Orthotown September 2022 - 62

Fig. 9
Fig. 11 (Images courtesy of Dr. Wassim Bouzid)
Fig. 10
Fig. 12
would be required to eliminate black triangles,
injectable resins and BioClear matrix
systems are very useful to establish aesthetic
and hygienic interproximal contacts.
3: Transitional line angles. In my experience,
this is one of most neglected steps
when orthodontists perform IPR. Orthodontists
often leave flat proximal surfaces
after IPR and fail to appreciate the role
the transition from the facial surface to the
interproximal contact has in natural tooth
shape and aesthetics. In cosmetic dentistry,
this is called " flow. "
I recommend using a flexible disc on
a slow-speed handpiece to restore transitional
line angles after IPR procedures.
This avoids the appearance of teeth being
" bonded together. " Fig. 9 illustrates a situation
that required IPR to smooth the
transitional line angles and get an aesthetic
final result.
4: Insical embrasures. Once transitional
line angles and contacts have been
refined, incisal embrasures can be detailed.
Research has indicated that orthodontists
understand the aesthetic benefits of semi62
SEPTEMBER 2022 // orthotown.com
Case study
The patient in Fig. 12 was seeking aesthetic
improvement for her smile. While
her orthodontic situation was not comrounded
embrasure forms in both men and
women.9
Careful attention to the rounded
shape of incisal edges can bring " youthfulness "
to a smile, as seen in the pairing of
Fig. 10.
5: The three facial contours. Just as
the buccal surface is not flat from mesial
to distal, nor is it flat from the gingival to
the incisal edge. Attention must be paid to
these contours for light reflection. As seen
in Fig. 11, the facial surface of the incisor
is slightly curved occlusogingivally for optimal
light reflection. Perfecting these contours
is a vital step in optimizing aesthetics.
6,7: Macro- and microaesthetic
texturing. Resorting to adjustments of
macroand
microaesthetic
textures
is
rarely required, but it gains greater importance
when restoring small lateral incisors
by positive coronoplasty or adjusting
tooth shapes during cuspid substitution.
plex, creating beautiful teeth along with a
beautiful smile presented some challenges.
Her smile (Fig. 13, p. 64) had inadequate
maxillary transverse deficiency, further
complicated by previous extractions
of four bicuspids. She displayed good VIP/
VID, which made things more straightforward.
In considering the principles of
tooth contour and tooth shape, her central
incisor tooth proportions were closer
to 80% than 75% (which would have been
more attractive), connectors were poor,
the incisal edges were flat and the teeth
were very triangular in shape.
Improvement in the frontal plane,
transitional line angles, incisal embrasures
and the three facial contours was required
(Fig. 14, p. 64). I thought her tooth color
was acceptable so bleaching would not be
necessary.
The patient was treated with Pitts21
fixed appliances (OC Orthodontics) and
an " active early " case management strategy.
IPR was undertaken using the protocols
outlined in this article, with refinement
of both transitional line angles and
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Orthotown September 2022

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