Australasian Dentist Issue 92

CATEGORY 52 AUSTRALASIAN DENTIST Introduction: The benefits of orthodontic treatment have long been recognised by the dental profession and patients alike. The need, or want, to correct crowded or malaligned teeth dates back to at least 1000 BC (Proffit, Fields, & Sarver, 2007). Generational changes including ubiquitous marketing, the advent of social media, ‘selfie camera’, and more recently beautifying smartphone apps have resulted in dramatically increased emphasis on having a “straight, white smile” amongst other cosmetic improvements (Ramphul & Mejias, 2018). A big portion of the general population, the adult demographic, showed a reluctance to wear braces due to its visually obtrusive nature (Wheeler, 2017). Instead, some adults would undergo dental restorative procedures to mask underlying malalignment or just live with the malalignment – many of whom adopt a closed-lip smile or decreased social and psychological well-bring (Afroz et al., 2013; Koidou, Chatzopoulos, & Rosenstiel, 2018; Mampieri, & Giancotti, 2013). As a result of Align’s aggressive consumer-facing marketing, the number of patients asking to be treated with Invisalign® steadily rose, particularly in the adult population (Align, 2019). Beyond the aesthetic benefit, other benefits when compared to braces include: improved patient comfort, reduced pain, better periodontal health, reduced soft tissue irritation and fewer clinical emergencies (Weir, 2017; Rossini et al., 2015). For patients presenting with a desire to improve their smile, it is prudent for today’s thinking clinician to not only focus on teeth, but to make a complete facial aesthetics assessment. Various authors have described many different approaches and different landmarks, perhaps highlighting the subjectivity of ‘beauty’ (Robbins & Rouse, 2016; Machado, 2014; Rotundo et al., 2015). Adapted 8 principles of smile design: 1. Buccal corridors: remain a critical aspect of smile aesthetics. We aim to, when possible, for medium corridors (5-15%) 2. Smile Cant: in order to achieve facial harmony, the smile line must coincide closely with the interpupillary line (Shyagali, et al 2008) 3. Reduction of gummy smile: reduction of gingival display can be achieved via intrusion of maxillary teeth, facial injectables such as botox or fillers in labia oris elevators, crown lengthening or a combination of all three. 4. Smile Arch and ‘central/lateral step’ 5. Golden ratio: The golden ratio of tooth sizes is followed as closely as possible to achieve visual harmony. 6. Facial and maxillary midline: coincident midlines, particularly the facial and maxillary midline, can lead to less distraction to the eye 7. Incisal edge shape 8. Tooth colour Diagnostics and Treatment Planning A thorough clinical examination, patient interview and complete set of records were taken to help us formulate our treatment potential. Using a digital platform, we provided our patient with a number of different treatment options, which allowed her to visualise the benefits and risks of treatment, as well as the end results (see figure 1 – 5). Clinical Examination Clinical examination shows the patient presents with multiple missing posterior LINICAL Aligners and smile makeovers – the benefits are clear By Dr John Hagiliassis and Dr George Abdelmalek George Abdelmalek John Hagiliassis Series 1 – Pre Op photos