[MUSIC] My name is Markus Blatz and I'm Chairman of the Department of Preventive and Restorative Sciences At Penn Dental Medicine. Today, I've given you a brief overview over the area of aesthetic dentistry and what we can do to create beautiful smiles. Aesthetic dentistry is dental treatment that focuses not only on improving the appearance of teeth, but also restoring the proper function. Some of you may be already familiar with aesthetic dentistry, and I will show you some of the more common treatment options that are available today. There are numerous factors that could lead to an unattractive smile. For example, tooth discoloration, malformation, carious destruction, or cavities, and poor positioning. More severe factors are fracture and loss of teeth, which are typically caused by disease, trauma or other injuries. Let's take a look at this young patient. We can probably all agree that he has unattractive teeth. Not only that, his teeth are loose, and sensitive to hot and cold foods and drinks. With a patient-centered treatment plan, we can design and recreate front teeth that are not only more attractive, but also improve chewing function. It's important to understand that it is not our goal to create the same smile for every patient. We know that natural teeth and smiles have some degree of variation. In addition, there are different perceptions and preferences as to what is considered aesthetic. And sometimes, even some slight imperfections may appear more pleasing and natural than perfectly lined up teeth. It is therefore key to work closely with the patient and to determine his or her specific needs and preferences. However, there are some fundamental aesthetic parameters and guidelines that are well documented in the scientific literature. In some sense, designing a smile is like painting, or sculpting. You have to understand natural proportions, and dimensions to replicate them. So, what is the first thing you notice about someone's smile? It's how the teeth are aligned in the face. It's the symmetry, it's the harmony. Next, we evaluate how many teeth are actually visible and how much tooth structure is displayed when the mouth is slightly open. And the lower jaw is addressed. We then also assess how many teeth are visible during a smile. The more visible the teeth are, the more important tooth color and shape become. When we connect the inside edges, or tips of the upper teeth, they form a line that typically follows the curve of the lower lip. Taking a closer look at the teeth themselves, they have specific positions, dimensions, and proportions. They are also in proportion with one another. If teeth are too long or too wide, they are not aesthetically pleasing, and could impact chewing function. The grey lines in this photo indicate angulation of the teeth. Angulation refers to the direction in which the teeth are pointing. Be aware that, while this is a two dimensional image, all these parameters must be considered in a three dimensional space. The surrounding gingiva, also referred to as gums, provides a natural framework for the teeth and is therefore quite important. Non-symmetric or excessive gum display makes a smile less attractive. Now that we have assessed the fundamental aesthetic parameters we can design a new smile and decide on the treatment steps and materials necessary. The type and extent of treatment necessary to create an attractive smile greatly depends on the severity of the patient's individual situation. So in simple cases where the patient may be only concerned with the color of their teeth, treatment might only consist of tooth whitening. However, in severe cases they may require extensive restorative treatment and sometimes even surgery and orthodontics. The general goal of modern dentistry is to be minimally invasive. We want to avoid cutting tooth structure, and we want to preserve teeth as long as possible. This younger patient here was unhappy with the slight crowding of his front teeth. When we closely examined them, we could also see that the existing composite restorations started to fail. We then slightly prepared his teeth to accommodate for laminate veneers. Laminate veneers are basically very thin porcelain shells that have bonded to the teeth. If shape, proportions, and color follow the fundamental aesthetic parameters and blend with the surrounding teeth, the results can be aesthetically pleasing. This patient wanted to whiten her teeth. She already had one crown, which unlike natural teeth, cannot be whitened with conventional tooth bleaching products. Therefore, we needed to replace the existing crown. The tooth underneath was severely compromised and previously built up with a gold cast post and core to support the crown. When the whitening of the upper teeth was complete, the dental technician fabricated a new crown to match the lighter color and the aesthetic and morphologic features of the neighboring teeth. You may agree that the restorations done on this 45-year old female patient are not aesthetically pleasing. The severity of the tooth destructions require preparation of all teeth for full coverage crowns. Her new smile was designed based on the fundamental aesthetic parameters we discussed earlier, and the dental technician was able to fabricate beautiful and naturaly looking crowns. When teeth are completely missing, we can replace them with bridges or implant-supported restorations. And here you can see some examples for that. Dental implants, or bone screws, can support crowns and bridges to replace missing teeth which were lost due to traumatic injuries or other reasons. This young patient lost one of his front teeth in a bicycle accident. An implant was surgically placed into the bone. Here we can see the implant crown coping on a stone cast. Again, the dental technician applied the veneer and porcelain in layers to the coping, matching the surrounding teeth as closely as possible. In some of the more severe cases, for example, when all teeth are lost, the only option left to rebuild function and aesthetics may be a removable denture. This complete denture replaces not only the teeth but also the gums. But even in those challenging cases we can achieve natural looking results when we follow the fundamental aesthetic parameters and guidelines. Modern treatment modalities and materials are excellent tools to craft natural looking, functional, and long lasting restorations. I hope you enjoyed our brief excursion into the world of aesthetic dentistry.
