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)