B) Analysis of the endobuccal environment of the tooth (image
1)
a) Periodontium
As we said previously, the periodontium has all its importance in
esthetics (17) but also in the bio-functional integration of the
reconstitution (10,11). According to the state of periodontal health,
the therapeutic decision can vary. In addition, for esthetic reasons
(18), the position of the gingival edges of the maxillary anterior teeth
can be brought to be modified by gingival or osteo-gingival plasties
(19,20).
Adjacent teeth
Teeth color: Determining the color of the lateral incisors can be
complex due to the high saturation of the adjacent canine teeth and the
generally less saturated central one. Some teeth may have peculiarities
such as white stains from fluorosis or brown stains from a molar incisor
hypomineralization (MIH) (21). It should be noted whether the patient
wishes these particularities to be reproduced on the future
reconstitution or removed in advance.
Tooth size : The literature is not unanimous on this subject. The golden
ratio (width/height) of 62% does not seem to be the most esthetic ratio
(22) for lay people. Indeed, patients seem to prefer maxillary lateral
incisors with a ratio of 67% or 72% (23,24). According to German et
al. 2016, the mesio-distal diameter of a maxillary lateral incisor is
2mm less wide than that of the maxillary central incisor (25).
Positions of the teeth : A smile is considered esthetic if the maxillary
central incisal edge is at the same level as the maxillary canine edge
(26) and if the maxillary lateral incisal edge is between 0.5 and 1.5 mm
more coronal than the central one (6,8,27).
c) Occlusion (static and dynamic)
The evaluation of the anterior guidance as well as the occlusal contacts
in terms of dynamics and statics is necessary in order to select the
type of restoration and thus ensure its durability (28).