Photos Are Great for Diagnosis, But Don't Get Faked Out

I rely heavily on photography to help me get to a correct diagnosis and to enable my ability to treatment plan. I like to look at a photo with lips in repose and then an image with a big natural smile. It is also important to really observe your patient and remember that an image is a static impression of a dynamic system. Consider the photos of my patient Pat:

If I use these photos as a tool to create an esthetic tooth arrangement it might look something like this.

I might consider either intruding the upper anteriors or crown lengthening them to create less gingival display for Pat. However, if you look at the lips in repose, she shows about 2-3 mm of central incisor. Do I really want to make these teeth longer? Now, look at a more natural smile when she wasn’t trying so hard to pose.

Pat’s centrals are actually 11 mm in length, a very normal length and when she smiles naturally there is nothing wrong with her gingival display or even the tooth position. If I crown lengthened those teeth or intruded them and added to the incisal edges they would be much too long. Instead we decided to simply replace her composites and do subepithelial connective tissue grafts to cover the exposed root surface and leave the length alone.