A Guide to Accreditation Criteria Contemporary Concepts in Smile Design Peers en een ee en ‘ Perec iM of Cosmetic Dentistry/ American Academy LN of Cosmetic Dentistry’ i ekChapter 1 - Global Esthetics #8 assessment of dental esthetics begins, quite simply, with the smile A the images we are so intently evaluating are of beautiful and healthy then the frame that encircles these players on the stage are the soft sssses ofthe supporting structures, the lips, and their orientation in the face. wlesthetics focuses on these criteria that are observed in unsetracted smiles; Sow the smile orients to the face. Understanding the parameters ofthis global ‘atsix is critical starting point fora smile that harmonize withthe patient, both physcilly end psychologically. These postions and contours of teeth do not occur “by sccident’s rather, they are affected by the unique functional parameters of Ss patient. Violation of these criteria results in an unbalanced appearance thet afiéct the patien’s esthetics and functional comfort. Criteria that constitute slobal esthetic parameters are the smile line, the midline, the incisal edge position, the incisal plane, and the buccal corridor. SMILE LINE The smile Tine (Fig 1) refers to an ‘veginary lin thats traced along the Sncisal edges of the maxillary anterior ‘seeth and should mimic the curvature of the superior border of the lower Bp while smiling, Consideration should be given to any significant Sp asymmetry or extreme curvature ‘of the lower lip’ A second criterion the smile line illustrates that the centrals are preferably slightly Jooger (or at the very least not any shorter) than the cuspids along the Sscisal plane. The importance of this srierion can be observed when the opens ae Apa si. 197 oe 5. Tan er Fee othe os brea ies suce te ep - SD. 6, ase 5. er ee Sea nal ts. Pst Ds 157 D786 7. Bnd Glo Dar om Pee sey fl eel etd et cls Ee esr De 201200245 385-8 70-4020 200511 pub 202 4g 8. ery, Sc yen a cpt Comper art ce moa worwancd.com EiChapter 4 - Pink Esthetics PERIODONTAL HEALTH Our quest to study hetics relates to all elements of smi - bsolute best health possible, This inci he periodontal architecture. There a prosthetic design that does not suppor periodontal health, The gingivae should be ippled, and firm, and should exhibit ‘@ matte surface. The papillae should be pointed and should gingival embrasures right up to the ct area (Fig 27). This will help to prevent open and black triangles. health must be established prior to final restorations and, if at all possible, commencement of restorative treatment. Figure 27- Contours of the restorations must support optimal periodontal health, onder to maintain gingival health, special care must De Paid to all phases of treatment, from preparation and impression-taking to temporization. The provisionals must display excellence in terms of fit, marginal adaptation, emergence profik Properly developed occlusion in centric and excursive movements, singival contour, incisal contour, and a OVATE PONTIC In fixed partials, ovate pontics are the preferred design of the relationship of the intaglio surface of the suspended restoration to the edentulous ridge. This facilitates hygiene maintenance due to the bullet-shaped tissue surface, Ovate pontics enhance esthetics by making the prosthesis mimic the eruption of a natural tooth fom its surrounding. gingivae (Fig 28). Ridge augmentation procedures often are required prior to Pontic site (Vigs 29-31). A common error observed in deficient Ponti sess the use fridge lap pontic. A ridgelap pontic fails Figure 28 - An ovate pontie ‘design presents the to simulate the presence of a natural tooth due to the inadequate illusion thatthe missing tooth fsactealy erupting aration of the “socket” Presence of fcil-supporting periodontal architecture from the tissue Figure 29 - Preoperative - A ridge lap Figure 30- Ovate pontic design allows Figure 31 - Com Pontic design with falling periodontal for tissue development. challenges t health miss Bi AYb:OUP eee eee eee eee eee GINGIVAL CONTOUR, SHAPE & POSITION The gingival architecture should be appropriate in all views and in ith smile des ingival height position or level) of the centrals The cervical should be symmetrical. It atch that of the cuspids acceptable forthe laterals to Figure 32 - Equal gingival zeniths from cuspid to cuspid are an acceptable display the same gingival level relationship. (Fig32) Figure 33 - An ideal gingival architecture positions the gingival zeniths of the laterals approximately 1 mm below a line connecting the centrals and the cuspids. However, the resulting ay be too uniform i is prefera ble to exhibit a rise and fallin the soft tissue by having the gingival contour over the laterals locate toward the incisal compared to the tissue level on the centrals and cuspids ( The least desirable gingival placement over the laterals is for it to bs Figure 34 - The least desirable relationship is to have the gingival zeniths of the _apical to that of the centrals and laterals above the line connecting the centrals and the cuspids, or cuspids (Fig 34). a —————$—$—Chapter 4 - Pink Esthetics If deviations from architecture are ide gival recontouring, reshaping andlor aug! considered a symme rh Figure 35 - The position of the gingival zenith gives a visual sense of convergence of the anterior teeth. circular shay axillary should gival shape that cal. The gingival zenith represents the height of contour of the p for each tooth. Th ust distal of the cen ‘gingival zenith for the centrals and cuspids ; and for the laterals it is usually in the tooth due to the concavity frequently observed with the mesial nice contours (Fig 35). These prescribed gingival contours aid in the convergence of the mesial axial inclination of the anterior teeth.’ REFERENCES 2. Wek 9, Seaman en Me 2 3. ch. Sie iChapter 5 — Special Considerations FUNCTION & OCCLUSION As we have learned from the ancient Greeks, esthetics can be no more than a mirror of the relative health of the functioning system. The visual forensic signs of occlusal disease can be universally and readily identified. To make any attempt to alter the surfaces of teeth without first considering functional health can only lead to an unpredictable result It is beyond, the scope of this resource to explore and recommend the appropriate criteria for healthy functional design; however, it is assumed that protocols within the standard of care will be utilized. ‘The esthetic criteria outlined in this guide, Contemporary Concepts in Smile Design, are intended as an. ideal guideline that may or may not be possible within the special considerations of each case. CHOICE OF MATERIALS ‘There is no single choice of restorative material that is best within the subset af Accreditation case types. These choices in materials will continue to expand as material science evolves. However, the choice of material, from luting cement to the type of porcelain used, must be based upon the specific, justifiable requirements of each case. There needs to be a marriage between the physical properties of the material related to the parameters of strength and esthetics to create an optimal result that replicates nature. The specific indications for material utilization must be documented in the literature to be considered part of an acceptable standard of care under the auspices of Accreditation, RESPONSIBLE ESTHETICS In the pursuit of enhancing patients’ smiles, it is the responsibility of the restorative team to present treatment protocols that prioritize the conservation of tooth structure in achieving the desired results."* The advances made with current materials and techniques no longer require gross over-reduction of tooth surfaces that results in irreversible damage to the patients teeth Iatrogenic damage is the disfigurement or injury to adjacent teeth, or the aggressive and careless preparation of teeth. As our patients’ advocates in their care itis our mission to restore their health and function, from the existing state of disease and d agement of our patients d is the responsibility ofthe restorative dentist to consider all disciplines of dental care nage. Comprehensive tal care may not be entirely restorative in nature, It in our recommendations to patients, As the “quarterback” of the interdisciplinary team, the restorative dentist must be able to recommend solutions for dental treatment that are in each patient’s best interests. This may include orthodontics or periodontal architecture enhancements prior fo restorative treatment.