Fall 2002 Presentation Summary:

"Anatomy of a Smile"

Presented by Dr. Roy Gunsolus on February 1, 2002, at the Northern Region meeting.

Summarized by Dr. Bruce Hawley, Northern Region Editor

Educate your patients and referring dentists

Dr. Gunsolus gave the audience an introductory bonus by discussing ways to meet the continuing challenge of educating our patients and referring dentists.

His first example was to form an interdisciplinary study club. He then discussed other ideas, such as traditional doctor lunches, “lunch and learn” meetings with staff persons, courses for individual dentists and/or selected staff from multiple offices, a review with the referring doctor of a case with beginning and final records, and inviting an dentist to an orthodontically oriented inter- disciplinary lecture.

Dr. Gunsolus put three strategies at the top of the list for educating the dental community.

• Presentations for doctors and staff on specific topics, as well as opportunities for mutual problem solving.
  
  
• Case reviews to walk the dentist through diagnosis, and evaluate the treatment outcomes, to let the dentist appreciate both the complexity of orthodontic treatment and the individual patient benefits.
  
  
• Participation in a study club with an interactive environment where the dentist’s patients can be discussed in an informal, mutual growth atmosphere.

Smile Anatomy

The elements that contribute to the anatomy of an individual’s smile are complex.

They include: upper lip length, incisor length with lips in repose, incisal/gingival display on smiling, proportional height/width of incisors, incisor color and clarity, incisal edge shape, cant of the frontal occlusal plane, width and extension of smile line, dental and facial midlines, relationship of upper incisal edges to the curve of the lower lip, competence of the lip/lip strain, relative heights of gingival margins, and the quality and quantity of gingival tissues.

One can measure the vertical dimensions of nose to lips (range of 16–28mm) and the amount of tooth structure showing in lip repose (generally 3–4mm).

On smiling, the incisal display may range between 50–110%. The maximum gingival display is 1-2 mm.

Patients with vertical maxillary excess tend to have more dental and gingival display. Esthetically they look better if the gingival is healthy.

A highpull headgear can influence vertical growth in the growing patient, but this is difficult to accomplish, and risky to promise. Lefort I maxillary surgical impaction and gingivectomy are other ways to reduce gingival display.

Some fine points made by Dr. Gunsolus

Irregularly positioned incisors may have gingival height discrepancies, influencing their appearance. Irregular wear of certain teeth can also compromise post-ortho esthetics.

In cases of mottling or discoloration, Dr. Gunsolus suggests adding restorative material adjacent to the orthodontic brackets to camouflage the defects.

When you extrude a tooth, it is important to achieve proper torque; a headfilm can allow you to assess and monitor the tooth procumbency. Incorrect torque will affect the gingival margin.

Final records sometimes will disclose what we did not see prior to debanding. During the retention period, a good restorative dentist can help you manage any remaining challenges to a beautiful smile.

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