Steps in creating a beautiful smile

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The incisal contours are not mirror images, which add to the vitality of the teeth.

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The axial inclination should be more mesial and the gingival height .5 to 1mm below a line drawn from the central to the cuspid.

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The axial inclination should be more mesial and the gingival height .5 to 1mm below a line drawn from the central to the cuspid.

Drs Larry W. Rosenthal and Ken M. Hamlett review key factors in achieving optimum outcomes in aesthetic cases.

The single most important factor in creating a beautiful smile is the ability to visualise the final result before you begin.

Laboratory communication, including photographs and models of the approved temporaries, is a key to success.

A thorough lab prescription detailing shade, texture, central length, incisal translucency, and any other pertinent information helps to facilitate a predictable result.

To develop properly proportioned teeth, it is essential to properly address many characteristics, such as contours, shade, size and length of centrals, phonetics, and occlusion.

This leads to a key artistic technique - the art of recontouring - with both temporaries and, if necessary, the final restorations.

Laboratory communication, including photographs and models of the approved temporaries, is a key to success.

Key characteristics

Occlusion should be developed both in the temporisation stage and in the final restorations, and should be balanced in both vertical and anterior excursive movements.

A vertical opening of 2 to 3mm can be achieved with little or no problem if the joint is stable and pain-free.

If the occlusion is locked in excursive movements, muscle activity (e.g., lateral pterygoids) may be stimulated and produce spasms and perhaps pain.

Each practitioner must work out the occlusion based upon his or her own personal occlusal philosophy.

The occlusion must be balanced for success. One way to check the final restorations in all movements is with a computerised occlusal analysis system (e.g., T-ScanII [Tekscan; South Boston, MA]).

Phonetics

Phonetics should be checked in the temporaries for incisal edge position and length.

This can also be checked in a trial mock-up on the patient's original teeth using flowable composite; as well as in the mouth with an evaluation of the "F" sound, in which the maxillary Incisal edges touch the border of the lower lip; and the "E" sound, in which the maxillary incisal edges should be approximately one-half the distance between the lips.

These positions are helpful in determining incisal edge length. The correct position of the lingual incline of the upper teeth and labial of the lower teeth can be determined by the "S" sound.

Shading

Shading is extremely important in creating natural-looking restorations.

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