A SMILE WITH BALANCE

Ultimate Styles Dental Laboratory12 Mauchly Unit M

Irvine, CA 92618, USAE-mail: nao@ultimate-dl.com

Naoki Hayashi, RDT

Case 1 Dentist: Dr Norman F. Huefner

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Case 2 Dentist: Dr Kurt R. Schneider

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Case 3 Dentist: Dr Chris C. Liu

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Fig 4 Provisional restorations werefabricated based on the diagnosticwaxup. With the patient now able tovisualize the restorations, it was pos-sible to discuss the shape and posi-tion of the final restorations in detail.

Fig 5 Final restorations were fabri-cated after careful evaluation of theprovisionals with input from the pa-tient. The line angle of the central in-cisors was made more prominent, andthe lateral incisors were positionedmore facially than the provisionalrestorations.

Fig 3 Preparation. A proper amountof reduction and placement of mar-gin line was determined. Space be-tween the mandibular central incisorswas to be restored with compositeresin.

Fig 1 Preoperative view of patient’sexisting restorations.

Fig 2 Diagnostic waxup.

A SMILE WITH BALANCEIn esthetic restorative treatment of the anterior re-gion, the appearance of a restoration is as impor-tant as its function. Evaluating the appearance isbest done at a normal speaking distance from thepatient. Remember that the evaluator’s opinion isas important as the patient’s esthetic preference, asit often can change the patient’s perception.

Esthetic restorations should be in balance withvarious facial expressions. Ideal, well-balancedrestorations are not distinguishable from the natu-ral dentition. A naturally balanced restoration issuch an important goal for each patient. Properlyincluded irregularities sometimes add balance. Fa-cial architecture, sex, and age, as well as skin, eye,and hair color, are other important determinant fac-tors for well-balanced restorations.

CASE 1The treatment goal of this case was to improve theesthetics of existing restorations. Length, long axisof teeth, and incisal arch line were out of balancewith the patient’s face. The patient was also nothappy with the unnaturally white shade of therestorations.

Since the patient’s esthetic demand was so high,because her job involved being in front of people,a good amount of discussion took place amongthe dental ceramist, dentist, and patient to ensurea common goal. It was made clear that the finalrestoration would be properly balanced in color,shape, position, and function with the patient’sface.

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CASE 2This patient’s maxillary central incisors were frac-tured at the incisal third in an accident. The patientwanted these teeth restored exactly the way theyappeared previously. It was determined upon re-view of photographs from before the accident that

the patient’s original teeth were a little too long.After careful discussion with the patient, it was de-cided to shorten the central incisors according tothe patient’s facial architecture and smile line.Alignment of the restorations was also changed tobalance them with the flared lateral incisors.

Fig 7 The master cast reproducedthe abutments clearly and accurately.Porcelain laminate veneer restorationwas indicated. The cervical marginwas beveled since the shade of theabutment matched the intendedshade of the restoration.

Fig 8 Completed restoration. All de-terminant factors were taken intoconsideration. The restorations weretried in the mouth for final evalua-tion.

Fig 6 Preoperative fractured centralincisors.

CASE 3Goals of this case were to improve color and shapeand then close the diastema between the central in-cisors. Six anterior teeth were included in the restora-tion to be balanced with the facial architecture.

Fig 10 At the central incisors, thedistance from the mesial line angle ofthe abutment to that of the restora-tion was 2 mm, so a mesial shift ofthe distal line angle by 2 mm wasnecessary to maintain the toothwidth. The same modification was re-quired for the other restorations. Themesial line angle of the lateral in-cisors therefore needed to be over-lapped by the central incisors, butthe restoration managed to concealthis overlap.

Fig 11 Margin placement of lateralincisor veneers at the mesial aspect.The width of the central incisors canbe well-controlled by this manipula-tion.

Fig 12 Completed restorations.

Fig 9 Preparation. Space betweenthe maxillary central incisors was 4.5mm. Restorations would be designedto balance the six anterior teeth inaddition to filling the space.

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