Smile Analysis considering the face, smile line, tooth proportion, position and symmetry.

This pretty young lady from Ireland had only one upper front tooth. The upper lateral incisors had root canal therapy and posts placed. The laterals were then prepared for a dental bridge but more tooth reduction was taken from the mesial. The mesial of both canine teeth were reduced so that the laterals could be “distalized.” The central incisor tooth was extracted and a bone graft was placed. A temporary lab-processed bridge is shown in this photo.

This patient came from Ireland and stayed from Monday to Friday of one week. Treatment was performed in only four hours on one day with the help of an Endodontist, Oral Surgeon, Joseph Tuil Dental Lab and a Cosmetic Dentist.

A second lab-processed temporary bridge, reinforced with Ribbond, was placed before the patient’s departure. She will return from Ireland in three months for fabrication and insertion of the final porcelain bridge. This second visit will also occur during one week.

Lip Line Analysis. This is used to study the appearance of the face and teeth while smiling and speaking. It is aesthetically pleasing to see symmetry in smile line gum contours and teeth proportion and color.

A broken dental crown fracture in the upper anterior present a cosmetic challenge with a high smile lip line. Tooth extraction may be the best aesthetic choice if crown lengthening gum surgery is needed. This is because gum surgery in the visibile upper anterior will dramatically alter the appearance of the face and smile after the smile line gum contours change. This will also alter the front teeth proportions and symmetry.

If attempted, crown lengthening should focus on obtaining tooth stucture from the palatal to compensate for limited labial gingival reduction. Failure will usually occur labially.

Dental emergency – a front tooth crown fell out. This dental crown appears to have been cemented with lots of excess dental cement with the hope of providing retention. It won’t work. The porcelain crown margin appears to end on the post and core, not solid tooth structure. This also won’t work.
The high smile lip line prevents crown lengthening periodontal gum surgery because it will change the front teeth symmetry and proportion. The patient was informed that tooth extraction, then a dental implant or fixed teeth bridge, was ideal treatment. The dental cap was recemented at her request after verbal and signed informed consent that it could easily come out again and be swallowed – or aspirated.

Consideraion of the Smile Lip Line, Tooth Symmetry and Proportion in placement of a porcelain crown – dental cap – on an upper peg shaped lateral incisor tooth #10. Root canal therapy was also performed. Before and after pictures are shown.

Smile line contour consideration when repairing a dental bridge. This patient only wanted his current teeth bridge to be repaired. Photo 1) The dental bridge is fit over the dental bonding repair. Photo 2) The teeth bridge was cemented with dental resin cement. The mesial wing was also bonded to the distal of the lateral. Photo 3) The gingivectomy was chosen over a flap because the patient had a low lip line and so the development of a pseudopocket with a flap was avoided. The red indicates where the gum line could have been. Photo 4) The final result. The patient is informed of the need for bridge replacement when finances allow. Photo #3 of 3.