Aesthetic treatment planning, or smile designing has become an integral part of today’s dental treatments. Improving the smile is no longer a by-product of a treatment plan, but is actually the goal of modern dental therapy.
The biggest challenges for the dental practitioner come in creating outcomes aesthetic for complex cases that involve various disciplines of dentistry. A systematic approach to planning and sequencing treatment can eliminate guesswork from the equation, and empower a practitioner in creating predictable results.
The gingival positions are based on the lip line the gingival architecture should be planned to provide a pleasing framework to the teeth. An ideal gingival display would involve about 1 mm to 3 mm in a wide smile. The tooth proportions are selected so that the final form of the teeth fits into the framework created by the incisal edges, and the gingiva and the teeth are arranged for the ideal amount of display and inclination to complement the face. Along with the aesthetic analysis, a functional evaluation is performed to ensure that the phonetics and occlusion are in synergy with the aesthetics.
Steps for success
• Facially generated aesthetic treatment plan
• Diagnostic wax-up, mock-up, or trial smile (3-D visualisation of the plan)
• Interdisciplinary procedures
• Orthodontic tooth movement
• Periodontal crown lengthening
• Site development and implant placement
• Controlled and conservative tooth reduction using preparation guides, keeping the outcome in mind
• Creation of lifelike temporaries that provide functional and aesthetic data
• Use of the matrix and stents during fabrication of the restorations
• Cementation of the restorations - realising the smile design
• Development of the diagnostic wax-up, mock-up, or trial smile
Based on the aesthetic analysis, a 3-D review of the plan is designed to evaluate aesthetic and functional feasibility. This is usually done with a wax-up on study casts, and provides a spatial evaluation of the final tooth positions and form. Precise information regarding tooth positions and angulations, gingival architecture, and occlusal relationships can all be evaluated using this wax-up.
Visualising the final tooth form and positions enables us to determine the type of treatment modalities required to achieve the planned result. Interdisciplinary procedures such as surgical enhancements, occlusal reorganisation, and tooth movement or tooth replacements can be planned accordingly.