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DENTAL TECHNOLOGY, JULY-SEPTEMBER 2023
cosmetic section 23

FIG 1: First aspect of the patient’s smile – micro-aesthetics and nano-aesthetics

FIG 2: Macro-aesthetics, 180° evaluation, with and without smile

FIG 3: Measurements based on the ‘rule of 20’ using Hufriedy’s meter FIG 4: Patient with ‘wish smile’, colour test, shape and dental measurement

The dental measurements of the upper incisors were performed dental elements, without an adhesive system. The BLXL composite
to start planning the ‘rule of 20’. According to the rule, the height of resin (Empress Direct, Ivoclar) was used, according to the measures
the central incisor is equal to its width plus 20%, the height of the defined by the ‘rule of 20’.
lateral incisor is equal to the width of the central incisor, and the A picture was taken and shown to the patient for analysis and
width of the lateral incisor is equal to its height minus 20% or the approval. Afterwards, a template can be made for filing approved
width of the central incisor. measurements, and the facets are removed and stored to use as a
The central incisors were 8mm wide and 7mm high. According to surgical guide. The patient was advised to have tooth whitening,
the literature reviews, the width of this dental element was within gingivoplasty and rehabilitation with composite resin in the whole
average. The Hufriedy Chu meter was used. mouth.
These measurements are based on averages found by Sterret The treatment started with at home whitening. The gel of choice
(2003), Magne et al (2013), and Yamaguto and Vasconcelos (2005). was carbamide peroxide 15% (Opalescence) and it was prescribed
It is important to relate dental measurements and positions with the for 21 days to be used four hours a day.
dental arch and smile line height. Dr. Viviane Álvares performed gingival plastic surgery to increase
Once the measurements are defined, their application results in the size of the teeth. The facets from the ‘wish smile’ were used as
proportional, harmonic and individualized smiles (Fradeani and a surgical guide, harmonizing the relationship between the teeth
Corrado, 2006). Table 2 shows the application of the ‘rule of 20’ in and gum. A healing period of 30 days was undertaken before con-
the planning of this case. tinuing treatment (Figure 5).
After the recovery time, rehabilitation with composite resin start-
WISH SMILE ed, following the sequence below of five days:
In the same session, the ‘wish smile’ was performed (Figure 4) – a • Day one: occlusal rehabilitation began in the upper posterior
technique where the smile test is performed under the patient’s own teeth: UR7, UR6, UR5, UR4, UL4, UL5, UL6 and UL7 - to reduce