing.
I share with cosmetic dentists a view
that anterior tooth height-to-width proportions
of 75%-78% are most attractive.
I also agree with Pitts' assertion that anterior
teeth should have long contacts that
extend below gingival margins, to avoid
development of black triangles as the tissue
recedes. In adult patients where slenderizing
in excess of aesthetic proportions
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Orthotown September 2022

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