Managing Space in the Anterior Dentition

Lasseigne, Tyler P.; Chiche, Gerard; Tokutomi, Hiro; Wiltz II, Cramin P.; Mendez, Arturo J.
December 2011
American Journal of Esthetic Dentistry;Winter2011, Vol. 1 Issue 2, p138
Academic Journal
A majority of the population regards separation of the anterior teeth as esthetically displeasing. If treatment is provided without properly analyzing such gaps and identifying the cause, the spaces may reopen. This article introduces a linear protocol to effectively assess and diagnose the etiologic factors creating the separation of anterior teeth. The clinician must pinpoint the location(s) of the space, measure the amount of separation, and identify the etiologic factors. Proper analysis will also reveal whether interdisciplinary treatment is needed. As an example of this protocol, a case is presented in which there was splaying of the maxillary anterior teeth. A systematic approach was taken to effectively analyze and diagnose the cause of separation. Splint therapy was used to ensure that the condyles were fully seated. The mandibular position was recorded and reproduced with mounted casts on a semiadjustable articulator. The maxillary posterior teeth were removed from the casts to evaluate the coupling of the anterior teeth, followed by trial equilibration. The wax-up was transferred to the patient's mouth for approval and to ensure that the tooth proportions were in harmony with the face. Conservative treatment using partial and full laminate veneers was administered to close the gaps. Tooth position was maintained by rechecking the occlusion and placing a Hawley retainer in the maxilla. This linear protocol increases diagnostic efficiency and allows the clinician to successfully manage splaying in the esthetic zone.


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