Anterior Analysis and Restorative System (AARS)
Case study continued ...
STEP FIVE - set the sizes
Close the gauge fully and zero it. Manually slide the Dentagauge open until you set it at the proposed width of the lateral (8.1mm in this case). Screw the setting knob on top slightly to apply friction, and it will be easy to get the number you want with practice. Then fully lock the gauge so you can manipulate the instrument without the dimension changing.
STEP SIX - Secondary assessment
Go back to model with this proposed width set on the Dentagauge, to see what the implications are regarding enameloplasty, orthodontics and/or periodontal problems due to excessive overhangs. In this case it visually shows that we need to strip a small amount off the distal of the UL1.
This is confirmed
by the quick addition of the space at UL2- UL3 of 1.40mm + the UL2 width
at 6.36mm, = 7.76mm, which when subtracted from the new lateral width
of 8.1mm yields a 0.35mm difference - which comes off the central incisor
distal enamel. You could also consider the possibility of adding 0.7mm
to the mesial of the UL3, and re-calculating the distance between canines
and then getting new incisal widths from the table. If 0.7mm was subtracted,
36.5mm becomes 35.8mm which yields 7.9mm and 10mm for the incisors. A
lateral of 7.9mm starting at the new halfway position in the gap between
the UL3 and the UL2 would require more enamel removal from the UL1, but
would reduce the over contouring of the UR2 mesial.
If the patient was periodontally reactive, or had a high lip line and was going to make a fuss over a black triangle, this option may well be advised. In addition, although the UL3 is larger than the UR3, these two teeth are not usually seen in the same visual field so that subtle differences in their widths can be tolerated, unlike the incisors.
STEP SEVEN - further assessment
Put the same setting on the UR2 and consider the implications.
A large overhang
will be created. This may require some skillful contouring to avoid gingivitis,
and even so, a black triangle may well be created and foodstuffs e.g.
seeds, would be likely to lodge in this area. It would be much better
if the lateral could somehow be pushed or pulled to the mesial so that
half of the addition could be transferred distal side, thus creating
two smaller, more natural, more aesthetic and healthier extensions. We
will keep this in mind until the analysis is completed.
STEP EIGHT- assess centrals
Set the Dentagauge to 10.2mm and pick this measurement up from the previously marked width of the proposed lateral. (Use a sharp pencil to mark the previous spot on the plaster, or a black marking pen to mark the flowable composite which is then scored with the sharp metal tip of either Dentagauge to make a white line underneath.
The implication
in this case is the midline diastemas will be closed not by half to one
and half to the other, but by 2/3 to the UL1 and 1/3 to the UR1. Make
sure your flowable composite is not over bulked in this area, because
you get better accuracy if the score marks in the flowable are at the
contact area with respect to the buccal lingual dimension, i.e. not sticking
out towards the buccal. If you're flowable score marks are towards the
buccal you will inevitably need to rotate the Dentagauge, you will not
be square on to the tooth and therefore not accurate.
STEP NINE - length vs. height analysis
Consider the proposed width of the central incisor at 10.2mm and ask: Will this width look odd against the existing height? Then refer to section 2 of the Dentagauge booklet, as this shows the average proportions. Assuming this mannequin is a Caucasian male, the height "should be" 1.18mm times the width. In this case it "should" be 12.036mm.. (Say 12mm). Using the Dentagauge 2 (not the DG1) set 12mm on the digital scale and then go back to the model. This shows that over 2mm "should" come off the gingival. This is where clinical judgment comes in ...a smaller amount, say 1mm, could possibly be achieved without flaps and osseous removal. This assumes there is approx 3mm of biological width remaining after a simple 1mm gingivectomy.
A compromise with slightly wider teeth than the average person could probably be obtained without significant surgery. This compromise would also reduce the amount of tooth visible when smiling, which at 10.2mm by 12mm could start to look a bit too much. Hence the compromise to wider looking teeth may not really look worse in the big picture, and may also save the patient having the expense, inconvenience and risk of apically repositioned flaps.
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