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accurate measurements (German et al, 2016; Medeiros, 2013; history and clinical evaluation should be the north of any therapeutic
2018). decision.
Together with the ‘wish smile’, the patient can already see their The diagnosis of dental changes, whether infectious
treatment suggested in the first session, optimizing the patient’s or degenerative, are also part of the first appointment and the
and the professional’s time, which is a real challenge in dental ‘oral care always unique program’ was an important tool for the process.
treatments. In this clinical case, degenerative diseases were responsible for more
The 4D protocol extends far beyond smile aesthetics, it also than 3mm of vertical tooth loss, which affected the vertical occlusion
seeks to restore facial aesthetics and stomatognathic system dimension and smile aesthetics.
balance. Its goal is to create a simple and accurate step-by-step The use of composite resin proved to be an excellent additive and
guide for the first query. conservative alternative for aesthetic and functional rehabilitation
Together with aesthetics, another challenge of modern of the smile. Ceramic contact lenses were suggested, but the patient
dentistry is early diagnosis, implementing prevention strategies decided for a totally conservative and reversible therapy.
and treating degenerative diseases that affect teeth (Al-Dlaigan The patient and dentists were visibly satisfied with the
et al, 2001; Barron et al, 2003; Bartlett et al, 2008; Hamasha et al, final result. Further studies are needed to broaden planning options
2014; Harpenau et al, 2011). Both acid erosion and physical wear and to facilitate communication among specialties, focusing on more
have many origins and can often manifest simultaneously. conservative options. n
Studies have shown the high prevalence of acid erosion, even in
younger people (Al-Dlaigan et al, 2001), which is already observed
in clinical experiences.
The complex aetiology of dental erosion justifies the variation
in the occurrence, distribution and severity of injuries, and the
aetiological factors involved may have either intrinsic (Barron et
al, 2003) or extrinsic origin.
While intrinsic factors are related to individual biological
changes, extrinsic factors generally involve behaviour and lifestyle ABOUT THE AUTHORS
components. Degenerative diseases have been interfering with the
vertical dimension of occlusion (Medeiros, 2018).
The use of composite resin in patients with bruxism and dental
corrosion is a conservative and reversible way to restore aesthetics
and function damaged by structural loss (Alfadda, 2014; Baratieri
and Guimarães, 2008; Frese et al, 2012; Pashley et al, 2011; Pontons-
Melo et al, 2012). Oral rehabilitation with the use of composite
resins has been highlighted in the scenario of aesthetic dentistry.
The technique is affordable and a quick procedure with a simple
preparation, when needed (Magne et al, 2000). CYNTIA GALVÃO GOMES
In this case, the team’s evaluation showed that it is an ortho- DE MEDEIROS
surgical case, but the patient had already had two previous Cyntia is an aesthetic
orthodontic treatments and refused this possibility. dentist in private practice
‘Wish smile’, suggested on the first appointment, showed and a lecturer at the New
benefits and some limitations of composite resin rehabilitation – York University College of
and was an important factor in the patient’s choice, which was its Dentistry
greater differential.

CONCLuSION
Dentistry goes far beyond the teeth – it is also part of the structural
balance of the face, which is directly affected by measurements
and position. The 4D protocol seeks to comprehensively assess
the patient during the first appointment with the didactic division
in five steps: macro-aesthetics, micro-aesthetics, nano-aesthetics,
‘rule of 20’ and the ‘wish smile’.
The first three bring clarity to the appointment, and the ‘rule of
20’ and ‘wish smile’ help find dental measurements accurately and KAROLINE LEÃO
facilitate communication with the patient. Karoline is an aesthetic
Therefore, diagnosing and planning should address the triad: dentist in private practice
aesthetics, functional balance, and tissue health – considering that

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