Dental 'Cloacopapyrology' – Planning the Smile

This is the fourth part in Dr. Jeff Bonk's “Dental Cloacopapyrology” series.

In “Dental Cloacopapyrology – Implementing Basic Photography,” I discussed the importance of clinical photography. Once the photographs have been captured, it is time to begin the treatment planning process.

Generally, when we or the patients are looking at the teeth, the objective is always to produce a balanced and symmetrical smile. It goes without saying in most cases. I find that the key to developing a sense of where you are and where you need to be is to provide some basic orientation for the treatment planning process.

Based on Spear's Facially Generated Treatment Planning (FGTP) principles, applying tooth outline templates to the photographs help provide a perspective of tooth size and proportion. This is important to gain visual clarity.

My first step in designing a smile or establishing proposed tooth contours, is to indicate the general parameters upon which to apply proportioned teeth. There are three key lines with which I always begin my treatment planning process.

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I begin with placing the vertical midline. This sets the stage for the center point of the face and the smile. Next, I outline the proposed smile line that I am attempting to create. Based upon some additional criteria obtained from the patient examination and in other photographs, the smile line is drawn to reflect the incisal position of all the teeth within the esthetic zone.

My third key reference is designating the gingival contours of the upper anterior teeth. With these three lines I am easily able to plan and outline a proposal of restorative outcome that will be properly fit into the patient's face to reflect their ideal smile.

The image above highlights the three lines that are key to planning and developing a predictable outcome. I apply this technique and theses lines to any case, be it a single tooth or an entire restoration. Beginning with a visual direction with reference lines leads to greater success.

Additionally, communication with your interdisciplinary team is improved when these photos are shared and discussed. Next time you have an esthetic case to plan, just “line it up!”

Jeffrey Bonk, D.D.S., is a member of Spear Resident Faculty.