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Esthetic Smile Design


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A Multidisciplinary Approach to Diastema Closures

Published in: Education

Esthetic Smile Design

  1. 1. A Multidisciplinary Approach to Diastema Closures Andi-Jean Miro, DDS Jill Varriale, DMD John R. Calamia, DMD
  2. 2. Abstract Dental students and practitioners alike should develop treatment strategies focused on providing patients with functional, physiologic, and esthetic restorations. Although this is the foundation for proper treatment, the aspect of esthetics is frequently not considered a high priority. As dental standards rise, greater emphasis is being placed upon esthetics along with functionality. Esthetics can be considered the difference between good dental care and dental excellence. The modern dentist must navigate between various types of restorative options, smile guidelines, and patient preferences to meet patient expectations and achieve exceptional esthetic results.
  3. 3. The Setup In the following case, a comprehensive treatment plan was created to address the chief concerns of the patient, a first-year dental student, who was seen for a restorative consultation by the Undergraduate Honors in Aesthetic Dentistry Program at the NYU College of Dentistry (NYUCD). Andi-Jean Miro, DDS, was an AACD APEX Scholarship winner. The multidisciplinary treatment plan guided the team to the desired esthetic results with a combination of dental modalities including orthodontics, implant therapy, and restorative treatment. By using multiple benchmarks—such as the smile evaluation forms and revisions of provisionals—to gauge patient preferences, the clinicians were ultimately able to achieve an esthetic result that exceeded the patient’s expectations.
  4. 4. Smile evaluation form, page 1. The smile evaluation form was used as an adjunct to radiographs, photographs, and study casts to determine possible treatment plans to address the patient’s chief complaint.
  5. 5. Smile evaluation form, page 2.
  6. 6. Initial full-face image. Initial profile (right and left).
  7. 7. Initial smile, non-retracted.
  8. 8. Initial retracted views.
  9. 9. Patient’s initial smile evaluation form.
  10. 10. Occlusal analysis.
  11. 11. Lateral cephalometric and panoramic imaging, pre-orthodontics.
  12. 12. Phase One of orthodontics.
  13. 13. Phase Two of orthodontics.
  14. 14. Post-orthodontics, full face.
  15. 15. Post-orthodontics smile, non-retracted.
  16. 16. Post-orthodontics, retracted. This case emphasizes the importance of communication and collaboration between the orthodontist and restorative dentist.
  17. 17. Lateral cephalometric and panoramic imaging, post-orthodontics.
  18. 18. New smile evaluation form.
  19. 19. Diagnostic wax-up. Matrixes. It was paramount to the patient that the preparations be as minimally invasive as possible.
  20. 20. Pre-orthodontic space, post-orthodontic space, post-implant placement.
  21. 21. Preparations. Provisionals.
  22. 22. Restorations prior to insertion. While every practitioner may plan a case in a different way, it is important to keep the esthetic outcome at the forefront of the treatment plan.
  23. 23. Postoperative full-face image.
  24. 24. Postoperative smile, portrait image.
  25. 25. Postoperative portrait. The occlusion was adjusted accordingly. The restorations were polished and the incisal edges were recontoured slightly.
  26. 26. Dr. Andi-Jean Miro was in the Undergraduate Honors in Aesthetic Dentistry Program, New York University College of Dentistry (NYUCD). She is an instructor in NYUCD’s Department of Cariology and Comprehensive Care, and is currently in private practice in New York City. She can be contacted at Dr. Varriale is an orthodontist in Astoria, Queens, New York. Dr. Calamia is a professor in NYUCD’s Department of Cariology and Comprehensive Care. He maintains a private practice in New York City. Disclosure: The authors did not report any disclosures.
  27. 27. To receive the quarterly, peer-reviewed Journal of Cosmetic Dentistry, available to members only, enroll as an AACD member at