Digital Smile Design concept delineates the final potential result of crown lengthening and porcelain veneers to correct a gummy smile

Richard Trushkowsky, DDS
Cariology and Comprehensive Care – International Aesthetics,
New York University Division College of Dentistry, NYU College of Dentistry
David Montalvo Arias, DDS
Cariology and Comprehensive Care – International Aesthetics,
New York University Division College of Dentistry, NYU College of Dentistry
Steven David, DDS
Cariology and Comprehensive Care – International Aesthetics,
New York University Division College of Dentistry, NYU College of Dentistry

Prior to initiating any treatment, it is necessary to visualize the desired out-comes. It then becomes possible to for-mulate the steps required to achieve this result. Digital Smile Design (DSD) utiliz-es patient input and information gath-ered through diagnostic procedures to create an esthetic treatment scheme. In the case presented here, the NYUCD Esthetic Evaluation Form, intraoral and extraoral photographs, mounted diag-nostic casts, physical examination, and radiographs were the diagnostic modal-ities. The gathered information served as a starting point for a wax-up and in-traoral mock-up. This case report dem-onstrates how the DSD served as a tem-plate for crown lengthening procedures and design of the final porcelain veneer restorations.

Esthetic dental concerns have become more widespread among people with rel-atively affluent lifestyles in at least some segments of the population in almost all countries. Patients’ esthetic awareness and expectations have increased, so that close to what are perceived to be ideal outcomes are required. Long-term stability necessitates dental restorations that are congruent with the periodon-tium and occlusion.1 An esthetic smile consists of three main constituents: the teeth, the lip framework, and the gingi-val scaffold.2 An ideal smile has the fol-lowing properties: minimal gingival dis-play, symmetry and harmony between the maxillary gingiva and the upper lip, healthy gingival tissue filling the entire interproximal spaces, harmony between the anterior and posterior segments, teeth with correct form and position, proper tooth color and shade, and the lower lip parallel to the incisal edges of the maxillary anterior teeth and to an im-aginary line going through the contact points of these teeth.3,4 When a smile displays a disproportionate amount of gingiva, this phenomenon is referred to as a gummy smile.

At rest, young women usually display 3 to 4 mm of the maxillary central inci-sors, and young men display an aver-age of 2 mm or less. Extraoral causes of a gummy smile are vertical maxillary excess (VME), hypermobile upper lip (HUL) or a short upper lip. Face height is usually measured by dividing the face into thirds. A visual diagnosis of VME can be made when, on cephalometric analysis, the lower third of the face is longer than the middle and upper thirds.

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