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PRACTICE
BDJ Aesthetic Dentistry Series
Diagnosing and treatment planning inadequate tooth display
F. Spear1
In brief
Helps clinicians understand the possible aetiologies for inadequate tooth display.
Provides advice on what to look for clinically to make a correct diagnosis of the aetiology.
Suggests when restorative dentistry may correct the inadequate tooth display.
Helps in the understanding of when non-restorative options will be necessary to achieve the desired outcomes.
Some of the most challenging patients to produce a pleasing smile for are those who present with inadequate tooth display (either due to tooth position, the patient has normal size teeth, but they arent exposed adequately to ll out the smile) or due to tooth size (the teeth are small, often due to tooth wear). The key to understanding how to manage these patientsis to learn to understand the possible aetiologies that could produce the condition, and learn how to diagnose which aetiologies exist for your patient. Potential aetiologies for inadequate tooth display in patients with normal length unworn anterior teeth: excessive lip length; inadequate lip mobility; inadequate vertical eruption of the anterior teeth; inadequate facial prominence of the maxillary anterior teeth; vertical maxillary deciency; and anterior maxillary deciency.
This article, the rst in a British Dental Journal series on the topic of aesthetic dentistry, reviews the clinical ndings consistent with diagnosing each of the above etiologies, and then reviews the treatment options available for correcting the inadequate tooth display.
male to female, and also changes over time with ageing.24 However, using absolute values of how much of the central incisors show at rest to determine the central incisor incisal edge position has signicant limitations, ie all 30-year-olds should not get 3.5mm of central showing at rest, just as all 50-year-olds should not show 1.5 mm at rest, even though the 33.5mm display in a 30-year-old, and the 11.5mm display in a 50-year-old, would t the average amounts found in Vig and Brundos classic study. Ultimately, it is important aesthetically that the edges of the centrals are at least visible at rest. If they are not, regardless of the age of the patient, there will be inadequate tooth display, not just when the patients lip is at rest, but also when they are speaking.5
What the lip...