Cosmetic dentistry
- Introduction, History, and Definitions :
For any individual, the appearance of their teeth can have a significant impact on their self-confidence, self-esteem, and how they are perceived by others. By changing the shape, thickness, length, and color of their teeth, it is possible to influence their perception of age, personality, and self-confidence.
Unlike previous generations, today’s society places great importance on aesthetics.
History : Cosmetic dentistry was born in the United States with Doctors Charles Pincus and Ronald Goldstein who created the first Academy of Cosmetic Dentistry in 1976. In Europe, the first Society of Cosmetic Dentistry appeared in 1983: the SFDE (French Society of Cosmetic Dentistry).
A “smile culture” is observed and dental surgeons participate in a standardization of the smile by establishing standards and protocols.
Definitions :
- Aesthetics : relating to beauty = synonymous with pretty.
- Cosmetic : is a substance or mixture intended to be placed in contact with various superficial parts of the human body, in particular the epidermis, hair systems, lips, nails, teeth and oral mucous membranes.
- Causes of Dental Aesthetic Problems :
Dental aesthetic problems, like other diseases, can be caused by genetic or developmental abnormalities, infectious agents (e.g., caries and periodontal disease), and/or environmental factors (malnutrition, diet, stress, trauma, etc.) and include:
- Discolored teeth;
- Malformed teeth;
- Worn or broken teeth;
- Poorly made fillings (secondary to tooth decay);
- Spaces between teeth;
- Misaligned teeth;
- Missing teeth.
- Aesthetic criteria
3.1 The forgiven in the facial frame
3.2 Forgiveness in the labial framework
The lips are the framework of the smile and define the aesthetic zone; the curvature and length of the lips have a great influence on the quality of the teeth exposed at rest and during function.
3.3 Dental arrangement
The size, profile and inter-arch and intra-arch relationships of the teeth are the dental factors that contribute to the beauty of a smile.
3.3.1 Tooth size
Tooth size is determined by measuring the incisal-gingival length and the mesio-distal width. The normal value of the width/length ratio of the maxillary central incisor is between 0.75 and 0.8 mm.
3.3.2 Dental shape and profile
The shape of the teeth can be classified into three types: rectangular, triangular and ovoid. The vestibulolingual thickness must be respected during a corono-peripheral reconstruction, knowing that a maxillary central incisor has a thickness of 2.5 to 3.3 mm.
3.3.3 Intra-arcade relationships
- The midline is the most important focal point in an aesthetic smile. The maxillary inter-incisal line should coincide exactly with the labial frenulum and the facial midsagittal line.
- As for the axis of inclination of the maxillary anterior teeth, it must be aligned in such a way that the incisal edges converge medially.
- Youth is expressed by a convex edge line.
- The contact points of the anterior dental segments coincide with the incisal edge and the curvature of the lower lip.
- The incisor embrasures have a distinct appearance that depends on age and gender. Very pronounced embrasures indicate youth and femininity; very short embrasures correspond to advanced age and masculinity.
3.3.4 Inter-arch relationships
In the sagittal plane, when pronouncing the letters V and F, the maxillary incisors must touch the mucous edge of the lower lip.
3.4 The gum
The architecture of the gum, through its shape and contour, profoundly influences aesthetics.
3.4.1 The neck line
The neck line is determined by the level of the marginal gingiva of the maxillary teeth. It must follow the shape of the upper lip. A gingival line is harmonious when all the conditions are met:
- The gingival scallops of the central incisors are symmetrical (they must be located either at the same level or 1 mm apically to those of the lateral incisor).
- The gingival scallops of the lateral incisors are never more applied than those of the canines.
- The gingival scallops of the canines are at the same level or located more apically than those of the central incisors.
3.4.3 Interdental papilla
The presence of interdental black holes due to papillary loss is often a reason for consultation for some patients concerned about aesthetics.
Apart from the aesthetic damage suffered when the smile uncovers the dental cervical embrasures, the loss of papillary volume can cause problems with phonation and saliva retention.
3.4.4 Smile classification
Tjan et al. divided smile lines into three categories:
- The high smile line, which represents a smile revealing the entire crown height of the anterior maxillary teeth and a continuous band of gum;
- The average smile line, which represents a smile revealing 75 to 100% of the anterior maxillary teeth and only the interproximal gum;
- The low smile line, which represents a smile revealing less than 75% of the anterior maxillary teeth.
3.5 Gummy Smile
A smile is said to be gummy if more than 3 mm of gum is visible during a smile. An excessive amount of soft tissue is visible.
3.6 Criteria for an ideal smile :
The level of the marginal gingiva of the maxillary teeth should follow the shape of the upper lip. The line of the upper lip touches the marginal gingiva of the central incisors and canines. The gingival architecture is parabolic and the position of the marginal gingiva is symmetrical from right to left. The most apical point of the gingival scallop reflects the angulation of the long axis of the tooth. The lower lip touches the incisal edge of the 6 anterior maxillary teeth.
Other unsightly situations :
- Spaces between teeth;
- Discolored teeth;
- Misaligned teeth;
- Poorly done fillings: Old and defective restorations;
- Old restorations with dental amalgam (unsightly).
- Unsightly periodontal defects
4.1 Periodontal diseases
4.1.1 Gingivitis
The initiation of periodontal disease occurs in the papillary areas and the marginal gingiva and results in a transformation of the papilla with clinical signs associated with gingivitis: redness, bleeding, edema, etc.
The transformation of the gingival architecture will have an influence on the symmetry and length of the teeth as well as their relationship with the smile line.
4.1.2 Periodontitis
Periodontitis and its treatments will cause an unsightly recession of the marginal tissues. The teeth appear longer with width/length ratios unfavorable to harmony; the embrasures are higher, and sometimes the contact points disappear in favor of diastemas.
4.2 Failure to respect the biological space
This can result in an acute or chronic inflammatory response or the appearance of marginal recession, unsightly pathological signs.
4.3 Marginal tissue recession
4.4 Gingival asymmetries
4.5 Toothless ridges facing bridge intermediaries
4.6 Interference of the frenulum on the gingival contour
4.7 Gingival dyschromia
- Cosmetic dentistry?
5.1 Teeth whitening : is a process that lightens the discolorations of the enamel and dentin of a tooth using a whitening solution that is carbamide peroxide or hydrogen peroxide.
The new whitening pen that makes our teeth instantly whiter thanks to blue light technology. (Easy application thanks to its brush).
5.2 Direct Veneers. Hollywood Veneers : A Painless, Aesthetic Solution.
Cosmetic medicine offers a new alternative to give our teeth a youthful look: dental veneers.
5.3 Implants : correspond to an artificial root which is fixed directly into the bone.
5.4 Fitting dental jewelry :
- Goal : To bring a spark to your smile.
- High quality dental jewelry in :
- 18K gold and white gold and rhinestones.
5.5 Tattooing and Piercing : An Increasingly Common Practice.
The practice of piercing is a real public health problem. The question of the role of health professionals arises, on the attitude to adopt, how to view piercing: Is it an illegal medical act?
Piercing is not a harmless act and can be dangerous. Immediate and delayed complications can appear, limited to the oral cavity or with systemic repercussions. Infectious agents (viruses and bacteria) have an opportunity to penetrate (if they can be present on this site).
There are complications :
- During the piercing: vascular injury (hemorrhage, prolonged bleeding), nerve injury (paresthesia, loss of sensitivity, mobility, taste), muscle injury, allergic reaction to the material used.
- Short term: pain, vascular or inflammatory disorders, local or loco-regional infection, allergic reaction.
- In the long term: healing problems, dental problems (abrasion, crack, fracture), creation of interdental diastemas, creation of cavities, particularly for anterior labial frenulum piercing (by repeated rubbing of the jewel causing progressive abrasion of the enamel and increasing the risk of caries), periodontal problems (gingival recession, bone loss, inflammation), mucosal trauma and incrustation of the jewel in the tissues.
a. Main germs :
- Staphylococcus: S. aureus, S. epidermidis.
- Streptococci.
- Pseudomonas aeruginosa.
- Anaerobes: gangrene.
- Tetanus.
- Syphilis.
- Leprosy and mycobacteria.
b. Viral infections :
- Viral hepatitis: B, C, D.
- HIV.
- Papillomavirus.
- Herpes.
How bacterial infection is transmitted :
- Material used.
- Local.
- Professional hands.
- Client’s skin flora: primary and secondary infection , underlying condition (skin disease, etc.).
- Ink.
Action to take :
- How to remove piercing equipment? And how to do it +++
- Antibiotics?
- Know how to direct people to specialist medical advice.
- Conclusion :
Dentistry is currently experiencing its golden age. Dentists can make a significant difference in their patients’ lives. Dentists are able to think outside the box and perform work that would have been unimaginable just a few years ago.
Cosmetic dentistry
Wisdom teeth can cause pain if they erupt crooked.
Ceramic crowns offer a natural appearance and great strength.
Bleeding gums when brushing may indicate gingivitis.
Short orthodontic treatments quickly correct minor misalignments.
Composite dental fillings are discreet and long-lasting.
Interdental brushes are essential for cleaning narrow spaces.
A vitamin-rich diet strengthens teeth and gums.