~IVe - Goldstein Garber & Salama...tions in adult orthodontic treatment. Curr Opin Cosmet Dent Review.67-74, 1993. 3. Levitt HL. Orthodontic treatment for the adult periodontal patient.

.

In

for rapid smile makeovers, the inadequate management of the total oralfacial esthetic pattern and lip drape can be problematic. Compositebonding or veneering also harbors the potential risks of overaggressivetooth preparation, or the overbuilding of adjacent teeth to correct pooralignment. In addition, there is a significant long-term maintenanceconcern with bonding and veneering restorations because they havelimited life spans and will need to be periodically refabricated.10.11

T oday's "cosmeti-

cally aware" adult

patients are seek-ing out advice and opin-ions about oral/facialesthetics from dental

professionals. Recently,many articles have beenpublished about the"quick fixes" available inesthetic therapy. With theadvent of next-generation

restorative materials and the ability to predictably bond to remainingtooth structures, some authors advocate composite bonding or veneeringof misaligned teeth, rather than orthodontic therapy. Composite bondingor veneering are certainly viable solutions in some cases and give patientsthe option of a shorter treatment time; in other cases, they are poor choic-es when a patient desires a more conservative option with a goodlong-term prognosis, less maintenance, and improved facial form.

Today, dental professionals worldwide can offer their patients signi-ficantly improved dental esthetics with modern restorative materials.However, simply changing the color and shape of the dentition and usingceramics to better reflect light because of poor tooth angulation limits theability to adequately address overall facial dimensions. When a dentistreviews these types of esthetic issues with an adult patient, an overall

TREATMENT USING RESTORATIVE MATERIALS

Although restorative materials may offer patients the opportunity

Figures 1 through 3-The

patient insisted upon thebest option to cMnge her

overall ,~mile tI.I' well lISimprove her lower facial

esthetics.

CONTEMPORARY EsTHIJICS AND RESTORATIVE PRACTICE

.

~IVe

Case Study continued

Figures 4 through 8-The patient exhibited overall class

[[ bimaxillary protrnsion with moderate crowding in both

the upper and lower jaws. Orthodontic therapy was the

superior option and the least expensive choice to addressthe patient's esthetic andfunctional complaints.

facial esthetic treatment plan withall appropriate options and possi-ble limitations also needs to be

presented.

In many cases, orthodontictreatment gives the patient a bet-ter, more conservative option at areduced cost, and with a greaterimpact on overall facial harmonyand esthetics. With today's tech-nology available in orthodon-tics'Z.3.4 the ability to treat patientswith esthetic appliances, lighterwires, and in shorter treatmenttimes is also available. In manyinstances, limited adult orthodon-tic therapy can be completed infewer than 12 months and can becombined with limited restorativedentistry and bleaching.

CASE REPORTIn early 1997, a patient pre-

sented to our office with protrud-ing teeth and an unattractive smile

Make Strong SmilesWith RibbondThe one reinforcement #1 in toughness,that does it all. manageability

p . d t I I. t .and results..erlo on a sp In Ing.Endodontic posts and cores

M t I f b ' d 1mm , " ,.e a- ree rl ges c'

.Replacement of 2mmavulsed teeth "", '.,,- \ ,

.Trauma stabilization 3mm 1;;; , ' (~ \ ~., , ,

.Orthodontic retainers 0;, ~

Periodontal splints

TREATMENT USING

ORTHOOONTICS

Unlike restorative materials,

orthodontics will not only create a

straighter and more attractive

smile, but can also improve lip

form and lower facial profile. The

potential to orthodontically

expand arch form and, thereby,

the smile to the comers of the lip

and fill the buccal vestibule is

important to today's esthetic treat-

ment planning. This can more ide-

ally be established with appropri-

ate orthodontic tooth reposition-

ing, while restorative materials

alone accomplish this to a lesser

degree.Orthodontic treatment can

avoid "aggressive dentistry;'

including tooth preparation, possi-

ble endodontic therapy, and sig-

nificant restorative dentistry. It is

also a less expensive long-term

maintenance proposition2 because

it avoids the necessity of refabri-

cating failing restorations. The

unaltered natural dentition has an

enhanced life span, unlike restora-

tive materials that, over time, may

risk chipping, staining, leaking, or

decaying.3

2mm , ,,- \

3-~-~ l;~ .","'(~~

4mm

New, Ribbond- THM

.THM- ThinnerHigher Modulus

.Only 0. 18mm thick. That'shalf the thickness of theOriginal Ribbond.

.Even better manageability

.No memory

.Won't unravelCircle 76 on Reader Service Card

.Strong

.Durable.Easy.Proven

Case Study continued

Figures 9 through Il-The patient, toward the end of her orthiidontic tlzerapy and during the detailing stage. Note the improved occlusal cla.~s I molar and cuspid relationships.

(Figures 1 through 3). The patientinsisted upon the best option tochange her overall smile as well asimprove her lower facial esthetics.Although restorative materialscould have positively altered indi-vidual tooth esthetics for thispatient, they could not haveaddressed her overall lower facialcontour and protruding dentition,and actually may have exacerbat-ed these problems. Figures 4through 8 show the patient's over-all class I bimaxillary protrusionwith moderate crowding in boththe upper and lower jaws.

In this case, only orthodontictherapy could reduce this patient's

protrusion, significantly improveher lower facial drape and lip sup-port, and straighten her dentition.She could also avoid significantrestorative dentistry, which wouldlimit costs.

, II II 1,L.Iexqulsue VlTillil.!f

grealer slrenglh 2

less bacleria 3

ACtU,1 P'"ent of D, H,roldB."mprten. Phll'delphl'. P,

Labo"to'Y F.b,ia"on byAm"ecd,", Dental Ce"mits

Both l,te"ls wece ..nocedwith Captek trowns -perle,"y matching the n,,",,1tentra" ,nd '"'pids

The patient was treated withesthetic porcelain brackets(Allure, GAC International,Inc.) in the upper arch and stan-dard stainless steel brackets in thelower arch, so her orthodontictherapy was fairly inconspicuous.Because of the patient's protru-sion and the need for maximumanchorage to retract the anteriorteeth, the four first bicuspids wereextracted as part of orthodontictherapy. This allowed for an

-,~

~.

eslheHcs wilhoul com"rom1se

, Shoher, I DDS, Dental Product Repart, ] 997

,. Jun..vee. N,. Nad1anson. D" G;ordano, R.. A R..ea.W Repart an Captek

, Goodson, M"et ai,t Dent R.. 1999; 78 (specia/ issue)Ab IJ8

~

o 0

921-2227

www.captek.com

Circle 36 on Reader Service Card

CONTEMPORARY ESTHETiCS ANO RESTORATiVE PRACTICE

Case Study continued

Figures 12 and 13-The expanded arch form of the

upper and lower arches helped to create a wider smile,fill the buccal vestibules, and enhance the overall

esthetic result.

improved lower facial drape andprovided her with lip competency.The maxillary and mandibularteeth were aligned and thenretracted within 16 months.Figures 9 through II show thepatient toward the end of herorthodontic therapy and duringthe detailing stage. Note theimproved occlusal class J molarand cuspid relationships. Figures12 and 13 display the expandedarch form of the upper and lowerarches that helped to create awider smile, fill the buccalvestibules, and enhance the over-all esthetic result.

Figures 14 through 16 showthe results after debonding andpolishing. Note the alignment ofthe dentition and the esthetic andfunctional results. Figures 17 and18 display the final facial viewsafter orthodontics. Note theimproved esthetics of the lowerface; the lack of protrusion al-lowed for a better lower facialdrape of the lips and supportingstructures. Broadening the archallowed for a wider smile to fill thebuccal vestibules and avoided any

"negative spaces." Figures 19 and20 show the pre- and postoperativesmile views; the postoperativeview shows the newly developeddentition alignment and improvedesthetics. The patient followedorthodontics with at-home bleach-ing to maximize the effect andbrightness of her new smile.

FEBRUARY 2001 CONTEMPORARY ESTHETiCS ANO RESTORATIVE PRACTICE

Case Study continued

Figures 14 through 16-Results after dehonding a/Id polishing. Note the uliglllnent (!{ the dentition and the esthetic uJul.functionul results.

Figures 17 and 18-Thefinalfacialviews after orthodontic.~. Note the

improved esthetics (!f the lowerface; the lack ~fprotrll.~ion allowed

.for a better lower.facial drape of the

lips and ~.upporting .\'fruclure.~.

Compare to Figure 3.

CONCLUSION

A dentist should evaluate and

consider both orthodontic solu-

tions and restorative options for

adult patients seeking esthetic

improvements. With the advent of

adhesive restorative materials, the

dental profession may be avoiding

orthodontics for their patients too

often. Dentists should first consid-

er cost, facial esthetics, mainte-

CONTEMPORARY ESTHETiCS ANO RESTORATiVE PRACTICE

Case Study continued

Figures ]9 and 20--Pre- and posloperalive smile

views; Ihe posloperalive view shows Ihe newly devel-oped denlilion, alignmenl, and improved eslhelic.l',

nance, long-term prognosis, time,function, and health before sug-gesting treatment options to

patients. .

REFERENCES1. Salama MA, Salama H. An interdiscipli-

nary approach to the management of theadult mutilated dentition: a case report.Compend Contin Educ Dent 13(4)-328-340. 1992.

2 Salama MA, Same 0. Esthetic considera-tions in adult orthodontic treatment. CurrOpin Cosmet Dent Review.67-74, 1993.

3. Levitt HL. Orthodontic treatment for theadult periodontal patient. J Can DentAssoc 57(10)-787-789, 1991.

4. Musich DR. Assessment and descriptionof the treatment needs of adult patientsfor orthodontic therapy: characteristicsof the solo provider group (I). Int J AdultOrthodon Orthognath Surg 1 ( 1 ):55-67,1986.

5. Wise RJ, Nevins M. Anterior tooth siteanalysis (Bolton Index): how to deter-mine anterior diastema closure. Int JPeriodontics Restorative Dent 8(6)-8-23,1988.

6. Kokich VG. Shapiro PA. Lower incisorextraction in orthodontic treatment. Fourclinical reports. Angle Orthod

54(2):139-153.1984.7. Marks MH, Rosen PS. Adult orthodontics.

periodontic and cosmetic enhancements.Compend Contin Educ Dent 12(8):584-

588,1991.8. Ingber JS: Forced eruption: alteration of

soft tissue cosmetic deformities. Int JPeriodontics Restorative Dent 9(6)-416-

425,1989.9. Goldstein MC. Bums MH, Yurfest p.

Esthetic orthodontic appliances for theadult. Dent Clin North Am 33(2):183-193. 1989.

10. Goldstein RE, Belinfante L, Nahai F.Change Your Smile, ed 3. Chicago. IL.Quintessence Publishing Co., 1997.

11. Goldstein RE. Esthetics in Dentistry:Individual Teeth, Missing Teeth, ed 2.Ontario, Canada, BC Decker, Inc.. 1998.

Protection. Convenience. Savings.

Your patients expect sate dental treatment that won't expose them Uni-Covers. Sleeves. Tray Covers. Patient Drapes. and Hazard Bags.

to cross cantamination. Your staff expects the same assurances. at the best pnce.

And. your equipment recuires simiiar protection trom airborne debns New VIGILANCE I-WEAR are high qualny .lightweight. and

and aIr abraSIon particles. comtortable protective eyewear tor you. your staff. and your

Boswortih offers product technologies that allow for appropnate patients AvaIlable at a traction of the cost af other brands.

asepsis procedures to be accomplished easily and reliably in VIGILANCE enzyme detergent and GJ.C. oxygenating formula tray

less time cleaner easily Scrub away blood. debns. and matenals for speedy

cleanup Compare performance and saveSIMPLASTlC Is the only barrier protection system with 5 dffferent

options and a dispensing unit to accommodate your entire office. Make it safe Make it simple. Make it affordable. Make it Bosworth

r'o\~~

j.,'0 ~/~ ("--""".,.1

"VJIGllANCE~ DE1ERGENT FlfXO~ SALIVA EJECTORS8UYJBOmES llfGEM , BOm""', 8UY5BAGSllfC'1VE , BAGf11fE

GTC- WAY ClEANER VIGlLANCE- "WEAR8UY2BOI1lESllfCElYflBOrIlEFllfE BUY4PAiR llfCEIVEIPAIRFIlfE

S1MPLASnC-BUY 2 ROllS .., COONT ...",OVfIISI1fC"Vf A FII£' """""',,"' I /1OUJQJCO(M"",",O\IE/IS

,..-,-. ""... ".. -""' "10,114/.,.,,",,,-..""' I0 3/I/DI4/3G/O' '--I0,",by S/31/D' 0,"

Circle 20 on Reader Service Card

7227 North Homlin Avenue. Skokie, Illinois 60076 USA

800.323.4352 .Fox: 847.679.2080 .Emoil. HJ8inlo@bosworth.(om .bosworth.(om