Risk Category IV: Esthetics:

     People whose smiles demonstrate the entire front teeth, along with the gum level above, are more challenging to make dentistry in the front look indistinguishable. Some show next to nothing when we smile, the low risk situation. The condition, location, size, shape of teeth, the gumline presence, as well as an individual’s expectations can also influence the risk factor for this category, raising the level of risk.

     Our initial examination includes a series of photographs of not only teeth, but how much is displayed at various smile positions, and angles. This is essential in determining and influencing the outcome of our final restorations.     

     A well designed treatment plan involving front teeth, whether it is driven by esthetic desire, or needed by restoration, and includes the front teeth, considers these variables. There are times when the teeth may be short, and an undesirable gummy smile is present. By moving the gumline up, we can reduce the risk of esthetic challenge, making the teeth more proportionate at the same time we level gum lines, moving these into an area where it is less visible.

     Replacement of a front tooth is challenging. It can be done with either a fixed or removable option. The fixed choice may be a bridge, or an implant. It is very hard to make any of these choices predictably hard to detect, and in situations where the lip raises, and shows the whole gumline, this is our highest risk. We frequently make this less noticeable with the use of grafting gum before we complete the dentistry, typically done by a surgeon. When implants are used, placing a provisional crown as early as possible helps make the gum develop quicker, making it less noticeable.

     I frequently tell our clients that dentistry has a ‘functional ‘ life which exceeds its ‘esthetic’ life. This implies that after a number of years, we may see that our efforts have become visibly noticeable, such as when recession of the gum occurs, or adjacent natural teeth darken. However, our results may continue to function properly for an extended period of time.