CATEGORY 68 AUSTRALASIAN DENTIST CLINICAL Introduction In the world of aesthetic dentistry, achieving the perfect balance between form and function is an art. Short teeth, often accompanied by a gummy smile, present a unique set of challenges that demand a meticulous treatment strategy. This case study delves into the assessment, planning, and execution of crown lengthening surgery, offering a roadmap for practitioners seeking insights into managing similar cases. Discover how a thoughtful treatment plan, tailored to the specific needs of the patient, not only addressed the cosmetic concerns associated with a gummy smile but also tackled the fundamental issue of insufficient tooth structure – a lack of ferrule effect. A patient-centered approach is paramount, ensuring transparent communication of all viable options. The case study presented herein evaluates the integration of gingival analysis into the treatment plan, showcasing how to address these often interrelated components. Short Teeth Recognising short anterior teeth is crucial in the practice of aesthetic dentistry. The average dimensions of an adult central incisor according to Magne 2003 has a width of 9.1mm and a length of 11.7mm. However, using general tooth dimensions does not take into account the differences in stature of the individual, the difference in size seen in male and female patients and the racial differences in dimensions. What is more clinically useful is to use the crown width to length ratio. Analysis of this ratio shows that unworn central incisor teeth have an average ratio of 78%, in Caucasians and a ratio of 72% in Asians (Magne 2022). Where we can start to diagnose short teeth is when the length of the central incisor becomes similar to the width, resulting in a tooth that assumes a squarelike appearance. The literature is scarce in pinpointing the precise threshold, but Magne 2022 gives us a starting point. He defines worn teeth with a ratio of 87%, providing a basis for labelling a tooth as short. Figure 1 highlights the visual change where short teeth with a ratio over 100% was treated with crown lengthening surgery and restorative work, resulting in a more harmonious final ratio of 78%. After establishing the diagnosis of a short central incisor, a crucial decision revolves around whether to enhance it’s length through incisal edge addition of surgical apical relocation of the gingival margin. This decision-making process is pivotal, as merely extending the length without a comprehensive understanding of underlying factors may yield aesthetically displeasing outcomes concerning the patient’s face and smile. Furthermore, it has the potential to negatively impact occlusion by modifying the jaw’s guidance pattern and restricting the envelope of function. In addition, successful management of short teeth necessitates the identification of aetiological factors to prevent subsequent damage post-treatment. The common causes of short anterior teeth stem from attrition, erosion, a history of trauma and iatrogenic causes from adjustments made to the incisal edge. Gummy Smile A gummy smile can be considered as more than 2.0mm of gingival display during a high smile (Peck 1992). While this criterion may be subjective across various cultures, Kokich 1999 observed that an upper gingival display of ≥ 4.0mm during a high smile line was considered as unattractive by clinicians and laypeople. A comprehensive understanding of the diagnosis of a gummy smile is required given that treatment options are aetiologically specific and incorrect treatment could result in undesirable and irreversible outcomes. Harmony Restored: A Case Study on Short Teeth, Gummy Smile and a Lack of Ferrule Effect Dr. Andrew See By Dr. Andrew See BDS Hons (Syd), FRACDS, MSc(Lond), PGDipDentImplantology, FCGDENT(UK), FICOI, MFDS RCSEng Abstract This clinical case study delves into the realm of aesthetic dentistry as we unravel a compelling case that showcases the successful treatment of a complex dental scenario involving short central incisors, a gummy smile, and the challenge of a lack of ferrule effect. This case explores the intricate approach taken to address these interconnected issues offering practical insights for managing such challenging situations. Treatment planning emphasised the necessity of a holistic treatment approach for optimal results. Full-face photographs are included with written consent from the patient. Download Dr See’s Gummy Smile Blueprint for a more in-depth practical guide to diagnose a gummy smile and select the appropriate treatment. Go to drandrewsee.com/gummysmile for your free copy. Fig 1. Analysis on central incisor ra.os Fig 2. Absence of ferrule on 11 and unfavourable tapered preparation 21.
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