Leading and Trailing Edges: Part 1

February 22, 2018 Richard Green DDS MBA

When Dr. Richard Green read Dr. Lee Ann Brady’s blogs on pitch and bevels, he decided to jump in with a thoughtful response. Read on for more discussion of this fascinating topic.

Crossover and Movement: Consider the Edges

I loved Dr. Brady’s article concerning edges (pitch and both bevels) and the conversation about natural teeth, composition, and porcelain. I was reminded of some of my learning with and from Henry Tanner while refining my occlusion in the mid-70s. It worked for me no matter what material and bite splints were used.

Henry was the first to introduce me to ‘crossover.’ At the time, one of the anterior teeth you did not talk about were the cuspids. They too have important facets (pitch and two bevels) that need to match cusp tip to cusp tip, regardless of the material.

When moving into crossover and the cuspid tips touch, if the pitch facet does not match or is pointed, sloped, or rounded, you often see the masseter or temporalysis muscle twitch. This occurs as the patient hesitates in their movement. That smooth transition back to the incisal edges of the centrals and laterals is important.

I also realized during my career that certain patients (teens, golfers, baseball players) would often stabilize their head while their teeth were cuspid tip to tip or in a crossover position at the point of their impact with the ball.

Improvements can be accomplished by simply taking the flat portion of a ½ J (wheel fine diamond) and creating matching facets on upper and lower cuspids. Polish them and both the leading and trailing bevels so that the movement becomes smooth. If the patient wants to stop cusp tip to cusp tip on the upper and lower cuspid, there is a stable stop and the muscles are comfortable.

To be continued…

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Richard Green DDS MBA

Rich Green, D.D.S., M.B.A. is the founder and Director Emeritus of The Pankey Institute Business Systems Development program. He retired from The Pankey Institute in 2004. He has created Evergreen Consulting Group, Inc. www.evergreenconsultinggroup.com, to continue his work encouraging and assisting dentists in making the personal choices that will shape their practices according to their personal vision of success to achieve their preferred future in dentistry. Rich Green received his dental degree from Northwestern University in 1966. He was a early colleague and student of Bob Barkley in Illinois. He had frequent contact with Bob Barkley because of his interest in the behavioral aspects of dentistry. Rich Green has been associated with The Pankey Institute since its inception, first as a student, then as a Visiting Faculty member beginning in 1974, and finally joining the Institute full time in 1994. While maintaining his practice in Hinsdale, IL, Rich Green became involved in the management aspects of dentistry and, in 1981, joined Selection Research Corporation (an affiliate of The Gallup Organization) as an associate. This relationship and his interest in management led to his graduation in 1992 with a Masters in Business Administration from the Keller Graduate School in Chicago.

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Case Study: All Porcelain Restorations

February 20, 2018 Glenda Owen DDS

Dive into this case for a look at Dr. Owen’s thought process and treatment protocol leading to porcelain restorations. 

Angela was 27 when she came to us asking about options to improve her smile. She was getting married within a year. She hated the appearance of the bridge #3-6 that had been placed in high school. It was repaired at the buccal margin of #6 the day of delivery. She also said she wanted to avoid implants because of time issues and she didn’t want more crowns.

Patient Background

Angela was congenitally missing #4, 7, 10, 12, 13, 20, and 29. In the past, she had implants to replace the lower bicuspids and said the process took too long. Her previous dentist had placed two upper bridges – #3-7 with pontics on #4 and #7 and #14-10 with pontics on #13 and #10. The space for #12 did not exist.

 

Treatment Plan

I noticed her narrow central incisors compared to her laterals and the general contour and color of the bridges. I knew we could improve her smile with all porcelain restorations. Implants to replace missing teeth and veneers on the centrals would make a difference. We did a wax up that she took home to study, comparing it to the model of her existing restorations. She visited the periodontist who would do the implants and I showed her lots of photos of other cases similar to hers.

Creating Porcelain Restorations

Ultimately Angela agreed with our plan. She had implants replacing #7, 10, and 13. We used Zirconia abutments and e.max crowns, as well as an e.max crown for #14. She opted for a Zirconia bridge #3-5. While she was healing, we made provisional bridges, including the cantilevers for the laterals. She was hesitant about the veneers on #8 and #9, but before we began I removed the bridges and created a trial restoration with the wider veneers and proper bridge contours. I took photos and let her think about it before she agreed. She got married with a beautiful new smile.   

What interesting cases are you currently working on? 

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Dr. Glenda Owen practices in Houston, Texas where she lives with her husband Kevin. She is a graduate of the University of Texas Dental Branch in Houston. Dr. Owen is a faculty member and member of the Board of Directors for The Pankey Institute.

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Who Captures The Facebow Record?

February 10, 2018 Roger Macias DDS

Do you feel reticent about having someone other than you use the facebow? 

A Spatial Reference Point Story

Recently over the holidays as I was “channel surfing” I came across the movie Apollo 13. This is one of those movies that no matter how many times I have watched it, I just have to stop and watch it one more time. Every time I do, I can’t help but get misty-eyed when it gets to the part when the crew make it back to Earth safely (SPOILER ALERT … But you probably read this in the history books anyway).

For me, there is one super exciting moment in the film when Astronaut James Lovell (aka Tom Hanks) has to find a reference point to correct their descent back to Earth from space or burn up on re-entry. Since he cannot use his on-board computers, he lines up his spaceship with the Earth in his window.

“Keep the Earth in the window!” A spatial reference point! Too much correction and their spaceship burns up on re-entry. Too little and they skip off the Earth’s atmosphere.

Make Your Facebow Process Simpler

In our dental offices, the facebow is used to give us a spatial reference point for mounting diagnostic or working models of our patient’s dentition. This is done onto an articulator that approximates the realities of our patient. Sure, you might be able to mount casts arbitrarily, but is your accuracy reproducible? The facebow is a simple tool in our armamentarium to make our life easier.

The question remains, “Is this a task that the dentist must perform?” In my office when we create exquisite dental mountings, I delegate this task to my awesome dental assistants.  With a little training they can do this immediately and the procedure only takes a few minutes.

This involvement is a great way for them to demonstrate their knowledge. It paves the way for more opportunities to open conversations about the Dentist’s Care, Skill, and Judgement. They become your chairside cheerleader and highlight your expertise. They will also express how a critical bite registration record or protrusive record performed by the dentist will only enhance the outcome of treatment.  

Information gathered through the use of a facebow makes our dentistry more predictable. It distinguishes you and your team as a highly trained dental practice.

Don’t burn up on re-entry or skip off into space. Glide effortlessly into beautiful predictable dentistry by using your facebow. Keep your Earth in the window!

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Roger Macias DDS

Dr. Macias obtained his dental education at the University of Texas Health Science Center Dental School at San Antonio and graduated in 1983. While establishing his private practice, Dr. Macias was an assistant professor in the Department of General Practice at the UT Dental School from 1983 until 1989. He is the team dentist for the San Antonio Rampage, the WNBA San Antonio Silver Stars, the San Antonio Missions Baseball Club as well as numerous college universities and high schools in the south Texas area. Dr. Macias is active in numerous dental study clubs and is currently a faculty professor at the world renowned L.D. Pankey Institute for Advanced Dental Education in Key Biscayne, Florida. Among Dr. Macias’s many accolades and awards, he has received his Fellowship in the American and the International College of Dentistry as well as the Pierre Fauchard Academy.

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Case Report: Ceramic Veneers & Invisalign Part Two

January 3, 2018 Mike Crete DDS

This is part 2 in a series where Dr. Mike Crete describes an conservative esthetic case where he combined Invisalign and veneers.  Part one looks at helping the patient become aware of the possibilities. Read on for the conclusion.

A Smile Dialogue

… All of this conversation took place in about 5 minutes at the end of the patient’s initial hygiene examination. I then invited him to return for a ‘complimentary smile analysis’ appointment where I would take a series of digital photos and then sit down with him and talk about what we could do to improve his smile.   

I find I can build trust and credibility with a new patient by offering to see them for this complimentary appointment. It only takes about 20 minutes and I typically ‘convert’ the patient to a records appointment (comprehensive exam, X-rays, and mounted study models).

The records appointment was scheduled. More co-discovery revealed how significant Drew’s self-esteem was impacted by his smile and his ‘baby face and baby teeth.’ The records appointment was followed by a diagnostic wax up (or a “3D Design” as I like to call it when talking to patients).

Then a consultation was done to review treatment options. This was a formal case presentation using Powerpoint, photos, and mounted models. Drew’s mother sat in on the consultation appointment.

By having accurately mounted study models on a semi-adjustable articulator, I was able to determine I could give Drew an ideal occlusion AND a pleasing smile. This would involve some minor tooth movement using Invisalign for 6 months and then restoring his upper and lower anterior teeth with conservative porcelain veneers. His posterior teeth were equilibrated during the restorative process. Also, an upper bite guard was fabricated for nighttime wear and added protection of the restorations.  

Drew graduated from college approximately 18 months after I first met him. He completed an internship during his final semester and then was hired by the Fortune 500 company immediately following graduation. He recently got married and said to me, “After I had my teeth done everything in my life started to fall into place. I graduated, got a great job, and met the love of my life. Thanks, doc.”  

Changing a smile and changing a life. It’s being able to impact the lives of others in this way that makes it so rewarding to practice dentistry!  

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Dr. Mike Crete lives and practices in Grand Rapids, MI. He graduated from the University of Michigan dental school over 30 years ago. He has always been an avid learner and dedicated to advanced continuing education., After completing the entire curriculum at The Pankey Institute, Mike returned to join the visiting faculty. Mike is an active member of the Pankey Board of Directors, teaches in essentials one and runs two local Pankey Learning Groups in Grand Rapids.

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Case Report: Ceramic Veneers & Invisalign Part One

January 2, 2018 Mike Crete DDS

Dr. Crete discusses an anterior esthetic case from the initial conversation to finished treatment plan for a patient who lacked smile confidence.

Patient Profile

Drew became a new patient at my practice as a 20-year-old junior in college. His reasoning was: “Just to get my teeth cleaned.” During his initial hygiene appointment, he mentioned the “spot” on his front tooth (#9 – small pit filled with composite 10 years prior).  

He asked: “Can you put some new bond on there and make it match better? Even when my dentist did it the first time, it was always obvious.”

I heard his question as a window to ask further questions and find out a little bit more about him. At Pankey, we call this, ‘knowing your patient.’ It can start with an introduction to a new patient during a hygiene examination.  

Asking the Right Questions for Case Acceptance

I began by asking, “Do you know why you had the bonding done?” and “Did you have a cavity?”  

His answer was, “No, I have been playing hockey since I was really little. I was not always good about wearing my mouth guard and I chipped my teeth a lot.”   

Further questioning revealed he was referring to the enhanced mamelons and pitted enamel areas of his anterior teeth as “chips.”

His parents had elected not to have the chips repaired because they were told it was cosmetic treatment and their insurance would likely not pay anything.  

The Value of Open Dialogue

I then asked a few more open-ended questions like, “Is there anything about your smile you would change?”  

His answer: “Well, I always feel like I have little teeth and it makes me look like a little kid. I wanted braces when I was in junior high but my dentist told me I had a good bite and braces wouldn’t fix all the spaces I have.”  

Further dialogue with Drew revealed a significant concern he had about graduating from business school in a year and having to go through interviews looking like a little kid. He said, ”I worry no one will want to hire me because I look so young.”

To be continued…

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Dr. Mike Crete lives and practices in Grand Rapids, MI. He graduated from the University of Michigan dental school over 30 years ago. He has always been an avid learner and dedicated to advanced continuing education., After completing the entire curriculum at The Pankey Institute, Mike returned to join the visiting faculty. Mike is an active member of the Pankey Board of Directors, teaches in essentials one and runs two local Pankey Learning Groups in Grand Rapids.

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Treating White Spot Lesions

December 29, 2017 Mark Kleive DDS

White and brown spot lesions on the anterior teeth can be very distressing for the patient and a frustration for clinicians. Normally, they are decalcification or deposits on the teeth from fluoride or other minerals.

They do not require restoration. We are hesitant to do this and sacrifice good tooth structure, but esthetically they can really bother patients. They reduce a patient’s confidence in their smile. Recently, I have found a solution to this clinical situation that meets both the patient’s esthetic demands and my desire to be conservative.

Reversing Lesion Color on Anterior Teeth

Icon, from DMG America, is a translucent resin infiltrate that reverses the color of the lesion. It brings the tooth back to its natural color, requires no tooth preparation, and protects the tooth from further decalcification or progression into a carious lesion.

After we isolate with a rubber dam, the tooth is etched with a special etchant included in the kit. The protocol requires a longer etching time then we are accustomed to with other procedures.

After each etching procedure, we rinse and dry the tooth. Then we apply a special drying agent that allows us to evaluate the final result prior to proceeding with the resin.

If the tooth color has not yet been optimized, the etchant is applied again. This can be repeated up to five times. Once we have completed the etching process and confirmed the result with the drying agent, the resin is applied and then cured.

The entire procedure is done without any anesthesia and is very comfortable for the patient. Icon can be used on the facial and also on interproximal areas.

The resin is not visible on an x-ray, so the kit comes with a card to give the patient. This is so that if they see another dental office in the future, they are aware that the interproximal areas will still appear decalcified on an x-ray but have been fully infiltrated with resin.

I really enjoy offering this incredible, conservative esthetic service to my patients.

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Dr. Mark Kleive earned his D.D.S. degree with distinction from the University of Minnesota School of Dentistry in 1997. Mark has had experience as an associate in a multi-clinic setting and as an owner of 2 different fee-for-service practices. For the last 6 years Mark has practiced in a beautiful area of the country – Asheville, North Carolina, where he lives with his wife Nicki and twin daughters Meighan and Emily. Mark has been passionate about advanced education since graduation. Mark is a Visiting Faculty member with The Pankey Institute and a 2015 inductee into the American College of Dentistry. He leads numerous small group study clubs, lectures nationally and offers his own small group programs. During the last 19 years of practice, Dr. Kleive has made a reputation for himself as a caring, comprehensive oral healthcare provider.

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Esthetics & Function: Incisal Edge Bevels

December 10, 2017 Lee Ann Brady DMD

There are three critical components to the incisal edge anatomy of anterior teeth. Understanding the function and esthetics of the pitch and two bevels is essential to creating an ideal patient result.

How can a clinician re-create the full anatomic form of the tooth in ceramics and composite? 

In my last blog on this topic, I discussed the dimensions, characterization, esthetics, restorative approach and challenge of mimicking ‘pitch‘ esthetics. Now, I’ll delve into mastering the bevels to create superior restorative results. Combining an esthetic pitch with functional bevels will ensure a smooth composite or ceramic outcome.

Components of Incisal Edge Anatomy Function and Esthetics: Bevels

The two bevels can be found on alternately the labial and the lingual of the transition zone between the pitch and these surfaces. They are often called the leading edge and the trailing edge.

Bevels

Dimensions: The bevels on both sides have a variable width. They can be between less than a millimeter to multiple millimeters long.

Characterization: The bevels lengthen in patients who grind their teeth in an excursive pathway pattern. Patients who parafunction edge to edge might eliminate the bevel. This makes it easier to shear enamel off on the labial or lingual side of the tooth. It also could result in chipping the edge enamel.

Function: The bevel is a transition zone to create smooth functional movement passing from excursive movements onto the pitch. Intercuspal stops on lower incisors are often on or gingival to the bevel.

Whether you are finalizing an equilibration, the occlusion on composites, or ceramics, perfecting anterior guidance is all about both pitch and bevel surfaces. These critical components are a great example of marrying form and function in your technique.

What is your restorative approach for recreating incisal edge anatomy? We’d love to hear from you in the comments! 

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Esthetics & Function: Incisal Edge Pitch

December 8, 2017 Lee Ann Brady DMD

The incisal edge anatomy of anterior teeth is quite complex. This complexity is fundamental to the esthetics of the tooth, as well as the function of incisors. How do we re-create the full anatomic form of the tooth in ceramics and composite? 

Components of Incisal Edge Anatomy Function and Esthetics: Pitch

When the full anatomic form is not precisely recreated, this can lead to esthetic and functional challenges. To successfully mimic this form, the clinician can rely on three components of incisal edges (from a lateral perspective): 1 pitch and 2 bevels.

We can visualize the pitch as the flat top of the incisal edge.

Pitch

Dimensions: Labio-lingual width of at least 1mm that increases from attrition or parafunction in edge to edge position.

Characterization: Pitch is not always parallel to the horizon and its relative position is dependent on the inclination of the incisor. Incisors are inclined just a little bit further to the labial at the incisal edge and the pitch has an upward slant toward the lingual.

Esthetics: The tooth shape and inclination results in an incisal edge esthetic of thinner enamel at the labio-incisal junction. It also creates the highly desirable visual translucence. Leveling the pitch to the horizon can change light reflection which is critical to esthetics of the tooth.

Restorative Approach: Often in ceramics we create a pitch that is level to the horizon and has decreased width of the pitch. This can compromise the esthetics of the translucency, but that can be gained back using stains.

Challenge: The challenge with this shape change in ceramics is that patients often sit in edge to edge position during parafunction. Insufficient pitch width may result in the patient experiencing functional challenges, not finding a comfortable spot to rest and increased parafunctional movement.

I’ll expand on understanding the two bevels in my next incisal edge anatomy blog …

What aspects of incisal edge anatomy do you find most challenging? Let us know in the comments!

 

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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The Technique for the Carolina Bridge

December 2, 2017 Harald Heymann

The Carolina bridge is an all-porcelain bonded pontic that can be used as an interim prosthesis and for many other valuable purposes.

In my last blog, I discussed why I love the Carolina bridge and its many applications as a restorative alternative. Now, I’ll provide an overview of the design and how to begin a case using the bridge.

Carolina Bridge Design

The design of the Carolina bridge bypasses problems found in Maryland bridges and adhesion bridges. The all-porcelain Carolina bridge is very esthetic because there is no metal substructure. There is also incredible light penetration.

Maryland bridges, on the other hand, are not esthetic due to the the graying created by metal wings. All-porcelain pontics, such as the Carolina bridge, often can be used when tooth anatomy comes before or restricts the prep and placement of a Maryland-type bridge. Also, it is easier to repair the proximal resin composite retaining connectors of Carolina bridges.

Carolina Bridge Case Technique

A case that illustrates a Carolina bridge technique is one where an adolescent patient presented with a missing maxillary right lateral incisor. A team consisting of a periodontist, an orthodontist, an endodontist, and a restorative dentist determined that a dental implant would be the best treatment once the patient reaches maturity.

The team decided to orthodontically submerge the endodontically treated root to best preserve the bony site for implant placement. They selected a Carolina bridge as the best interim prosthesis because the occlusal relationship was favorable and there was sufficient crown length of the abutment teeth.

At the first appointment, shade selection was determined and an elastomeric impression was made of the anterior segment. A working case, an impression of the opposing arch, and a bite registration were created. An all-porcelain pontic was fabricated of feldspathic porcelain by the laboratory. At the second appointment, the involved abutment teeth were fully cleaned and rinsed.

The pontic was trial positioned to assess the shade accuracy and the adaptation of the pontic to the residual ridge. Once the accuracy of the shade and fit was verified, the pontic was readied for cementation.

A silane coupling agent was placed on the etched proximal surfaces of the porcelain pontic to improve the bond strength. Preparation of the abutment teeth was done by lightly roughening the proximal surfaces with a coarse, flame-shaped diamond stone. At this point, the pontic was ready for bonding into the edentulous space.

Dr. Heymann will be a featured lecturer at the Pankey 2018 Annual Meeting in Nashville, TN.

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Harald Heymann

Dr. Heymann is particularly active in the clinical research of esthetic restorative materials and participates in a dental practice devoted largely to esthetic dentistry. He is a member of the Academy of Operative Dentistry, the International Association of Dental Research, and is past-president and a fellow of the American Academy of Esthetic Dentistry. He is also a fellow in the International College of Dentists, the American College of Dentists, and the Academy of Dental Materials. He also serves as a consultant to the ADA. The author of more than 190 scientific publications, Dr. Heymann is co-senior editor of Sturdevant's Art and Science of Operative Dentistry and the editor-in-chief of the Journal of Esthetic and Restorative Dentistry. He has given more than 1,400 lectures on various aspects of esthetic dentistry worldwide and has received the Gordon J. Christensen Award for excellence as a CE speaker. Dr. Heymann graduated from the University of North Carolina School of Dentistry. He is past chair and graduate program director of the department of operative dentistry and currently is the Thomas P. Hinman Distinguished Professor of Operative Dentistry at the UNC School of Dentistry

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Treatment Planning Papilla Esthetics

November 2, 2017 Lee Ann Brady DMD

Assessing and managing the papilla is particularly important when we are treatment planning esthetic cases. Usually, we pay attention to the papilla when planning anterior implants and are less focused on this when we are treatment planning natural teeth.

The papilla is valued in cosmetic dentistry because it is an essential element of smile esthetics. If we want patients to be truly happy with their results, we must include it in our early considerations.

Papilla Tips and Why They Matter

Many of our patients who are in their sixties and seventies will still show the tips of the papilla. This isn’t the case for other aspects such as the gingival margin. Because of this, it’s critical that we don’t ignore them when treatment planning a smile.

Two main aspects to focus on when diagnosing papilla esthetics are symmetry and papilla height compared to contact length.

Papilla Symmetry

Papilla heights should be symmetric across the midline. Papilla tips will vary for patients, with some creating a straight line when connected and others having a line that tips up toward the canines. Regardless, the left and right sides should mimic one another. For example, if the papilla tip is shorter between the canine and lateral, it should do this on both sides.

Papilla Height

Papilla height compared to contact length is also important. The papilla tip should take up 45-50% of the total length of the tooth from the gingiva to the end of the contact. Then the contact should use up the remaining 50-55% of this distance.

Looking at the existing papilla symmetry and height enables you to decide if the esthetics are acceptable. Your goal will be to maintain them optimally. If they are where you want them to be esthetically already, then you have a reference to determine the positive or negative effect treatments like crown lengthening, ortho, and restorative procedures could have. If papilla esthetics are not where you want them to be, you can use these parameters to evaluate treatment options and improve them.

What is your favorite part of treatment planning a case? We’d love to hear your thoughts in the comments! 

Join us for a 2-day lecture course on Mastering Anterior Implant Esthetics led by Dr. Lee Ann Brady.

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DATE: April 4 2024 @ 8:00 am - April 6 2024 @ 12:00 pm

Location: The Pankey Institute

CE HOURS: 22

Regular Tuition: $ 3195

Single Occupancy with Ensuite Private Bath (per night): $ 290

THIS COURSE IS SOLD OUT The Blueprint for Running a Practice with Long-Term Growth Dr. Pankey’s original philosophy encouraged dental professionals to be proficient in 3 specific areas: technical mastery,…

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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