Let’s work out together 10 details we can see in this beautiful lady’s initial smile:
- Crowding on upper and lower arches
- Color discrepancy between all teeth
- Heavily filled dentition with few crowns
- Uneven gingival margins
- Interesting tooth form on upper right canine
- Exposed dentine/recession on upper central incisors
- Asymmetry in her lip dynamics
- Smile curve is pleasant
- Dissimilar tooth form of the two upper central incisors
- Length discrepancy of the upper two central incisors in her face
What are 30 more things we could consider:
- What does the photo series/OPG/bitewings/periapical radiographs reveal?
- Are there any jaw joint sounds?
- Load test? Immobilisation test?
- Any jaw deviation?
- Is the range of movement of the jaw within the normal range?
- Does her jaw move symmetrically on lateral excursions?
- Does she have any muscle tension?
- Does she clench or grind or have any other para-functional habits?
- What is her existing occlusion like?
- Is her occlusion acceptable?
- Does she have bilateral, equal intensity contacts?
- Is the crowded lower central incisor a chewing interference?
- Is there any urgent caries or root canal therapy you would need to attend to first?
- Is the upper left first premolar crown supported with an implant or natural tooth?
- Are the upper central incisors crowns?
- Did the upper central incisors extrude over time to now expose cervical dentine?
- Are there any younger smile photos of the patient to compare the cervical margin location of her central incisor crowns?
- How would you design her smile?
- Probing depths? Gingival assessment? Existing recession? Bone levels?
- Is she open to having orthodontic treatment?
- Is orthodontics alone enough to give her a nicer smile?
- Is she aware of the existing black triangles between her front teeth?
- Will she be compliant with orthodontic treatment?
- Is she aware that with orthodontics and unravelling of the crowding more black triangles can open up?
- Is she open to gingival or connective tissue grafts post orthodontics?
- How to manage the central incisor black triangle with any new restorations?
- Is it sustainable for her to have 4 monthly hygiene reviews while in orthodontic treatment?
- Is she open to further crowns/veneers post ortho?
- How many crowns/veneers at a minimum might she need to consider post orthodontic treatment to improve her smile.
- Will she be committed to the treatment plan?
……and the list goes on!
