uia estetica

Copyright

byN

otfor

Qu

intessence

Not for Publication

CLINICAL APPLICATION

50THE EUROPEAN JOURNAL OF ESTHETIC DENTISTRY

VOLUME 6 NUMBER 1 SPRING 2011

Smile Esthetics: a Methodology

for Success in a Complex Case

Jean-Christophe Paris, DMDPrivate practice, Aix en Provence, France

Stphanie Ortet, DMD Private practice, Aix en Provence, France

Annick Larmy, DMDPrivate practice, Marseille, France

Jean-Louis Brouillet, DMD, DDSPrivate practice, Marseille, France

Andr-Jean Faucher,DMD,DDS Private practice, Marseille, France

Correspondence to: Dr Jean-Christophe Paris

Academie du Sourire, 12, Cours Sextius, Aix en Provence 13100 France

Tel: 00 336 11226371; e-mail: [email protected]

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Abstract

The clinical case presented is the dem-

onstration of a multidisciplinary ap-

proach to a complex treatment. A pre-

cise methodology is important to ensure

that the treatment objectives are clear

to all the teams. The aim of the treat-

ment is to restore dentofacial harmony

to a young, 22-year-old, female patient

showing severe attrition of the anterior

teeth. The direct effect of this is an age-

ing of the smile. This type of multidisci-

plinary treatment, which seems compli-

cated at first, is greatly simplified once

time has been spent on the diagnosis

and treatment plan: it thereby becomes

a succession of clinical stages.

(Eur J Esthet Dent 2011;6:5074)



Copyright

byN

otfor

Qu

intessence

Not for Publication




Introduction

The smile can be a snapshot of the soul,

a weapon of seduction, the primary

means of communication, a reflection of

personality so many definitions, which

underline the essential role of the smile

in expression and communication be-

tween human beings.

The direct relationship between the

beauty of the smile and self-esteem

should also be mentioned, an extremely

important notion regarding the quality of

ones socio-professional life.1-3

These reflections affirm that the es-

thetic restoration of the patients smile

is an essential medical act. It can never

be approached with anything less than

a perfectly codified method, which rules

out failure, even if the success is not

complete.

This method consists of a checklist,

which brings together all esthetic and

functional parameters. It clarifies and

facilitates the work of clinicians, so that

they are able to perform complex es-

thetic rehabilitation by following clear,

step-by-step guidelines. A number of

checklists have been described in the

dental literature, and one of the most ac-

complished is that of Mauro Fradeani in

2004.4

The clinical case described hereaf-

ter reflects this approach and method

of diagnosis, which has been called the

Esthetic Guide.

The first step was to a make a deci-

sion regarding the treatment, either par-

tial, by integrating into an existing smile,

or global, by bringing a new harmony to

the smile.

The Decision-Making Table facilitates

this decision.

Materials and methods

The Decision-Making Table

By referring to the Decision-Making Ta-

ble3, it is possible to analyze a smile in

its entirety and approach a case study in

a precise and methodical way.

Using the guiding principles, which

govern smile esthetics, the Decision-

Making Table (Fig 1) is a therapeutic tool

that allows the clinician to reinforce an

esthetic diagnosis and treatment plan.5

Indeed, this evaluation of esthetic crite-

ria is more than just an analysis of the

dental composition. It also includes the

gingival tissues and the final esthetic

restoration in the framework of the smile

and face, taking into account the pa-

tients personality.

Thus, during an esthetic consultation,

this guide quickly brings to light any lo-

calized problems which will be treated

and assimilated into an initially-harmo-

nious smile, or determines if there is a

global problem, which then requires re-

habilitation of the smile.3

This new diagnostic approach will be

illustrated in the following clinical case.

The Esthetic Guide (EG)

When confronted with complex smile re-

habilitation, it is essential to think about

and elaborate a structured case study.

This is why, during the clinical exam,

the use of the Esthetic Guide (Fig 2) al-

lows for the collection of a great deal of

information relating to the patient (face,

smile, occlusion, and dental and gingi-

val composition).6

The Esthetic Guide is a guide to a clini-

cians therapeutic and esthetic decision,

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



depending on the results of the patient

examination.

Radiographic status

The radiographs did not show any endo-

dontic or periodontal conditions.

Photographic status

In esthetics, this collection of perfectly

codified documents is fundamental to

the establishment of the treatment plan,

in the same way as radiographs are for

the endodontist (Figs 3-14).

Fig 2 The Esthetic Guide.

Fig 1 Decision-Making Table.

Decision-Making Table

Balanced smile Disharmonious smile

localized problem global problem

I. FaceI.1 Visual balance between look and smile

II. Smile

II.1 Smile line

too high

too low

irregular

II.2 Esthetic frontal plane

too high

too low

asymmetrical

II.3 Sagittal plane

II.4 Horizontal plane

III. Dental composition

III.1 Dimensions

III.2 Proportions

III.3 Shade

III.4 Shapes

IV. Gingival composition IV.1 Gingival architecture

Integration Rehabilitation

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 3 Frontal view.

Fig 4 Side view.

Fig 5 Full smile.

Fig 7 Right view.

Fig 6 Four-tooth smile.

Fig 8 Left view.

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 11 Right view (canine edge-to-edge).

Fig 9 Frontal view (rest position).

Fig 13 Maxillary occlusal view (mirror).

Fig 12 Left view (canine edge-to-edge).

Fig 10 Frontal view (edge-to-edge bite ).

Fig 14 Mandibular occlusal view (mirror).

Copyright

byN

otfor

Qu

intessence

Not for Publication




Indeed, they enable the collection of

all the information regarding the initial sit-

uation, and constitute an element of ob-

jective comparison following treatment.

They are also a tremendous means of

communication with the patient and the

ceramist, giving precise indications.

Analysis of study models

Study models constitute a three-dimen-

sional reference of the initial situation

(Fig 15). Set in an articulator, they fa-

cilitate the dynamic appraisal of patient

function and make potential problems

visible.

Clinical case

A 22-year-old woman arrived at the of-

fice, showing severe esthetic problems.

Her smile, which she was embarrassed

about, revealed abraded and highly-dis-

colored teeth. The medical questionnaire

indicated that during her adolescence,

she had two serious orthodontic treat-

ments in order to put the two impacted

maxillary canines into their correct place.

Being perfectly aware of the impact of

this kind of imbalance on her personal-

ity, this young patient shared her wish to

find once again a smile in harmony with

her age.

Fig 15 (a to c) The examination of the study models shows a number of functional anomalies:

indeed, the abrasion of the anterior teeth reveals a

parafunction of the bruxism kind and dysfunctional

lateral movements.

a b

c

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



The patients esthetic expectations Taking into account this patients es-

thetic requests was a fundamental

step in the clinical success of her

smile.5 Being attentive to patients and

respecting their wishes enables per-

sonalized treatments, while remaining

within the functional possibilities and

morphophysio logical characteristics of

the patient.6-8

Indeed, a standardized esthetic ap-

proach is simply not possible. It is not

just an impersonal analysis of criteria.

Each patient and each smile is unique,

and the practitioner needs to know how

to create a natural harmony in order

for the beauty to be born again.3 In this

particular case, the patient provided

photographs illustrating the smile she

desired.

Esthetic analysisDetails of the Decision-Making Table for

the present case (Fig 16) follow.

Study of the faceA balance between the intensity of the

look and the vitality of the smile is es-

sential to the harmony of the face. It is

therefore the primary parameter to be

determined (Fig 17).

Study of the smileThe smile line is probably the most im-

portant feature of the smile. It is the posi-

tion of the teeth in relation to the soft tis-

sue: lips and gums. The smile line can be

low, medium, or high.9 In this case, the

smile line is low, the patient reveals only

a little of her teeth (Fig 18a). Because of

excessive abrasion of her incisors, the

esthetic frontal plane is flat and does not

correspond to the patients real age.

Fig 16 Decision-Making Table of the patient. Fig 17 This frontal view of the face demonstrates a significant contrast between this discreet smile

and the dominant look of the teeth, which the patient

is trying to hide.

Copyright

byN

otfor

Qu

intessence

Not for Publication




The maxillary anterior teeth seem to

be too buccal in comparison with the

maxillary lip. The presence of significant

diastema makes unsightly so-called

black holes visible (d13-14 = 1 mm,

d23-24 = 3 mm) (Fig 18b).

Study of the dental composition Measuring the teeth allows the clinician

to appreciate their proportions within the

smile.

Studying the width/length ratios7,10

enables one to reach the following con-

clusions:

the incisors are too short (Fig 18c)

the central incisors are too narrow

and square

the lateral incisors are too wide in

comparison with the central incisors

b

c d

Fig 18 (a to d) The shape of the teeth did not correlate with the patients face, personality, or age.

a

the canines are not sufficiently

present in the smile (Fig 18b).

The excessively dark color of the teeth

contributes to a recessive smile.

Study of the gingival compositionThe dental composition is highlighted

by the harmony of the gums, which

through their healthy state and harmo-

nious architecture reinforce the unity of

the smile.4,6 It is therefore an element

that should be taken into careful consid-

eration. A significant gingival recession

was located at the maxillary left canine;

when probing, the visibility of the probe

testifies to periodontal fragility.

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



The EG revealed asymmetrical gingi-

val contours at the maxillary incisors be-

tween the right and the left side (Fig 18d).

SummaryThanks to the Decision-Making Table,

this patients smile analysis showed the

need for a global rehabilitation, which

required an accurate esthetic study us-

ing the Esthetic Guide.4 The red crosses

symbolize abnormalities, and the blue

represent normality.

Treatment plan

Of course, various treatment options are

available, but it should be remembered

that the best solution for the patient is

always the least invasive. Also it should

always be asked if an irreversible prepa-

ration of the teeth could be avoided by

an orthodontic treatment. When this is

not possible, the golden rule is to show

a preference for composite restorations

over veneers, and veneers over crowns,

etc.

By referring to the results of the es-

thetic analysis, it is essential to take a

multidisciplinary approach to the treat-

ment:

1. OcclusionAnalysis

no history of trauma or previous or-

thodontic traction

behavior: clenching and bruxism

skeletal relationship: class III, skel-

etal open-bite

centric relation: incisal midline dis-

placed 2 mm to the right, stable

centric occlusion

mandibular incisors: normal occlu-

sion relationship

Fig 19 (a and b) The orthodontist carries out a functional set-up to reposition the upper incisor-

canine group; in this way, a simulation of the desired

orthodontic treatment can be obtained.

a

b

maxillary incisors: buccal inclination

increased by 5 degrees (class III

compensation), correct sagittal and

vertical position

anterior guidance: lack of canine

guidance and incisal guidance too

steep.

Conclusion

A behavioral rehabilitation, reinforced

by wearing a relaxing night guard, al-

lows for the correction of bruxism and

crispation parafunctions. The occlusal

analysis will determine the prosthodon-

tic reconstruction criteria:

strict preservation of the maximal

inter-incisal opening (good, stable

Copyright

byN

otfor

Qu

intessence

Not for Publication




posterior bite) and the occlusal verti-

cal dimension

preservation of the bite plane and

the Spee curve

rearrangement of the maxillary an-

terior teeth with bilateral equilibra-

tion of the propulsion, with a view

to achieving an effective cuspidal

guidance (Fig 20).

2. Orthodontics After positioning 13 and 23 on the arch,

these teeth will be moved back in order

to fix them in the best position in relation

to the opposing arch.

However, the class III tendency of this

patient implies a progressive increase in

the initial buccal position of the incisors,

in tandem with the closing of the diaste-

ma. This is why, in accordance with future

prosthetic rehabilitation, it is essential to

find the right compromise between an

excessively pronounced buccal version

and oversized diastema. It is here that

the notion of esthetic corridor is most im-

portant (Fig 21).

b

Fig 20 (a and b) Using this setup, a functional waxup of the palatine surfaces indicates by how much it is possible to extend the free edges while respecting functionality, and to reconstruct a correct anterior

guidance (according to the instructions of the occlusal analysis). Finally, a minimally invasive treatment

was chosen for this patient, with veneers instead of crowns, using orthodontic treatment to recreate the

anterior functions.

a

3. PeriodonticsTaking account of the gingival biotype

of 13 and 23, a gingival thickening (by

means of a subepithelial connective tis-

sue graft) will be necessary beforehand,

as well as a lengthening of the crowns at

the 12-11 level, with the aim of harmoniz-

ing the general situation of the gingival

margins. Finally, gingival palatine thin-

ning will be required in order to free the

incisor cingulums.

4. BleachingThe choice of an ambulatory technique

seemed most appropriate.

5. Prosthetic reconstructionWithin the framework of an esthetic and

harmonious restoration of the smile, por-

celain veneers were the obvious choice

thanks to their optical quality and the re-

spect shown to the tissue during prepa-

rations.

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Previsualization of the smile

There can be some difference between

the patients mental image, the words

used to express this, and how they are

understood. It is therefore essential to

give the patient a material idea of the

treatment, and this is why a previsualiza-

tion of the smile is recommended.11 This

therapeutic strategy makes it possible to

demonstrate the future treatment, and to

assess the proposition in a concrete and

life-sized way prior to preparing the teeth.

It not only clarifies the practitioners

reasoning, but also gives the patient the

possibility to express his/her approval

or reservations in an enlightened man-

ner throughout the various prosthetic

sequences.

Prior to any kind of treatment, and tak-

ing the importance of anomalies into ac-

count, a precise occlusal study is nec-

essary.

Initial conditionsThe occlusodontist and orthodontist

combined their requirements in order to

design a setup, which was both func-

tional and esthetic.

Diagnostic waxupUsing the dental model, a waxup was

made, prefiguring the ideal morphol-

ogy.12 It is the first materialization of the

esthetic project, since it informs the cli-

nician of the esthetic changes possible

in terms of future shapes and propor-

tions, taking account of the phonetic and

Fig 21 (a to c) These pictures show the intraoral orthodontic appliances, the distribution of the di-

astema and the compromise between the function

and esthetics. Such a treatment cannot be finalized

by orthodontic treatment alone.

a b

c

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 22 (a and b) Taking account of the patients wishes, these waxups demonstrate the appearance of a convex and symmetrical esthetic plan, an increase in the length of the teeth, and a reduction in the width

of the lateral incisors, hidden by a mesial inclination in relation to the initial situation.

Fig 23 (a to c) Initial situation.

a

a

c

b

b

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 24 (a to c) Esthetic setting: using the ortho-dontic setup and the functional waxup, the gingi-

val level is redesigned and the buccal surfaces are

remodeled in accordance with the ideal morphol-

ogy and the dimensions determined by the Esthetic

Guide.

b

c

a

occlusal data. In the case of this young

patient, the objective of the treatment

was to give her a powerful smile, by re-

inforcing the dominance of the central

incisors within a more feminine dental

composition (Fig 22).

Esthetic project Computerized previsualization

A virtual elaboration of the treatment de-

sired allows patients to visualize the re-

sult, which is motivating and reassures

them in their choice.13

This computerized approach, rein-

forced with a laboratory procedure (Figs

23 and 24), thereby strengthens com-

munication between the medical team,

the patient, and the laboratory techni-

cian (Fig 25).

Esthetic Project (EP)

Using the esthetic study, all data is col-

lected in order to develop a coherent EP.

Favoring realization in the mouth of

the diagnosis and treatment plan, the

EP constitutes an essential step in the

prosthetic rehabilitation.

Using resin mock-ups fixed to the un-

prepared teeth, the EP allows the patient

and laboratory technician to objectify

the anticipated effect of the future res-

toration.12

It represents a sketchbook, allowing

the practitioner to test the esthetic prop-

osition and validate it with the patient be-

fore any irreversible clinical steps have

been taken, hence its importance. Using

the esthetic and functional waxup, there

are two ways of realizing this project that

follow below.

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 26 (a to d) Direct esthetic project: using a transparent silicone splint moulded on to the corrected dental model, this procedure uses an automolding technique and, as its name suggests, is performed

directly in the mouth.

a b

Fig 25 (a to d) Computer simulation: using this wax previsualization, and thanks to the photographs made to the same scale, this tool facilitates insertion of the modified teeth under the patients lips. The

patient can see in advance the real result of the project.

a

c

b

d

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 26 (a to d) continued.

Fig 27 (a to d) Modifying the shape of the central incisors allows them to play a major role within the framework of the smile. The axis of the lateral incisors in relation to the canines has been modified, thereby

reinforcing the esthetic value of the central incisors.

d

a b

c d

c

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 28 (a to d) Indirect esthetic project: Using this waxup and following the indications given in the esthetic analysis, the laboratory prepares eight fine shells made of stratified composite resin, measuring

0.2 to 0.3 mm. These mock-ups are then transferred to the unprepared teeth.

a

c

b

d

Direct esthetic project Based on a waxup, this project is real-

ized directly in the mouth, following a

classic automolding technique. How-

ever, using a resin whose surface ap-

pearance is relatively crude runs the risk

of disappointing demanding patients

(Figs 26 and 27).

Indirect esthetic projectUsing a more sophisticated material,

which resembles the final ceramic more

closely, the mock-ups offer a more natu-

ral result. The illustration presented to

the patient will therefore be closer to re-

ality (Fig 28).

The final esthetic project on eight

teeth responds perfectly to the expec-

tations voiced by the patient during the

clinical examination (Fig 29).

Preparation of teeth impression stage

This stage is delicate in technical terms,

and demands great meticulousness.

Indeed, over-preparation leads to a

pointless mutilation, which can only be

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 29 (a to d) Note the more feminine cut, softer around the free edges.

c

a

d

b

offset by a thick layer of ceramic, giv-

ing the final restoration an artificial ap-

pearance.14 In the case of under-prep-

aration, it is difficult to correct any poor

positioning.

Reduction keys are therefore a precon-

dition to any preparation. Consequently,

these guides allow the operator to esti-

mate and check reduction volumes, in

order to make homothetic preparations

in the volume pertaining to the final res-

toration, rather than to the initial dental

volume. This allows for maximum con-

servation of tissue14 (Figs 30 and 31).

Contour shapes Preparations without a palatine inva-

sion are carried out. Using the silicone

guide, which allows visualization of the

shape and position desired, reduction

is performed according to the principle

of controlled penetration. Indeed, the

preparation, guided by grooves whose

depth is obtained using a calibrated bur,

must not exceed the contact points on

the proximal surfaces, and finish with a

very fine butt margin at the level of the

incisal edge.

Copyright

byN

otfor

Qu

intessence

Not for Publication




ImpressionSince the preparation limits are most

often supra- or juxta-gingival, making

the impression is not a serious chal-

lenge.16 Taking account of the esthetic

impact in this region, the method used

must be the least traumatic possible,

hence the choice of a double-mix im-

pression technique, used together with

a thin retraction cord.

Temporary veneers using mock-ups

The aim of this procedure is to conserve

the reconstruction criteria established

beforehand during the esthetic project,

and to combine it with the advantages of

elaboration using the indirect method, in

order to easily obtain quality temporary

elements (Figs 3238).

Fig 30 (a and b) The book-page key, sectioned horizontally, allows the entire preparation to be visual-ized from the incisal edge to the neck.15

a b

Fig 31 (a and b) Individual guides allow for production of the quantity of buccal tissue eliminated inside the mouth and on the occlusal surface.

a b

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 32 This method of making a temporary veneer is straight-forward, consisting of adding three elements: the diagnostic

mock-up, prepared during the EP, whose esthetic criteria have

been validated, and the mock-up, combined with a rebasing

material, is held in the correct position by means of a silicone

key. In this case, the choice of a photopolymerizable resin fa-

cilitates time management, since the operator can control the

final polymerization.

Fig 33 (a to d) This key is indispensable, because it creates a partial buccal support in which the masks can be bonded, and a broad palatine support that acts as a general stabilizer and avoids an overflow of

resin in this direction.

a

c

b

d

repositioning keyrebasing resin

mask

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 35 Using an ordinary spatula, the elasticity of the resin allows for easy removal of buccal ex-

cesses.

Fig 36 Potential interproximal excesses are cut out to allow for reinsertion.

c

b

Fig 34 (a to c) The prepared surfaces are coat-ed with a film of glycerine. Rebasing of mock-ups

is performed by injection of resin directly onto the

dental surfaces and in the sandblasted interior of

the models. Controlled application is accomplished

thanks to the repositioning key.

a

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Fig 39 (a and b) In this way, one can obtain replicas, which are true to the future restoration and a new smile, which is then submitted for the patients approval.

Fig 40 Thanks to this method (individual rubber dam), the practitioner is able to resolve problems of

insulation and contamination.

Fig 37 Final photopolymerization. Fig 38 Disinsertion: it is advisable to remove the entire block in such a way as to allow mechanical

locking during its sealing.

ba

This method of converting the masks

into temporary veneers requires the

making of an occlusal repositioning key,

which will guide the reinsertion of the

mock-ups in the correct position at the

rebasing stage.

Transitional restorations are not to be

neglected: by allowing both the patient

and practitioner to validate the EP in

concrete terms,3 they play a major role

in the prefiguration of the definitive res-

toration16,17 (Fig 39).

Copyright

byN

otfor

Qu

intessence

Not for Publication




Fig 43 (a and b) In accordance with the guiding esthetic principles, the smile line fits harmoniously with the curve of the lower lip even if the correction of the dental midline had not orthodontically been possible.

b

a b

Fig 41 (a and b) The diastemata of the upper jaw have been rearranged and significantly reduced.

Fig 42 (a and b) These photographs highlight a feminine and youthful dental composition.

a

a

b

Copyright

byN

otfor

Qu

intessence

Not for Publication

PARIS ET AL



Prosthetic fitting

The eight biscuits are tested. At this

stage, it is possible to analyze any po-

tential corrections to be made, and to

convey these modifications to the lab-

oratory.11 The veneers were made of

feldspathic ceramic at the laboratory in

order to obtain the most esthetic result.

Verification criteria at the clinical-

fitting stage:

accuracy of marginal adaptation

inspection of contact points

adherence to esthetic project: vali-

dation of shape, color, proportions,

transition lines, macro- and micro-

geography, and shape of the incisor

edges.

Bonding

Using an individual rubber dam11 greatly

facilitates the clinical stage of the bond-

ing procedure (Fig 40). The bonding

procedure follows a standard protocol

consisting of three stages:

preparation of the veneer: etching,

silanization, adhesive

preparation of the tooth: sandblast-

ing, etching, primer, then adhesive

bonding: because of the implemen-

tation of the individual rubber dam,

excesses are easily removed, and

there is zero risk of overflow onto the

neighboring teeth.

Clinical results

Since the photographic protocol used

before and after operating is identical,

the similarity of the final porcelain crea-

tions to the images of the transitional ve-

neers is apparent.

Fig 44 (a to c) When changing a smile, one must never underestimate the impact.

a

b

c

Copyright

byN

otfor

Qu

intessence

Not for Publication




Conclusion

This account of a clinical case, which can

be considered exemplary, is intended to

show the need for a rational approach to

all esthetic smile-restoration projects.

By resorting first to the Decision-Mak-ing Table and later to the Esthetic Guide in order to establish the diagnosis and

treatment plan, it is possible to success-

fully perform all of the stages, which lead

to the result shown in the photographs

above (Figs 4144).

The patients expression shows that

her requests regarding an esthetic,

functional, and, most of all, personalized

rehabilitation have been respected.

Each individual represents a specific

case, and it would not be possible to

perform a standard restoration without

insulting the patients personality and ex-

pectations. Reconstructing a pretty smile

gives patients more than just a healthy

and attractive appearance; it also pro-

vides a mental boost, which has a posi-

tive effect on how they see themselves.

Additional resources

The Esthetic Guide featured in the

present clinical case is available in pdf

format by request to richter@quintes-

senz.de.

Acknowledgements

Pierre Andrieu (dental laboratory, MOF); Profes-

sor Francis Louise (periodontics); Professor Jean-

Daniel Orthlieb (occlusodontics); Dr Jean-Stphane

Simon (orthodontics).

Operator: Professor Andr-Jean Faucher.

References

1. Graber LW, Lucker GW. Dental esthetics self evalu-ation and satisfaction. Am J Orthod 1980;77:163-178.

2. Terry RL, Davis JS. Com-ponents of facial attractive-ness. Percept Mot Skills 1978;42:918-919.

3. Paris JC, Faucher AJ, Makar-ian MH. Smile Aesthetics: Integration or Rehabilitation? Ral Clin 2003;14:367-378.

4. Fradeani M. Esthetic Reha-bilitation in Fixed Prostho-dontics: Esthetic Analysis. Chicago: Quintessence Publishing, 2004.

5. Talarico G, Morgante E. Psychology of dental esthet-ics: dental creation and the harmony of the whole. Eur J Esthet Dent 2006;4:303-312.

6. Paris JC, Faucher AJ. Le Guide Esthtique. Paris: Quintessence International, 2004

7. Chiche GJ, Pinault A. Esthet-ics of anterior fixed prostho-dontics. Chicago: Quintes-sence Publishing, 1994.

8. Fradeani M. Evaluation of dentolabial parameters as part of a comprehensive esthetic analysis. Eur J Esthet Dent 2006;1:62-69.

9. Rufenacht CR. Fundamen-tals of Esthetics. Chicago: Quintessence Publishing, 1990.

10. Duarte S, Lorezon AP, Sch-nider P. The Importance of width/length ratios of maxil-lary anterior permanent teeth in esthetic rehabilitation. Eur J Esthet Dent 2008;3:224- 234.

11. Magne P, Magne M, Belser U. The diagnostic template: a key element to the compre-hensive esthetic treatment concept. Int J Periodontics Restorative Dent 1996;16: 560-569.

12. Faucher AJ, Magneville B, Watine F, Koubi G, Brouillet

JL. Provisional facets and Aesthetic Project. Ral Clin 1994;5:25-33.

13. Goldstein CE, Goldstein RE, Garber DA. Imaging in esthetic dentistry. Chicago: Quintessence Publishing, 1988.

14. Grel G. The Science and Art of Porcelain Laminate Veneers. Chicago: Quintes-sence Publishing, 2003.

15. Magne P, Belser U. Bonded Porcelain Restorations in the Anterior Dentition: A Biomi-metic Approach. Chicago: Quintessence Publishing, 2003.

16. Derrien G. Provisional restorations with compound prosthetics. CdP 1991;73:67-74.

17. Rieder CE. Use of provisional restorations to develop and achieve esthetic expecta-tions. Int J Periodontics Restorative Dent 1989;9:122-139.

Copyright of European Journal of Esthetic Dentistry is the property of Quintessence Publishing Company Inc.

and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright

holder's express written permission. However, users may print, download, or email articles for individual use.

uia estetica

Documents

patients smile

introductionthe smile

smile esthetics

existing smile

complex treatment

dmdprivate practice

esthetic guide

dmd private practice