Addressing Compromised Smile Esthetics

We have reviewed the individual components of an ideal smile. However, it is important to note, that it is rare that an individual would have all those components prior to intervention. Comprehensive assessment of the patient’s current conditions and the deviations from the ideal is the initial step in creating a multidisciplinary treatment plan to address esthetic concerns. Further, an in-depth understanding of individualized patient needs, and desires is necessary to allow for development of a patient-centered and interdisciplinary treatment plan to address patient concerns.

Patient complaints limited to tooth shape and/or shade can generally be addressed with bleaching and/or restorative therapies. Many other complaints can have more complex underlying etiologies and require a more robust evaluation to determine the best ways to address those concerns. For example, short clinical tooth crowns may be associated with tooth fracture or wear, gingival overgrowth, or altered passive eruption. Thorough investigation of incisal display and lip position at rest and in full smile is necessary to allow to determine if orthognathic, orthodontic, restorative, or periodontal surgical interventions, or a combination of these, would be required.^2,74 In cases were the patient presents with little to no incisor display at rest with a normal lip line during full smile, this is generally associated with limited crown height incisally and the crowns may be extended using restorative techniques. Conversely, if the short clinical crowns are associated with excessive gingival display and normal incisor display at rest, the patient will likely require resective surgical intervention to perform a gingivectomy or a crown-lengthening procedure, depending upon the classification of altered passive eruption. Two common esthetic concerns, the methods to determine the proper diagnosis, the interventions to address these concerns are discussed here.