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Interdisciplinary management of anterior dental esthetics

In the past 25 years, the focus in dentistry has changed gradually. Years ago, dentists were in the repair business.
Routine dental treatment involved excavating dental caries and filling the enamel and dentinal defects with amalgam.

In larger holes, more durable restorations may have been necessary, but the focus was the same: repair the effects of dental caries.
However, with the advent of fluorides and sealants, as well as a better understanding of the role of bacteria in causing both caries and periodontal disease, the needs of the dental patient have changed gradually.

Many young adults who are products of the sealant generation have little or no caries and few existing restorations.
At the same time, our image of the value of teeth in Western society also has changed.

Yes, the public still regards teeth as an important part of chewing, but today the focus of many adults has shifted toward esthetics (How can my teeth be made to look better?).

Therefore, the formerly independent disciplines of orthodontics, periodontics, restorative dentistry and maxillofacial surgery often must join forces to satisfy the public's desire to look better.

This trend toward a heightened awareness of esthetics has challenged dentistry to look at dental esthetics in a more organized and systematic manner, so that the health of the patient and his or her teeth still is the most important underlying objective.

But some existing dentitions simply cannot be restored to a more esthetic appearance without the assistance of several different dental disciplines.

Today, every dental practitioner must have a thorough understanding of the roles of these various disciplines in producing an esthetic makeover, with the most conservative and biologically sound interdisciplinary treatment plan possible.

We start the treatment planning process with esthetics and proceed to function, structure and, finally, biology. We do not leave out any of the important parameters; we simply sequence the planning process from a different perspective. We choose this sequence because the decisions made in each category, especially esthetics, will directly affect the decisions made in the categories that are assessed subsequently.

Natural Oral Esthetics
Esthetic restorative procedures can be mastered consistently only if both clinician and ceramist are intimately familiar with the basic princioples of natural esthetics.
This overview of esthetic principles is not limited to only tooth esthetics but includes gingival esthetics and the final esthetic integration into the frame of the smile, face, and more generally, the individual.

Both dental and gingival esthetics act together to provide a smile with harmony and balance.
A defect in the surronding tissues can not compensated by the quality of dental restoration and vice versa.

Fundamental criteria

1) Ginvival health.

2) Interdental closure.

3) Tooth axis

4) Zenith of the gingival contour.

5) Balance of gingival levels.

6)Level of interdental contact

7) Relative tooth dimensions

8) Basic features of tooth form

9) Tooth characterization

10) Surface texture

11) Color

12) Incisal edge configuration

13) Lower lipo line

14) Smile symmetry

The final treatment objective will always result from a combination of knowledge and application of the aforementioned objective criteria, time, and patient's input.


Esthetics has become a respectable concept in dentistry. In the past, the importance of esthetics was discounted in favor of concepts such as function, structure and biology. But in fact if a treatment plan does not begin with a clear view of its esthetic impact on the patient, then the outcome could be disastrous. In today's interdisciplinary dental world, treatment planning must begin with well-defined esthetic objectives. By beginning with esthetics and then taking into consideration the impact of the planned treatment on function, structure and biology, the clinician will be able to use the various disciplines in dentistry to deliver the highest level of dental care to each patient. We call this process (interdisciplinary esthetic dentistry), and it really works.

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