Principles of cosmetic dentistry in orthodontics: Part 1. Shape and proportionality of anterior teeth

Abstract

In the past decade, there has been a remarkable upswing in interdisciplinary collaboration between dentists, orthodontists, and periodontists in smile enhancement, and now an entire field of “cosmetic periodontics” has evolved in collaboration with cosmetic dentistry. Contemporary orthodontic smile analysis is generally defined in terms of (1) vertical placement of the anterior teeth to the upper lip at rest and on smile (adequate incisor display but not too gummy), (2) transverse smile dimension (buccal corridors), (3) smile arc characteristics, and (4) the vertical relationship of gingival margins to each other. Through the interaction with these other disciplines and the knowledge gained, we have expanded our diagnosis of the smile to further refine the finishing of anterior esthetics for our patients. As our interaction with cosmetic dentistry has increased, we have become very aware of what standards guide the dentist who strives for an excellent smile. Through cosmetic bonding and laminate veneers, the dentist can control tooth shape by adding or taking away from the tooth, crown, or laminate. As orthodontists, we have generally limited our toothreshaping efforts to incisal edge “dressing.” The purpose of this article is to examine some cosmetic ideas and present new ways in which we can improve the smiles of our patients. In Part 1, I will define and illustrate how these principles are applied to improve the cosmetics of orthodontic patients. In Part 2, my coauthor and I will review the new laser technology available for reshaping soft tissues, and, in Part 3, we will discuss the clinical use of those lasers.