Dentaltown April 2021 - 14

show your work
case study

Building Better Bonds
Improving minimally invasive and
aesthetic anterior restorations

by Dr. Hemali Ajmera
Hemali Ajmera, DDS, FACD,
practices general dentistry
at Ajmera Dental Studio
with a focus on cosmetic
dentistry and comprehensive
care. She is a graduate of
the seven-year accelerated
BA-DDS program at New York
University College of Dentistry
and a member of Catapult
Education and the American Dental Association. She
gives back to the community by creating platforms for
education and by partaking in philanthropic causes in her
previous role as past new dentist chairwoman of the New
York State Dental Association and now as a fellow of the
American College of Dentists.

14

Extraordinary dental challenges require out-of-the-ordinary diagnostic methods.
Aesthetic restoration of malformed, misshapen and underdeveloped lateral incisors can range
from extraction with implant or bridge replacement, altering the proportions of adjacent
dentition to create space for restorations, to orthodontic realignment before tooth alteration
for restorative space.1 Based on your approach for preserving natural tooth structure and
what the underlying tooth structure allows for, minimally invasive aesthetic enhancements
can involve cosmetic bleaching, resin bonding, porcelain laminate veneers, metal ceramic
restorations or all-ceramic restorations.2
The primary consideration should be conservation and minimally invasive restorative
options. Assessment of the occlusion is necessary to determine if the lateral should be
repositioned to allow for optimal aesthetics. Upon reviewing line angles, embrasures and
positioning of the canine and central incisor, treatment planning can begin. In many
cases, minimal orthodontic alignment to create a lingually displaced lateral incisor by just
3 degrees in relation to the adjacent dentition or a minor extrusion or intrusion movement
can help manage facial clearance and gingival zeniths. Now, a minor bevel preparation on
the facial for optimal restorative outcomes is possible without removing tooth structure to
dentin on an already small tooth. Based on the defect, alignment can be performed before
or after permanent restorative dentistry.3
Smile design principles have found that narrow lateral incisors are considered unaesthetic;
meanwhile, the overall perception of the maxillary lateral incisor length is in agreement
with the long-established 1-1.5mm shorter lateral incisor with respect to the adjacent
central incisor and canine along with a wider lateral incisor. We know now that the golden
proportion is a range, not a single value, and that gender doesn't affect these aesthetics.
Because of this subjectivity and range of proportional acceptability, it is worthwhile to
discuss if lengthening a lateral incisor will suffice to create the preferred aesthetic result
before treatment of adjacent dentition or orthodontic movements to create increased width.4
Stronger products like zirconia that must bear occlusal forces have an opacity for which
they have undergone various transformations in their composition to provide improved
translucency, which in turn has compromised their strength. So decision-making on
minimally invasive restorations requires optimal strength for bonding on enamel and

APRIL 2021 // dentaltown.com

DT0421_Ajmera_ShowYourWork-MM.indd 14

3/18/21 9:10 AM


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Dentaltown April 2021

Table of Contents for the Digital Edition of Dentaltown April 2021

Dentaltown April 2021 - Intro
Dentaltown April 2021 - Cover1
Dentaltown April 2021 - Cover2
Dentaltown April 2021 - 1
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Dentaltown April 2021 - Outsert1
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Dentaltown April 2021 - Cover3
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