DIRECT VENEERS - FROM DESIGN TO IMPLEMENTATION
Figure 1 . 58 - y . o . woman visiting the clinic with frontal teeth damaged by attrition
Figure 2 . We selected a square tooth shape that matches “ phlegmatic ” temperament as a basis of further design
Figure 3 . In young patients , tooth width is generally 65 % of crown length . In older age , this ratio becomes generally 90 % – this is what we considered in the design phase
Shape differences : - Asymmetry between the two sides - Fractured teeth due to trauma - Abrasion - Attrition - Erosion - Peg lateral incisors - Restoration of teeth replacing missing teeth by means of orthodontics Positional abnormities : - Ectopic teeth - Disharmony in the incisal curvature - Diastema closure - Anomalies in the inclination of teeth - Torsion - Infraocclusion - Centerline shift Nowadays it is obvious that we might design the patients ’ smiles with different characters . According to Rosenstiel et al . gender , ethnic , age group etc . determines people ’ s thinking about the aesthetic smile character . Yet , there are people who cannot distinguish two different smile characters . 1 This points out the dentist ’ s responsibility to carefully design and provide the patient with different alternatives . Paolucci et al . worked out the theory of Visagismo , which is a new approach to direct veneer design . 2 In their opinion , the dissatisfaction of patients - which occurs so often in the clinical practice - is caused by the disharmony between the new smile created and the personality of the patient . Visagismo is a Portuguese word that means face shaping by
Figure 4 . Diagnostic wax-up
means of makeup . Visagismo is a guideline for dentists and dental technologists , which helps create restorations which combine esthetical appearance with psycho-social characteristics . A personalized treatment using these guidelines may result in changes in the patient ’ s behavior , posture and speech , too . 2 What does all this mean in the dentists ’ practice ? To answer this question , it is inevitable to define Hippocrates ’ four temperaments ( personality types ). The first is choleric / strong : assertive , objective , vigorous and passionate . The second is sanguine / dynamic : hearty , open-minded , talkative , joyful , brimming and enthusiastic . The third is melancholic / emotion-oriented : organized , perfectionist , restrained , shy . The fourth is phlegmatic / peaceful : tactful , non-violent , mysterious , idealistic , and prone to apathy and conformity . Paolucci et al . defined the characteristics of the teeth matching each temperament as follows 2 : Choleric / strong : Rectangular incisors , dominant central incisors , flat incisal edges , sharp cusps , vertical longitudinal axes ; Sanguine / dynamic : Triangular incisors , upwardarching smile line , converging tooth angles , inclined cusps ; Melancholic / emotion-oriented : Oval incisors , dominant central incisors , rounded cusps , delicate lateral incisors , round frontal tooth arch ; Phlegmatic / peaceful : Square incisors , lack of dominance , divergent tooth axes , horizontal configuration . 2 , 3 The above-mentioned features show that it may be necessary to learn the patient ’ s personality in order to set up a complex esthetical treatment plan .
34 STOMA . EDUJ ( 2016 ) 3 ( 1 )