If during the eruption phase there is a lack of movement, the result may be that the CEJ will remain partially covered by bone. The additional 2mm from the gingival epithelial attachment to bone combined with the sulcus depth is referred to as the Biological width.1 This normal recession causes the gingiva to recede to the CEJ resulting in a sulcus depth, which ranges from 1 to 2.5mm. This is called the passive eruption phase. After eruption, the gingival complex will gradually recede to create a sulcus depth 1 to 2.5mm from the CEJ. 2 – 4).ĭuring tooth eruption, the tooth actively erupts through the bone so that the CEJ is 2mm above the level of crestal bone. The gingival margin of the lateral incisor can range from being on the GHOC line to 1mm below while maintaining an aesthetic result (Figs. Figure 1 shows the ideal relationship of the GHOC A straight line, level with the horizontal plane (sometimes the interpupillary line if level) will join the gingival margin of the centrals and cuspids, this line will be harmonious with the upper lip which should just cover 1mm of the margin during full smile. Undoubtedly the easiest way to create a more aesthetic smile is to adhere to the smile design principle of the GHOC. It’s time to achieve the results that will become the new standard of care by raising the bar. Learning the ideal design features (Table 2) and how our treatment is influenced by, and influences these parameters, will enable us to raise the level of care we can give our patients. “You don’t know what you don’t know.” Unless we know what constitutes a beautiful smile we will be unable to achieve it. Often ignored, these gingival factors will definitively affect the aesthetic outcome of every case. The list of gingival considerations are of equal importance with the other set of factors on this list of smile design characteristics. This list of factors (Table 1) which are desirable to achieve a healthy and aesthetic smile must be applied to each patient in order to achieve the highest predictability of an aesthetic result. ![]() “Smile design” is the architectural blueprint we as Cosmetic Dentists use to plan the smile we are about to create. Watchwords like “Biological width,” “Ovate Pontics” and concepts of “crestal bone to contact point distance” guide our preparation and design so we are able to achieve the desired aesthetic tissue results. When considering tissue health, we must understand how the margin placement and fit, the provisional restorations, the contours and the tooth preparations will affect the ultimate tissue health and position. ![]() We must concern ourselves with the various factors of gingival architecture and understand how these and other factors so critically affect the overall aesthetic result of our restorative efforts. Not only must we be concerned with the overall health of the tissue, but the concept of the aesthetics of the tissue as well. These concepts of healthy tissue still hold true today, however the scope of these concepts has been expanded along with our knowledge. The concept of periodontal health has been a mainstay in restorative dentistry long before cosmetic dentistry had become defined to the levels we know today. It is our responsibility to understand the ramifications of these details and how they impact on the smiles we create. These factors, some major and some minor all add up to determine how pleasing the smile will be. ![]() The impact on the beauty of a smile from an uneven gingival contour height can be dramatic and although the position of the zenith of the gingival tissue seems like a small detail, it can greatly influence the axial inclination and emergence profile of the teeth. A gummy smile is as unaesthetic as a patient with severe recession. Framing the teeth, within the confines of the gingival architecture, has a tremendous impact on the aesthetics of the smile.
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