Derango 2010 esthetics Handout 5 - NZIMIDnzimid.org/resources/5. Derango 2010 esthetics Handout.pdf · Understanding Biologic Width and the Dentogingival complex Course III: Restorative

3/14/2010

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• Periodontal Disease

• Decay or Structural Failure

Periodontal

Biomechanical

RiskRisk CateCategoriesgories

Why can our dentistry fail ?

Failure

• Stresses to Restorative Materials or Teeth

• Esthetic Failures

Functional

Dentofacial

Low Risk

At Risk

LOW MODERATE HIGH

Low Risk

At Risk

LOW MODERATE HIGHLow Risk

At RiskERO/ABR RISK ASSESSMENTLOW MODERATE HIGH

Erosive / Arbasion LesionsRecession

tooth brush hardness

Attrition (see function)

Bone Loss (AAP > II)

Salivary Characteristics/xerostomiaMedical Conditions/gerd i.e.Medications / Supplements

Diet: Frequent Intake of Acidic Food/Beverages

Abrasivity of toothpaste

CARIES RISK ASSESSMENT

Rough White Spot LesionsActive Decay

Caries Restored in the Past 3 YearsInterproximal Enamel LesionsVisible PlaqueFrequent Sugary/Starchy SnacksOrtho Appliances of Partial DenturesXerostomiaExposed Root SurfacesFamily Members/Significant Other with DecayDeep Pits/Fissures, Developmental DefectsNon Fluoridated Water

Furcation Involvement

PERIODONTAL RISK ASSESSMENTPast History of Periodontal Disease PERIODONTAL PROGNOSIS GOOD FAIR POOR

Medical Conditions (Diabetic Pts: Risk Increases with >7% H1AC Levels)Family HistoryPregnancy

Smoker

Mobility

Bleeding on probing (prognostic)

Pocket DepthsRecession(if yes check erosion)

DNA Pathogen TestingGenotypeShort Roots (Not a "risk factor" but, prognostic indicators)

Oral Hygiene

Low Risk

At Risk

LOW MODERATE HIGH

Low Risk

At Risk

LOW MODERATE HIGH

Low Risk

At Risk

LOW MODERATE HIGH

\\Server\central form fi les\sec 9 Risk Forms

Tooth Shape

Bite Relationship (OPEN CONSTRICTED OTHER)

ESTHETIC RISK ASSESSMENTSmile LineBone CrestBiotype

Trouble with sleepPopping, clicking, joint soundsJaw pain, soreness, exhaustion, tension headachesGrinding, own/wear a occlusal guard BRUXING DYSFUNCTION NOT DETERMINEDExisting Wear(if yes check erosion) ACTIVE NON‐ACTIVE NOT DETERMINED YET

Trouble chewing a small piece of gumTrouble chewing bagels or dry chewy foodsTeeth changing in the last 5 years (wear, shorter/thinner, mobility, new spaces)More than 1 bite, clenching

FUNCTIONAL RISK ASSESSMENT

Isthmus Width of RestorationTooth Location in Mouth

DietHabitsRoot Canal Treated Teeth, Full Coverage / Large Direct RestorationsOpposing TeethFunctional Risk Diagnosis

Masseter Muscle SizePast History of Tooth Fractures (Reason for existing crowns)Sensitivity to Bite/ craze lines

STRUCTURAL RISK ASSESSMENTCariScreen Test Results

Low Risk

At Risk

LOW MODERATE HIGH

\\Server\central form files\sec 9 Risk Forms

Tooth Shape

p ( )


Esthetic Risk Keys Esthetic Risk Keys

Horizontal Symmetry Acceptable Alteration needed

Lip Dynamics Low Medium High

MAXILLA

Scallop / Form Flat Normal High

MAXILLA

Law of the Apparent

Once the obvious visual Once the obvious visual discrepancy is addressed discrepancy is addressed

the next discrepancy the next discrepancy

Once the obvious visual Once the obvious visual discrepancy is addressed discrepancy is addressed

the next discrepancy the next discrepancy the next discrepancy the next discrepancy becomes very apparentbecomes very apparentthe next discrepancy the next discrepancy

becomes very apparentbecomes very apparent

Dr. Rena Vakay

3/14/2010

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Law of the Apparent

Once the obvious visual discrepancy is addressed the next discrepancy

becomes very yapparent

Smiles by design

Law of the Apparent : Missing Papillae now apparent

Not so apparent

The Long Lip / Low Smile Line is Your FriendWhat about Biomechanical, Functional and Periodontal Risk as a result of treatment

3/14/2010

3

7 YEAR POST-OP GUMMY SMILE

Maxillary Impaction

GUMMY SMILE

Orthodontic Intrusion

GUMMY SMILE

Esthetic Crown Lengthening

3 Diagnoses, 3 Treatments

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Know Your Enemy

The Gummy SmileThe Gummy SmileThe Gummy SmileThe Gummy Smile

Differential DiagnosisDifferential DiagnosisThe Gummy SmileThe Gummy Smile

Differential DiagnosisDifferential Diagnosis

Short Upper LipHyperactive LipShort Clinical Crowns: Normal variation, Incisal Wear, Excess Gingival Coverage i.e. Altered passive eruption

Dentoalveolar ExtrusionVertical Maxillary ExcessCombination

Esthetic Diagnosis

The Five Questions

1. Face Height The face height measured in repose from the glabella to the base of the nose equals the measurement from the base of the nose to the inferior border of the chin. This means that the middle third of the face should approximately equal the lower third of the face.

2. Lip Length Measured in repose from the base of the nose to the inferior border of the maxillary lip in the young adult is approximately: Females: 20-22 mm Males: 22-24 mm

1:1 if >1:1 i.e. 1:1.2

If < Differential DiagnosisAverage lip mobility is 6-8 mm

3. Gingival line Drawn from Canine to Canine. Centrals should be on that line.

4. Length of the maxillary central incisor 10-11mm.

5. Feel the CEJ in the sulcus?

J. William Robbins, DDS, MA 2803 Mossrock, #201 San Antonio, Texas 78230 (210)341-4409 www.robbinsdds.com

• Short Upper Lip• Hyperactive Lip• Short Clinical Crowns: Normal

variation ,Incisal Wear, Excess Gingival Coverage i.e. Altered passive eruption

• Dentoalveolar Extrusion• Vertical Maxillary Excess• Combination

If > 9mm

g

If<9

If you can not feel CEJ

Dento-Facial Diagnosis

The Five Questions

1. Face Height The face height measured in repose from the glabella (mid-brow point) to the base of the nose equals the measurement from the base of the nose to the inferior border of the chin. This means that the middle third of the face should approximately equal the lower third of the face.

DX: Lower Third of the Face is Longer - Vertical Maxillary Excess TX: Orthognathic Surgery

2. Lip Length Measured in repose from the base of the nose to the inferior

border of the maxillary lip in the young adult is approximately: Females: 20-22 mm

Males: 22-24 mm Lip Mobility

Average lip mobility is 6-8 mm DX: Short or Hyperactive Upper Lip

Smiles by design

DX: Short or Hyperactive Upper Lip TX: Behavior Modification, Botox (www.mariopolo.com)

3. Gingival Line Drawn from Canine to Canine. Centrals should be on that line.

DX: Concave Gingival Line - Dentoalveolar Extrusion TX: Orthodontic Intrusion, Crown Lengthening Surgery, Segmental Osteotomy

4. Length of the maxillary central incisor l0-11mm.

DX: Less Than 10 mm - Microdontia, Wear, Altered Passive Eruption


DX: Can’t Feel CEJ in the Sulcus - Altered Passive Eruption TX: Esthetic Crown Lengthening Surgery

J. William Robbins, DDS, MA 1202 East Sonterra Blvd., Suite 402 San Antonio, Texas 78258 (210) 341-4409 www.robbinsdds.com www.coredentistry.com [email protected]

http://www.coredentistry.com/

1:1.2 lower third slightly longer

21 mm21 mm

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20-21


Central exposed in repose 5mm

AESTHETIC EVALUATION Face Height ________ Lip Length _________ mm Dental / facial Midline.____R/L Central exposed in repose. ____ mmCentral exposed in full smile (gummy smile). _____mm Distal extent of smile (tooth#) ______ R ______L Incisal edges to lower lip (follows smile line, covered by lip).

Buccal corridors-negative spaces Y/N Length of maxillary anteriors—(chart) Tissue levels-(chart) Angle of incisal plane—(chart)

20-21


5.5

Incisal wear-Y/N tooth #'s. ____ CEJ located Y/N _____ Posterior occlusal plane ( ok, step up, or step down). Tooth color_____________________

h li ( i l )

Central and tissue exposed in high smile 14-15mm AESTHETIC EVALUATION

Face Height ________ Lip Length _________ mm Dental / facial Midline.____R/L Central exposed in repose. ____ mmCentral exposed in full smile (gummy smile). _____mm Distal extent of smile (tooth#) ______ R ______L Incisal edges to lower lip (follows smile line, covered by lip).


AESTHETIC EVALUATION Face Height ________ Lip Length _________ mm Dental / facial Midline.____R/L Central exposed in repose. ____ mmCentral exposed in full smile (gummy smile). _____mm Distal extent of smile (tooth#) ______ R ______L Incisal edges to lower lip (follows smile line, covered by lip).


1:1.1 lower third slightly longer20-21

5.515

10.5 11

15 – 5.5 = 9.5mm of lip mobility

Central and tissue exposed in high smile 14-15mm


Tooth alignment(spacing, overlap).

PR NOTES

__________________________________________________________________


Tooth alignment(spacing, overlap).

PR NOTES

__________________________________________________________________

no

Y

10.5


Esthetic Diagnosis

The Five Questions

1. Face Height The face height measured in repose from the glabella to the base of the nose equals the measurement from the base of the nose to the inferior border of the chin. This means that the middle third of the face should approximately equal the lower third of the face.

2. Lip Length Measured in repose from the base of the nose to the inferior border of the maxillary lip in the young adult is approximately: Females: 20-22 mm Males: 22-24 mm

Average lip mobility is 6-8 mm

1:1.2

21mm

9.5mm


4. Length of the maxillary central incisor 10-11mm.


J. William Robbins, DDS, MA 2803 Mossrock, #201 San Antonio, Texas 78230 (210)341-4409 www.robbinsdds.com

Slightly curved

11mm

yes

• Short Upper Lip Q2 • Hyperactive Lip Q2

• Short Clinical Crowns: Normal variation ,Incisal Wear, Excess Gingival Coverage i.e. Altered passive eruption Q4 and 5

• Dentoalveolar Extrusion Q3

• Vertical Maxillary Excess Q1

Diagnosis Combination

Patient Preview to Reduce Risk

Using Cosmetic Imaging andDirect patient mock-up to

evaluate patient expectations

Direct Mock-up

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Computer generated incisal edge

Patient Generated Incisal Edge Mock-up

Smile Now Disposable Dental Template

http://www.yoursmilenow.com

HILA

Identifying Perio-Esthetic Risk Factors For Tooth Preparation

Patients Vision Lip dynamicsGingival Architecture and crest types

Low Risk

At Risk

LOW MODERATE HIGH

\\Server\central form files\sec 9 Risk Forms

Tooth Shape

p ( )


Risk to Restorative

typesShape of teeth

Understanding Biologic Width and the Dentogingival complex Course III: Restorative / Periodontal Interface

Courtesy of Dr John Kois

3mm2-2.5 mmDGC

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Dentogingival Complex

Normal Crest : 3 mm Facially 4 mm Interproximally


Bone Sounding


Normal Crest

High Crest

Low Crest

Low Crest : Risk for Recession

High Crest : Risk for Biologic Width Violation

Low crest risk of recessionLow crest risk of recession

Smiles by design

3mm >4mm

<2mm


Pre-op Pre-op

Temps 9 -10 Temps 7-10

Tarnow, D.P., et al, J Periodontal 1992;63:995-996

Black Holes?

At Insert Black Hole. Do we add porcelain or final bond the restoration ?

Tarnow Article:

Tooth form : Triangular, increased risk for black holes

Where is the bone??

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Insert of crown after 6 weeks of a poor fitting provisional

After resisting the urge to pick up a handpiece and prepare the tooth, a perio probe was used to determine the bone height which was less

than 3 mm from the crown margin

April 07 recall shows some improvement in 10 weeks

October 07 recall 7-8 months shows almost 3mm tissue to

bone

At insert

10 weeks 7-8 months

Provisional placed on #7Removed old crown #10

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Bone Sounding Bleeding point created by finepoint e-surge tip

Electrosurgey to desired position( can only be done if plenty of attached tissue)

New provisional made Envelope flap to provide access to bone Starting to create 3 mm for biologic width from margin to bone

Must remove bone past line angles Sutures placed

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Patient discussion regarding future shape of centrals after restoration

Papilla tip to bone > 5mm risk for recession with resulting in a more square tooth form. Great for mock-up or imaging for patient acceptance before treatment

Smiles by design

• Gummy Smile• Tooth Form• Low crest ?• Patient Expectations?

Triangular / Black holeRecession

Esthetic Risks Porcelain Veneer Preparation System

• Bur Blocks see next slide

• Metal perio probe• Pencil for depth cuts• Electric handpiece t t 20 • Electric handpiece set at 20

• Red, Green interproximal strips• Brassler Discs• Flexi model set up• Shade guides, Retractors

Determining Biologic Width

Facial Interproximal

Preparation SystemDepth guides Pencil depth guides

Preparation System

Smiles by design

Uniform reduction Margination

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Preparation SystemDepth guides Pencil depth guides

Uniform reduction Margination

Preparation SystemIncisal reduction Bevel incisal 1/3

Smiles by design

Preparation System

Incisal reduction

Bevel incisal 1/3

Prep- shadesRounding line angles

Provisionals

Lab instructed to create more pronounced line angle for a triangular look

Reducing Risk Through Communication

•Patients: Visions and expectations of what is possible

•Laboratories: Communication of desired results

•Specialists: Understanding the desired end of

treatment and how we get there

Law of Apparent

Patients Desire : Nice Smile

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•Help Patient/Dr communication

H l id ti

Flexi ModelsA dentist’s tool to lower risk

•Help guide preparations

•Temporization

•Lab Communication

Quick direct mock-up to help understand patients desire and expectations

Prep # 8 flexi model no other teeth prepared. Note how little tooth structure removed

Armentarium Duloid Impression

Temp #8 using existing position of # 7 and # 9

4,5,6,7 Prepared and temps made using Temp #8 as reference

Temps 4-8 used as guide for preps ,temps and lab communication

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4-8 temps will be used as a guide/reference for preps and temps 9-13

Preparations

Smiles by design

Spot bonding for temps

I think posterior segments could be slightly shorter to follow lower lip and # 8 and # 9 could be slightly longer

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Final Temps

Patient’s Goal A Nice Smile




•Specialists: Understanding the desired end of treatment and how we get theretreatment and how we get there

Schedule 3. [Please see Schedule 5 for negatives first.]Orthodontic Movements for

START by clicking HERE and entering width Symmetrical Extensions. Date Moved Initial

Move UR3 Right by: 0.00Move UR2 Right by: 0.92

Schedule 1. Move UR1 Right by: 2.12Enter Existing Tooth Widths: As of Date Initial Move UL1 Right by: 1.74

Move UL2 Right by: 3.99Upper Right Canine (UR3) 8.31 Move UL3 Right by: 0.15Upper Right Lateral Incisor 5.60Upper Right Central Incisor 9.10Upper Left Central Incisor 8.80Upper Left Lateral Incisor 0.00 Schedule 4. Upper Left Canine (UL3) 8.00 Resulting Post-Orthodontic

Interim Tooth Gaps. Date Confirmed Initial(Then enter gaps)

Schedule 2. Resulting UR4-UR3 Gap 0.00Enter Existing Tooth Gaps: As of Date Initial Resulting UR3-UR2 Gap 0.88

Resulting UR2-UR1 Gap 1.00UR4-UR3 Existing Gap 0.00 Resulting UR1-UL1 Gap 0.38UR3-UR2 Existing Gap 1.80 Resulting UL1-UL2 Gap 3.95UR2-UR1 Existing Gap 2.20 Resulting UL2-UL3 Gap 3.84UR1-UL1 Existing Gap 0.00 Resulting UL3-UL4 Gap 0.15UL1-UL2 Existing Gap 6.20UL2-UL3 Existing Gap 0.00UL3-UL4 Existing Gap 0.00 39.81 10.20 50.01

Schedule 5. Suggested

#

Lateral ExtensionsAfter Tooth Movements.

Negative numbers require trimming & data re-entered in

Schedules 1 and 2.

Please note: any negative no. in schedule 5 requires trimming by the indicated amount and reentering new widths and gaps in Schedules 1 and 2 before

Ortho Engineer™ version 1.5

www.erskinedental.com.au

Date Performed InitialSchedule 6. UR3-Distal Extension 0.00Resulting Tooth Widths after UR3-Mesial Extension 0.00Movements and Lateral Extensions. based on centralsAchieving these UR2-Distal Extension 0.89

symmetrical, proportional UR2-Mesial Extension 0.89Upper Right Canine 8.30 8.80 tooth widths - without any UR1-Distal Extension 0.12Upper Right Lateral Incisor 7.37 7.20 gaps - is the purpose of UR1-Mesial Extension 0.12Upper Right Central Incisor 9.33 9.00 Ortho Engineer™. UL1-Mesial Extension 0.27Upper Left Central Incisor 9.33 9.00 UL1-Distal Extension 0.27Upper Left Lateral Incisor 7.37 7.20 IMPORTANT: Please do UL2-Mesial Extension 3.69Upper Left Canine 8.30 8.80 8.8 not change the italicized UL2-Distal Extension 3.69

50.00 arc number, because it UL3-Mesial Extension 0.15Arc - mesial of UR4-UL4: 50.01 32.40 underpins Ortho Engineer™. UL3-Distal Extension 0.15

Bonus: Bonus:Non-Orthodontic Tooth Size Calculator for Canine-to-Canine. Non-Orthodontic Tooth Size Calculator for Lateral-to-Lateral.

Use this mini-calculator for situations where you will not move teeth Use this mini-calculator for situations where you will not move teethorthodontically. First, measure your patient's arch length from mesial of orthodontically. First, measure your patient's arch length from mesial the first premolar to the contralateral tooth. Measure as close to buccal of one canine to the contralateral tooth. Measure as close to buccalside of contact point as possible using Dentagauge 1 and 2. Your side of contact point as possible using Dentagauge 1 and 2. Yourmeasurement must reflect the sum of each tooth width & gap, so as to measurement must reflect the sum of each tooth width & gap, so as to account for non-linear arch. account for non-linear arch.

Second, enter your patient's total arch length in the yellow box. Second, enter your patient's total arch length in the yellow Suggested tooth sizes are displayed for a symmetrical, proportional, box. Suggested tooth sizes are displayed for a symmetrical, gap-free smile. The mini-calculator assumes each lateral incisor should proportional, gap-free smile. The mini-calculator assumes be 79%, and each canine should be 89%, of each central incisor. each lateral incisor should be 79% of each central incisor.

Total Arc: 50.01 Total Arc: 32Upper Right Canine 8.30 Upper Right Lateral Incisor 7.06Upper Right Lateral Incisor 7.37 Please enter arc above, Upper Right Central Incisor 8.94 Please enter arc length Upper Right Central Incisor 9.33 from mesial of UR4 to Upper Left Central Incisor 8.94 from mesial of UR3 toUpper Left Central Incisor 9.33 mesial of UL4, press enter. Upper Left Lateral Incisor 7.06 mesial of UL3.Upper Left Lateral Incisor 7.37 Proportional tooth Press enter.Upper Left Canine 8.30 widths will appear at left.

Schedule 3 or 4 are used.

Dr Daniel Ward : Dentistry Today May 2008

3/14/2010

15

http://www.whereillinoissmiles.com/whats_new.phpPing files

www.iconico.com

Ping files Dr Dave Rice

Curt move everything to patients right side(close spaces) this will help midline and create space so that #10 can be made larger to match #7 I will add to the distal of #10

Move everything over and create space on distal of #10 then I will bond to match #7

Are these teeth in the correct position?

3/14/2010

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Schedule 3. [Please see Schedule 5 for negatives first.]Orthodontic Movements for

START by clicking HERE and entering width Symmetrical Extensions. Date Moved Initial




Interim Tooth Gaps. Date Confirmed Initial(Then enter gaps)

Schedule 2. Resulting UR4-UR3 Gap 0.00Enter Existing Tooth Gaps: As of Date Initial Resulting UR3-UR2 Gap 0.88

Resulting UR2-UR1 Gap 1.00UR4-UR3 Existing Gap 0.00 Resulting UR1-UL1 Gap 0.38UR3-UR2 Existing Gap 1.80 Resulting UL1-UL2 Gap 3.95UR2-UR1 Existing Gap 2.20 Resulting UL2-UL3 Gap 3.84UR1-UL1 Existing Gap 0.00 Resulting UL3-UL4 Gap 0.15UL1-UL2 Existing Gap 6.20UL2-UL3 Existing Gap 0.00UL3-UL4 Existing Gap 0.00 39.81 10.20 50.01

Schedule 5. Suggested

#

Lateral ExtensionsAfter Tooth Movements.

Negative numbers require trimming & data re-entered in

Schedules 1 and 2.

Please note: any negative no. in schedule 5 requires trimming by the indicated amount and reentering new widths and gaps in Schedules 1 and 2 before


www.erskinedental.com.au

Date Performed InitialSchedule 6. UR3-Distal Extension 0.00Resulting Tooth Widths after UR3-Mesial Extension 0.00Movements and Lateral Extensions. based on centralsAchieving these UR2-Distal Extension 0.89

symmetrical, proportional UR2-Mesial Extension 0.89Upper Right Canine 8.30 8.80 tooth widths - without any UR1-Distal Extension 0.12Upper Right Lateral Incisor 7.37 7.20 gaps - is the purpose of UR1-Mesial Extension 0.12Upper Right Central Incisor 9.33 9.00 Ortho Engineer™. UL1-Mesial Extension 0.27Upper Left Central Incisor 9.33 9.00 UL1-Distal Extension 0.27Upper Left Lateral Incisor 7.37 7.20 IMPORTANT: Please do UL2-Mesial Extension 3.69Upper Left Canine 8.30 8.80 8.8 not change the italicized UL2-Distal Extension 3.69

50.00 arc number, because it UL3-Mesial Extension 0.15Arc - mesial of UR4-UL4: 50.01 32.40 underpins Ortho Engineer™. UL3-Distal Extension 0.15

Bonus: Bonus:Non-Orthodontic Tooth Size Calculator for Canine-to-Canine. Non-Orthodontic Tooth Size Calculator for Lateral-to-Lateral.

Use this mini-calculator for situations where you will not move teeth Use this mini-calculator for situations where you will not move teethorthodontically. First, measure your patient's arch length from mesial of orthodontically. First, measure your patient's arch length from mesial the first premolar to the contralateral tooth. Measure as close to buccal of one canine to the contralateral tooth. Measure as close to buccalside of contact point as possible using Dentagauge 1 and 2. Your side of contact point as possible using Dentagauge 1 and 2. Yourmeasurement must reflect the sum of each tooth width & gap, so as to measurement must reflect the sum of each tooth width & gap, so as to account for non-linear arch. account for non-linear arch.

Second, enter your patient's total arch length in the yellow box. Second, enter your patient's total arch length in the yellow Suggested tooth sizes are displayed for a symmetrical, proportional, box. Suggested tooth sizes are displayed for a symmetrical, gap-free smile. The mini-calculator assumes each lateral incisor should proportional, gap-free smile. The mini-calculator assumes be 79%, and each canine should be 89%, of each central incisor. each lateral incisor should be 79% of each central incisor.

Total Arc: 50.01 Total Arc: 32Upper Right Canine 8.30 Upper Right Lateral Incisor 7.06Upper Right Lateral Incisor 7.37 Please enter arc above, Upper Right Central Incisor 8.94 Please enter arc length Upper Right Central Incisor 9.33 from mesial of UR4 to Upper Left Central Incisor 8.94 from mesial of UR3 toUpper Left Central Incisor 9.33 mesial of UL4, press enter. Upper Left Lateral Incisor 7.06 mesial of UL3.Upper Left Lateral Incisor 7.37 Proportional tooth Press enter.Upper Left Canine 8.30 widths will appear at left.

Schedule 3 or 4 are used.

Dr Daniel Ward : Dentistry Today May 2008

http://www.whereillinoissmiles.com/whats_new.php

Ping files

www.iconico.com Ping files Dr Dave Rice

http://www.erskinedental.com.au/

Schedule 3. [Please see Schedule 5 foOrthodontic Movements for

START by clicking HERE and entering width Symmetrical Extensions. Date




Interim Tooth Gaps. Date Co(Then enter gaps)

Schedule 2. Resulting UR4-UR3 Gap -0.32Enter Existing Tooth Gaps: As of Date Initial Resulting UR3-UR2 Gap -0.31

Resulting UR2-UR1 Gap 0.10UR4-UR3 Existing Gap 0.00 Resulting UR1-UL1 Gap 0.16UR3-UR2 Existing Gap 0.00 Resulting UL1-UL2 Gap -0.20UR2-UR1 Existing Gap 0.00 Resulting UL2-UL3 Gap 0.14UR1 UL1 E i ti G 0 00 R lti UL3 UL4 G 0 43


UR1-UL1 Existing Gap 0.00 Resulting UL3-UL4 Gap 0.43UL1-UL2 Existing Gap 0.00UL2-UL3 Existing Gap 0.00UL3-UL4 Existing Gap 0.00

Schedule 5. SuggestedLateral ExtensionsAfter Tooth Movements.

Date PeSchedule 6. UR3-Distal Extension -0.32Resulting Tooth Widths after UR3-Mesial Extension -0.32Movements and Lateral Extensions. Achieving these UR2-Distal Extension 0.01

symmetrical, proportional UR2-Mesial Extension 0.01Upper Right Canine 7.36 tooth widths - without any UR1-Distal Extension 0.08Upper Right Lateral Incisor 6.53 gaps - is the purpose of UR1-Mesial Extension 0.08Upper Right Central Incisor 8.26 Ortho Engineer™. UL1-Mesial Extension 0.08Upper Left Central Incisor 8.26 UL1-Distal Extension 0.08Upper Left Lateral Incisor 6.53 IMPORTANT: Please do UL2-Mesial Extension -0.29Upper Left Canine 7.36 not change the italicized UL2-Distal Extension -0.29

arc number, because it UL3-Mesial Extension 0.43Arc - mesial of UR4-UL4: 44.30 underpins Ortho Engineer™. UL3-Distal Extension 0.43

Bonus: Bonus:Non-Orthodontic Tooth Size Calculator for Canine-to-Canine. Non-Orthodontic Tooth Size Calculator fo

Use this mini-calculator for situations where you will not move teeth Use this mini-calculator for situations where yoorthodontically. First, measure your patient's arch length from mesial of orthodontically. First, measure your patient's athe first premolar to the contralateral tooth. Measure as close to buccal of one canine to the contralateral tooth. Measuside of contact point as possible using Dentagauge 1 and 2. Your side of contact point as possible using Dentagameasurement must reflect the sum of each tooth width & gap, so as to measurement must reflect the sum of each tooaccount for non-linear arch. account for non-linear arch.

Second, enter your patient's total arch length in the yellow box. Second, enter your patient's total arch length iSuggested tooth sizes are displayed for a symmetrical, proportional, box. Suggested tooth sizes are displayed for a gap-free smile. The mini-calculator assumes each lateral incisor should proportional, gap-free smile. The mini-calculatbe 79%, and each canine should be 89%, of each central incisor. each lateral incisor should be 79% of each cen

Total Arc: 44.3 ToUpper Right Canine 7.52 Upper Right Lateral Incisor 8.39Upper Right Lateral Incisor 6.48 Please enter arc above, Upper Right Central Incisor10.61 PleaUpper Right Central Incisor 8.10 from mesial of UR4 to Upper Left Central Incisor 10.61 fromUpper Left Central Incisor 8.10 mesial of UL4, press enter. Upper Left Lateral Incisor 8.39 mesUpper Left Lateral Incisor 6.48 Proportional tooth PresUpper Left Canine 7.52 widths will appear at left.

44.20

Negative trimming & da

ScPlease note: any negative no. in schedule 5 requires trimming by the indicated amount and reentering new widths and gaps in Schedules 1 and 2 before Schedule 3 or 4 are used.

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8mm 6.5 8.17.1 6.5

6.5 8.1 8.1 7.1

Ideal 7.36 6.53 8.26 8.26 6.53 7.36

Call me we need stanke to review I need #7 to change angle and open .16 mm space on mesial

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•Specialists: Understanding the desired end of treatment and how we get theretreatment and how we get there

"Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to habit of two things to help, or at least to do no harm.“

Hippocrates Epidemics, Bk. I, Sect. XI.

"Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things — to

"Declare the past”

Medical/Dental history, old habit of two things to help, or at least to do no harm.“ Hippocrates Epidemics, Bk. I, Sect. XI.

/ y,models, photos, etc.

" Diagnose the present”Comprehensive Exam

“Foretell the future”

Risk Assessment /Prognosis / g

“As to diseases, make a habit of two things — to help, or at

least to do no harm.”

Lower the risk or at least try not increase the risk There is not increase the risk. There is no Dentistry better than No

Dentistry.

THANK YOU

Documents

Derango 2010 esthetics Handout 5 - NZIMIDnzimid.org/resources/5. Derango 2010 esthetics Handout.pdf · Understanding Biologic Width and the Dentogingival complex Course III: Restorative