Anterior and posterior teeth contribute to the aesthetic qualities of the face through their color, shape and position as well as their relationship to adjoining and opposing teeth. Although surgical and orthodontic management can improve the relationship of teeth and jaws to one another, teeth that are deficient or defective in appearance should be restored and absent teeth should be replaced.
Teeth may be defective in appearance because of malformations present at birth or systemic problems that affect the development and maturation of the permanent teeth. The permanent teeth are usually of more concern. Because the tooth buds for the permanent teeth develop during childhood, some or all of these teeth may be systematically susceptible to developmental abnormalities in the enamel or dentin. The degree of developmental deficiency can be quite variable.
Restoring permanent teeth usually includes replacement of the defective or deficient tooth structure with an artificial material. Porcelain, with or without the support of a metal substructure, is usually the material of choice in cosmetic restorations. The existing tooth structure must usually be prepared to receive such restorations so that the artificial material maintains a healthy relationship to the neighboring teeth and their supporting structures. In some situations, it may be sufficient to cover only one surface; in other situations, all tooth surfaces must be covered with the artificial material.
In addition to defective teeth, a patient may have one or many teeth missing. Missing teeth are most ideally replaced with a prosthesis that is not removable from the mouth. The options include a fixed partial denture in which replacement teeth are attached to a single tooth or to multiple teeth on either side of the space. Restorations also may be needed for the neighboring teeth that will serve to anchor the replacement teeth.
Another commonly used option for repair of missing teeth is placement of an osseointegrated titanium implant(s) to which a porcelain crown(s) is subsequently attached. The implant is positioned in the patient's mouth for three to six months before the replacement tooth is attached to it in order to integrate the implant with the patient's own jawbone.
Dental and facial structures may appear deficient due to congenital, developmental or acquired factors. Although deficient bone may be augmented with natural or synthetic bone grafts, the final oral and facial contours are often difficult to predict. Removable prostheses may be needed to replace deficient structures in conjunction with or instead of grafting procedures. When used, removable prostheses can provide support to the lips and facial structures as well as replace missing teeth.
Orthodontics
Some of the most important aspects of a person's facial appearance are the smile and the appearance of the teeth. It is natural for the teeth to gradually change position over time. These changes sometimes result in visible rotation, tipping and overlapping of the teeth. In such instances orthodontic treatment can restore the teeth to smooth alignment.
As long as the tissues surrounding the teeth are healthy, orthodontic treatment can be performed at any age. Depending on the severity of the problem, the length of treatment can be from a few months to two years and the mechanism used can vary from a removable device to a complete set of braces on all the teeth.
During active orthodontic treatment, regular visits are required to adjust the orthodontic mechanism so that smooth and efficient tooth movement can occur. The adjustments typically are performed on a monthly basis but can be varied as needed in a specific circumstance. Occasionally the situation may require removal of one or more teeth if the space available is insufficient.
Orthodontic treatment almost always accompanies orthognathic surgery (jaw repositioning) procedures and can be easily combined with prosthodontic procedures when a change in tooth alignment is required before tooth restoration and replacement procedures can be performed.
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