The aesthetic smile: diagnosis and treatment.

Until recently, dentists’ and the public’s concept of dental aesthetics was necessarily limited to alterations of the teeth themselves. Dentists concerned themselves with changing the position, the shape and the color of the teeth basically restoring missing units or enhancing those already present. For the most part the dentist was forced to accept the pre-existing relationship between the three components of the smile; the teeth, the gingival scaffold and the lips. Interestingly, the restorative dentist’s concept of aesthetics varied considerably from that practiced by removable prosthodontists where, in the full denture set-up, they could not only select the most desirable shape and color of denture tooth concomitant with the patient’s facial features but could position them in the optimal relationship with regards to the upper lip, the lower lip and the commissures of the mouth thereby creating the desired ideal smile. The three basic tenets germaine to optimal aesthetics in removable prosthetics were not really a part of the restorative dentist’s rules, as any changes in the pre-existing lip-tooth-gingival relationships were thought to necessitate longterm orthodontic therapy, often in combination with orthognathic surgery or aggressive periodontal procedures. Today much of this has changed; with the advent of soft tissue periodontal plastic procedures designed to enhance dentofacial harmony following the same basic tenets as those of the removable prosthodontist. The domain of periodontics has changed from being strictly a health service to one where smile enhancement has been brought to the forefront of treatment planning. The essentials of a smile involve the relationships between the three primary components: the teeth lip framework the gingival scaffold.