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As treatment expectations of dental patients continue to escalate we, as restorative dentists, must provide an interdisciplinary treatment approach to ensure optimum results for our patients. In recent years the disciplines of periodontics, endodontics and oral surgery have continued to develop closer working relationships with the field of
restorative dentistry. Unfortunately, this is not the common relationship that exists with the discipline of orthodontics. Most orthodontic therapy is directed at the treatment of malocclusion and is conducted with limited or no input
from the restorative dentist. Orthodontics offers countless ways of assisting the restorative dentist in achieving treatment goals. Several of these orthodontic opportunities to enhance the restorative treatment plan are reviewed.
MeSH Key Words: mouth rehabilitation; orthodontics, corrective; patient care planning; patient care team
J Can Dent Assoc 2001; 67(9):516-20
This article has been peer reviewed.
Figure 2: The maxillary incisal curve and gingival plane both fail to
harmonize with the lower lip curve, and the midline is not oriented
vertically in the face, all contributing to an unattractive smile.
517
Reikie
gingival levels of teeth not only control the esthetic potential for our patients but also dictate the clinical crown
length available for restoration. During the initial clinical
examination, it is important to evaluate the maxillary and
mandibular gingival planes for bilateral symmetry and
harmony with the proposed incisal and occlusal planes of
the final treatment result. Although gingival asymmetries
are often addressed surgically (periodontal crown lengthening or orthognathic surgery), orthodontic treatment can be
an effective method of leveling the gingival planes before
restorative treatment. However, if gingival levelling is to be
achieved orthodontically, then the orthodontist must be
informed of this goal so that he or she can position the
orthodontic brackets on the teeth relative to the gingival
margins instead of the incisal edges and buccal cusp tips.
This treatment approach often results in uneven incisal and
occlusal surfaces during and after orthodontic treatment
because the arch wires level the gingival planes instead
of the teeth. This treatment method is appropriate for
patients scheduled for extensive restorative treatment
following orthodontics, allowing for the re-establishment of
incisal and occlusal harmony. When using this treatment
approach the orthodontist may need to recontour certain
teeth during the orthodontic treatment to maintain acceptable esthetics and function. Localized gingival asymmetries
can also sometimes be treated orthodontically. Forced eruption of an isolated tooth results in osseous and gingival
tissues migrating coronally with the tooth and thereby often
correcting gingival defects.9-12
As restorative dentists we often strive to avoid open
gingival embrasure spaces, particularly in the esthetic zone
of the mouth. The length and shape of interdental papillae
largely control the proximal contours of the restorations we
make. In turn, papilla length and shape are controlled by
the shape and volume of the gingival embrasure space and
the level of interseptal bone.13 In patients who have a
healthy periodontium and favourable interseptal bone
levels, papilla length and shape can be modified by changing gingival embrasure space through orthodontics or
restorative treatment. Crowded or rotated teeth, slipped
proximal contacts and unfavourable root proximities lead to
restricted gingival embrasure spaces in turn leading to
compromised papillae. Conversely, divergent roots or open
proximal contacts are accompanied by excessively large
embrasure volumes and result in short and wide interdental
papillae.14 A common complication following orthodontic
closure of a maxillary midline diastema is divergence of the
central incisor roots, leading to an enlarged gingival embrasure space and a short interdental papilla. When planning
treatment, it is important that the orthodontist and restorative dentist discuss soft tissue volume interproximally and
that the orthodontist appreciates the importance of orienting the brackets perpendicular to the long axes of the teeth
Journal of the Canadian Dental Association
519
Reikie
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