The Power Of 4: Preserving dental tissue
Nowadays, even after the advent of new materials, and the simplification on how to achieve good esthetics, it is often seen and suggested by clinicians to do restorations for all the teeth in the visible area. If a case is being planned for indirect restorations, it is suggested more so. The effort that goes into matching the restorations to the existing dentition is always an issue. It surely requires skills of a master technician to achieve high esthetics and preserve tooth tissue by not having to prepare teeth that are healthy and are in a reasonably acceptable position to achieve optimum esthetics.
The significance and role of the canines and more so if they are present in Class 1 is well established. If a clinical situation allows the canines not to be restored and a mutually protected occlusion to exist, then it is the author’s suggestion that one should try to plan 4 restorations that involve the incisors only in the upper arch.
The teeth might not be in golden proportion, but an attempt should be made to achieve a harmony and balance in dental and facial esthetics.
In order for the existing canines and bicuspids which as is being suggested should be in relatively good aesthetic position, the treatment of choice should be bleaching. It is also to be understood that in nature the incisors have a higher value compared to the canines and therefore even if the 4 anteriors were planned one shade lighter, the restorations integrate in the smile of the individual.
This makes the teeth have a lower value and in most cases eliminates the need for having restorations on them to achieve harmony.
There are three cases to show how only indirect bonded restorations can enhance aesthetics. The author acknowledges the craftsmanship of MDT Lamberto Villani of Oral Design in Dubai who fabricated all these restorations.
A patient came after endodontic treatment desiring better aesthetics for her teeth that had undergone physical trauma in the past. This is a preoperative frontal view
A 64 year old female patient came in to have her smile improved. There was chipping, some old bonding, different shades of teeth, reverse smile line and also some open embrasures in between tooth number 12 and 11.
A 45 year old lady wanted her smile to be enhanced. She had an old PFM crown on 21. Some diastemas, reverse smile line relatively large teeth.
It is hereby concluded that:
1) An attempt should be made to minimize and involve the teeth that have the greatest impact on the smile.
2) Use of layered ceramics provide very high quality esthetics.
3) Have very smooth preparations and try to restrict your preparations as much as is possible in enamel.
4) There is a power in 4 think less and not more.
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