Anterior Analysis and Restorative System (AARS)
Case study continued ...
STEP TEN - consider orthodontics
Stand back and look at all the additions and consider if orthodontics is desirable or essential. In this case it is evident that the UL1 would benefit by being moved to the right hand side since it would save stripping the enamel on the distal and would reduce the amount of overhang on the mesial of the UR2. As it turns out, the UR2 should ideally move in the opposite direction to the UL1, ie. to the left hand side, as discussed earlier. Since these movements oppose each other it would be very simple and elegant to use a rubber band which the patient wears only at night for a few weeks to achieve both movements simultaneously. This is routinely done by the author and has the huge advantage of not requiring any brackets, wires or causing any aesthetic or functional problems. Retention is provided by the composite addition or porcelain veneers which will fill the gaps and stop relapse.
There are many other ways to reposition teeth to gain optimum aesthetic and periodontal outcomes, but this will be the subject of another paper. If you don't have orthodontic skills you could still complete this case satisfactorily - as shown below - or, you could refer it to an orthodontist if the patient considered it worth the trouble and expense. It is sometimes very difficult to get the patient to go to an orthodontist, but they would be happy for you to do the orthodontics, if you had the skills. You also get more control and professional satisfaction if you do it yourself.
STEP ELEVEN - Reconstruct
Make additions in the mouth. Overbuild the lateral extensions to the enamel to achieve more than the desired widths, and then slowly cut back (making check measurements frequently until you achieve the proposed widths obtained from section 4 tables).
Fig 1: UL2 distal added and UL1 distal being stripped
Fig 2: UL2 mesial added and cut back and width confirmed
Fig 3: UL1 over built and extent of cutback determined
When this is done, with a fair degree of skill and accuracy, a very pleasing symmetrical and aesthetic result follows.
Finished construction
In summary,
a new system has been developed to aid general practitioners, prosthodontists,
technicians and orthodontists in the harmonious reconstruction of the
anterior segment, where significant spaces exist due to tooth size -
arch size discrepancies, peg laterals, missing laterals and various other
anomalies. Dentally specific tips have been created on digital calipers
which provide ease of use and accuracy. Doctors are reminded that they
should also monitor the buccal thickness of their reconstruction and
to review the aesthetics created when viewed from the 12 o'clock anterior
position, in order to achieve a symmetrical embrasure appearance. We
will leave it to the doctor to decide whether the ratios of these embrasure
lines should be in a golden, divine or devilish proportion. There are
many interesting ideas in this area however, the Dentagauge ratios are
based on the appearance as viewed perpendicular to each tooth, and are
based on normal human un-restored tooth widths as recorded in the literature.
The studies which were used are quoted in the Dentagauge booklet. It
is hoped that quality minded aesthetic dentists and technicians will
benefit from these new tools and associated charts.
Dr Craig M Erskine-Smith obtained his dental degree from Adelaide University in 1979 and shortly thereafter became very involved in cosmetic dentistry. In 1988 he developed gingival colored class v restorations. He became founding president of the Australia Society of Dental Aesthetics, NSW branch in 1990. He is the inventor of many new dental products and techniques including the cracked tooth model, Dentagauge™ and an anchorage system to facilitate general practitioner cosmetic orthodontics. He lectures in pre-prosthetic orthodontics and advanced cosmetic dentistry and is a fellow of the Pierre Fauchard Academy.
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