A male patient in his early twenties was self-conscious when he smiled due to the relatively small size of his upper right lateral incisor. He had a history of enamel hypoplasia affecting some of his dentition.
The initial consultation to evaluate the aesthetics of the patient’s smile revealed the upper right lateral incisor was also mesially inclined. The incisal edge of the upper right central incisor was slightly shorter than its contralateral counterpart. The gingival levels of the two lateral incisors were different and the gingival aesthetic line classification was class 1.
Lateral incisors are rarely symmetrical in nature. In this case the patient was not happy with the variation in form and width of the upper right lateral incisor. The space available for increasing the length of this tooth was very tight.
I discussed the treatment options with the patient and made him aware of all the factors mentioned above. He, nevertheless, only wished to proceed with the build-up of the upper right lateral incisor. He understood that slight re-contouring of the lower right canine would be required to accommodate the increase in length. The incisor was built up using thin layers of Heraeus Venus Pearl composite in the step-by-step process described below. I chose Venus Pearl on the basis of its aesthetics, strength and ease of application.
A clinician’s experience in handling the differing shades and opacities is also important to achieve the desired outcome. Over time, observation of composite systems and their enamel, dentine and incisal layers builds an understanding of how the restoration will finally appear. This, in turn, increases the predictability of aesthetic outcomes.
In this case, the initial treatment achieved an acceptable post-operative outcome. Time was then allowed for the composite to mature and the teeth to re-hydrate. One month later, at the revision appointment, I assessed the form of the restored tooth once again. The period between the two appointments allowed the patient to become accustomed to the look of his teeth. The patient was very happy with the natural result and could smile with confidence. Asymmetry between the lateral incisors is a natural phenomenon. It is tempting to make the teeth symmetrical, but this may detract from an otherwise natural and more harmonious appearance with the surrounding dentition. This is particularly so with the other parameters already mentioned in the aesthetic assessment of this patient. This perception, or aesthetic eye, is different for each clinician and also for each patient.
Further modifications can be made at the review appointment. This allows for a period of adaptation for the patient. It also gives the clinician time to evaluate the clinical photographs prior to making changes to the restoration. It is better to not rush tiny details after a long appointment staring at a small area. Time to reflect can be more fruitful for all concerned than time spent in haste.