In yesterday’s post I looked at some of the esthetic decision points in anterior tooth form and incisal embrasures. The consensus is that esthetic design is about what we and our patient find pleasing, not about specific rules related to embrasure form. On the other hand incisal embrasures serve a very critical functional role. When we violate this functional space in order to alter esthetics the consequences can be broken composite or porcelain.
I had a request to write a post about the relationship between anterior tooth form and incisal enbrasure size and shape and a patient’s gender. I personally associate more rounded open incisal embrasures as being feminine, and smaller more defined embrasure form as being masculine. Personal preference aside I decided to do some research before writing this piece. There are a large number of articles that discuss customizing smile design based on a patient’s age and gender, even their personality or face shape.
Once we have planned incisal edge or gingival position changes there can be a variety of next steps. We may want a way to show the patient the impact of the proposed esthetic changes directly in their mouths. One of the hesitations I experience with my patients when we discuss major esthetic changes is the unknown. I can tell you from personal experience when I was embarking on my own reconstruction, looking at a wax-up, even a perfect one, doesn’t transfer to what this will look like in my mouth. This simple, quick technique is a way to dispel all of the uncertainty and invest the patient in the outcome. Another next step might be the gingival surgery if the patient is ready to go. Whether you are doing the procedure yourself or sending it to a member of your interdisciplinary team, a surgical template is a great communication tool. The snap on trial smile doubles as a surgical template and I use it during the procedure to mark the tissue to remove. Lastly, many of my patients ask to take this simple piece of composite home to show their friends and family members. We simply place it in a retainer case, and off they go.
The dialogue about whether or not dentists should be treating patients with cosmetic BOTOX and fillers has been going on now for years. I have been peripheral to it, and have never really had a strong opinion either way. The number of states that have weighed in on the side of “yes” is increasing year after year, and yet the debate continues. This last weekend I attended a continuing education program and one of the presentations was on cosmetic BOTOX and fillers. To be honest the thirty minute presentation didn’t inspire me to want to be able to offer cosmetic BOTOX and fillers as a service in my practice. The next day I had the opportunity to closely observe two live patient demonstrations. The patients had very specific attributes of their appearance they were interested in changing.