International Journal of Esthetic Dentistry (EN), 03/2008

Excessive gingival display, frequently seen in adults and resulting in short clinical crowns, has been described in the literature by several authors as "altered passive eruption." It is defined as a dentogingival relationship wherein the gingival margin is positioned coronally on the anatomic crown and does not approximate the cementoenamel junction due to the disruption in the development and eruptive patterns of the dentogingival unit. This article describes how periodontal plastic surgery can remodel the attachment apparatus, reestablish the correct biologic width, eliminate the excessive show of gingiva, and expose the correct dimensions of teeth. Apically repositioned flaps with osseous recontouring can restore gingival health and the esthetic parameters of the smile line.

The aim of this study was to investigate the importance of the width/length (W/L) ratio of maxillary anterior permanent teeth in anterior esthetic rehabilitation. Digital photographs were taken of the anterior teeth for each participant (approximately 20 years old). A maxillary impression was taken with irreversible hydrocolloid and cast in die stone under vacuum. The widest mesiodistal width and incisogingival length of the tested teeth were measured. The data were submitted to analysis of variance, which showed significant statistical differences within each parameter (P .05). The width and length measurements varied between maxillary anterior teeth in the following order: central incisors > canines > lateral incisors. Maxillary central incisors displayed the largest W/L ratio (85%), maxillary lateral incisors (LI) displayed the smallest W/L ratio (79%), and canines displayed the intermediate W/L ratio (83%). These dimensions have a positive effect on the final restoration; therefore, it is suggested that the specific width, length, and W/L ratio should be used in esthetic rehabilitations of maxillary anterior teeth.

Dental erosion is a frequently underestimated pathology that nowadays affects an increasing number of younger individuals. Often the advanced tooth destruction is the result of not only a difficult initial diagnosis (e.g. multifactorial etiology of tooth wear), but also a lack of timely intervention. A clinical trial testing a fully adhesive approach for patients affected by severe dental erosion is underway at the School of Dental Medicine of the University of Geneva. All the patients are systematically and exclusively treated with adhesive techniques, using onlays in the posterior region and a combination of facially bonded porcelain restorations and indirect palatal resin composite restorations in the anterior maxillary region. To achieve maximum preservation of tooth structure and predict the most esthetic and functional outcome, an innovative concept has been developed: the threestep technique. Three laboratory steps are alternated with three clinical steps, allowing the clinician and the dental technician to constantly interact during the planning and execution of a full-mouth adhesive rehabilitation. In this article, the third and last step of the three-step technique has been described in detail.

The ultimate goal when closing dental diastemas is to establish an adequate interproximal contact, and to achieve an esthetic emergence profile of the respective teeth, with the interdental papilla filling the space underneath the contact area. However, the use of wedges for temporary tooth separation in order to compensate for the thickness of an interdental matrix usually compromises the emergence profile of the resin composite restorations. A black triangle underneath the interdental contact is the consequence. Still, to achieve sufficiently strong contact points, some type of tooth separation has to be done. A technique, where the matrix is shaped to provide an esthetic emergence profile, and a flowable resin composite is used as an interdental wedging material fulfills all the necessary requirements.

Adhesive dentistry has changed the face of traditional dentistry and has the potential to improve esthetics and reduce tooth preparation. However, the materials and techniques used in adhesive dentistry are generally more technique sensitive than those used in traditional dentistry. It is, therefore, important that strict guidelines and protocols are followed to ensure long-term success. Clinicians must be able to determine where adhesive techniques and materials can be used and where traditional, biomechanically sound techniques and materials should be used. There appears to be an increasing trend of young to middle-aged patients presenting with advanced generalized tooth surface loss. These dentitions are conducive to treatment that combines traditional and adhesive materials and techniques. This article discusses guidelines for treatment of these dentitions and outlines the clinical treatment involved in the full-mouth rehabilitation of a worn dentition using a combination of all-ceramic crowns, porcelain and gold onlays, and porcelain veneers.