Page 14 - DP Vol 19 No 6 pw_Neat

cosmetic section

CREATING DENTAL AND

FACIAL HARMONY

Cyntia Galvão Gomes de Medeiros and Karoline Leão present a case of oral rehabilitation
of a young patient with severe dental wear using the 4D protocol of planning

Performing aesthetic and functional rehabilitation requires precise due to dental caries, but by the disruption of oral cavity homeostasis, even
planning and diagnosis, as well as operational techniques. To aid this, in younger patients, the use of conservative procedures is important.
the ‘golden ratio’ was one of the first recognized systems to properly Composite resin is a material that allows teeth to be restored with an
plan a smile design (Fradeani and Corrado, 2006; Levin, 1978; additive – a reversible and safe technique, and, besides being aesthetic,
Lombardi, 1973; Preston, 1993). Currently, waxed models and digital meets the patients’ requirements and is easily repaired (Baratieri and
protocols are the most popular in tooth preparation (Coachman and Guimarães, 2008; Medeiros, 2018; Mondelli, 2003; Pashley et al, 2011).
Calamita, 2012).
The ‘rule of 20’ has also been suggested as a simple and accurate
method for defining the anterosuperior segment for dental
measurements (Medeiros, 2013; 2018).
In this case, the central incisor measurement is used as a reference to
define lateral incisor measurements (Medeiros, 2013; 2018), alongside
other variables observed at the first appointment.
The concept of aesthetics is subjective. Several articles have been
written and reviewed to find a standard to be followed in all cases
(Frese et al, 2012). Getting to know the patient’s particularities, and
respecting their wishes and expectations, are the first things to be
considered in the 4D protocol.
The dynamic and static analysis of the facial and dental components
are to be considered in the appointment as well.
Taking measurements and respecting the proportions between
the features associated with a smile when related to facial dimensions
and functions of the stomatognathic apparatus justifies the need
for an interdisciplinary approach for better treatment (Levin, 1978;
Lombardi, 1973; Medeiros, 2013; 2018; Mondelli, 2003).
The chemical and physical degenerative processes need to be
detected and treated since they compromise the aesthetics, function,
and structure inside the teeth.
Bruxism and acid erosion also affect the vertical dimension of
occlusion (Medeiros, 2018).
The causes may be multifactorial and could be associated with meal
patterns, lifestyle, and physiological changes, such as gastroesophageal
reflux (Barron et al, 2003; Bartlett et al, 2008; Hamasha et al, 2014; That being said, this article aims to present a case report of oral
Harpenau et al, 2011). rehabilitation of a young patient with severe dental wear using the
However, dental structure is being lost earlier in life, as observed 4D protocol of planning. Also, use of the tailored basic erosive wear
in students aged 14 in England (Alfadda, 2014). Therefore, effective examination (BEWE) (Bartlett et al, 2008) index was used to document
diagnosis and prevention measures need to be part of the first dental loss due to acid erosion, presenting the step-by-step aesthetic
appointment protocol (Bartlett et al, 2008). and functional rehabilitation with composite resin throughout the
When looking at cases where people have been losing their teeth not oral cavity.

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14 Dental Practice I November-December 2023 I Vol 19 No 6