The power of incisal embrasures

Tooth shape is one of the factors that has had a great impact on smile esthetics, and it is influenced by the individuals preferences, age, gender or cultural, and ethnic features. Also, incisal embrasure are often overlooked as one of the most important elements when designing a smile. Many of the characteristics we give a smile are embedded in the shapes and depths of these little triangular negative spaces. In fact, I can take a smile that looks completely worn down, aged, fake or just plain wrong, and by only changing the contours of the incisal embrasures, make it a beautiful smile. In this article I will show you how we can change the appearance of a smile by simply changing the incisal embrasures using direct CompoSite restorations.

smile with worn incisors

Fig.1
A 22-year-old male patient came to the dental clinic complaining of irregular incisal edges and the overall appearance of his smile. He wanted to improve his smile in a very simple way after finishing his orthodontic treatment.

smile after conservative enhancement of front teeth

Fig.2
The retracted view shows worn and chipped incisal edges due to the presence of malocclusion in the lower anterior area which fixed by orthodontic treatment.

illustration of incisal embrasures

Fig.3
The incisal embrasure is a space existing on the incisal aspect of the inter-proximal contact area between adjacent anterior teeth. This embrasure space is dictated in part by the morphology of the teeth.
This pattern of silhouetting created by the edges and separations between the maxillary anterior teeth against the darker background of the mouth helps define of the mouth helps define a good- looking smile. Functionally incisal embrasures allow the lower teeth to clear in excursive movements without being trapped. The depth of incisal embrasure between the two front teeth is usually 10%-20% of the contact area of the two teeth. The depth of the incisal embrasure between the next two teeth is usually a bit deeper and it continues going a little deeper as the teeth move more toward the back teeth. This is a characteristic of natural teeth.

smile design on photograph

Fig.4
It’s important to design the new smile and the length of the new upper incisal edges, and their contour following the anatomy of the lower lip.

intraoral smile design

Fig.5
We decided to increase the incisal length the extent needed to create a proper incisal embrasure, and make composite veneers for the upper first premolars to be continuous with the smile line.

split dam isolation

Fig.6
Rubber dam isolation is mandatory to provide a clean, contaminant-free environment.

total etching of enamel surfaces

Fig.7
No prep was required here, just additive work. Overextended etching was done to create a safe bonding area for perfect margin seal, except for the right canine and premolars. As all restorative work is going to be bonded onto enamel, totaletch for 30 seconds for the entire labial and incisal surfaces.

bonded enamel before composite layering

Fig.8
After applying a universal adhesive, it was gently air-blown to remove the solvent and then light-cured for 60 seconds in all directions to ensure complete polymerization of the adhesive layer.

palatal shells for incisal lengthening

Fig.9
After building the palatal shell to transfer the new design with CompoSite E (White Dental Beauty).

layered incisal edges with embrasures

Fig.10
Using multiple flowables to fill the incisal area and then layering E CompoSite White Dental Beauty as a final layer.

incisal restorations after finishing

Fig.11
A simplified protocol is ideal when polishing multiple restorations. First, a diamond perio bur is used to smoothen the composite and to adjust the anatomy. Then, a pop-on disc is used to define the angle lines and for further smoothing. As a third step, a beige spiral wheel (3M) is used to safely polish thanks to its flexible shape which adapts to all tooth surfaces.

polishing with lucida and dashing paste and star felt

Fig.12
As a last step, the Lucida™ Composite Gloss System by Styleitaliano was used. The disposable Lucida Star Felt is mounted on the autoclavable latch mandrel to buff the DiaShine Lucida Paste (completely water soluble).

finished incisal restorations on front teeth

Fig.13
Immediatly after final polishing.

contrast shoring anatomy of incisal embrasures

Fig.14
The black background highlights the incisal embrasures.

smile of patient after composite restoration of incisors

Fig.15
Post-session smile.

graphic lip line check for incisal anatomy

Fig.16
Two-week follow-up with little adjustments based on the patient’s requests. Note the harmonious smile line.

growing dimensions of embrasures

Fig.17
Right view. Note the gradual change in depth of the incisal embrasures between the teeth from central to canine for a good-looking smile.

incisal embrasure scheme

Fig.18
Left view.

before and after incisal restorations

Fig.19
Before and after comparison showing how the incisal embrasure can affect a patient’s smile.

smile after conservative enhancement of front teeth

Fig.20
At two-week recall, the full smile of a very satisfied patient.

Conclusions

Incisal embrasures play an important role in smile esthetics and influence the perception of attractiveness. In general, the semi-rounded embrasure form is the most preferred during direct or indirect restorative work.

Bibliography

1. Assad Duarte ME, Machado RM, Jardim da Motta AF, Mucha JN, Motta AT. Morphological Simulation of Different Incisal Embrasures: Perception of Laypersons,Orthodontic Patients,General Dentists and Orthodontists. J Esthet Restor Dent 29:68^78, 2017
2. Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132: 39–45.
3. Kerosuo H, Hausen H, Laine T, Shaw W C. The influence of incisal malocclusion on the social attractiveness of young adults in Finland. Eur J Orthod 1995; 17: 505–512
4. Blitz N. Criteria for success in creating beautiful smiles. Oral Health 1997; 87: 38–42
5. Devoto W, Saracinelli M, Manauta J. Composite in everyday practice: how to choose the right material and simplify application techniques in the anterior teeth. Eur J Esthet Dent. Spring 2010;5 (1):102-24.
6. Manauta J, Salat A. Layers, An atlas of composite resin stratification., Quintessence Books, 2012.
7. Villarroel M, Fahl N, De Sousa AM, De Oliveira OB Jr.Direct esthetic restorations based on translucency and opacity of composite resins. J Esthet Restor Dent 2011;23(2):73-87.
8. Manauta J, Salat A, Putignano A, Devoto W, Paolone G, Hardan LS. Stratification in anterior teeth using one dentine shade and a predefined thickness of enamel: A new concept in composite layering – Part II. Odontostomatol Trop 2014; 37 (47): 5-13
9. Morley J, Eubank J. Macroesthetic elements of smile design. J Am Dent Assoc 2001; 132: 39–45.
10.Kerosuo H, Hausen H, Laine T, Shaw W C. The influence of incisal malocclusion on the social attractiveness of young adults in Finland. Eur J Orthod 1995; 17: 505–512
11.Blitz N. Criteria for success in creating beautiful smiles. Oral Health 1997; 87: 38–42

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