Digital Smile Design (DSD)

Restorations commonly called zirconia are made from zirconium oxide-based ceramics. They can be used as a crown on an individual tooth or as a bridge in suitable cases. This material is not selected solely to change tooth colour; existing tissue loss, previous restorations, the bite and tooth position are assessed together. Whether a healthy tooth needs a crown is considered alongside more conservative alternatives.

When a restoration is needed because of tooth colour, shape or strength, zirconium oxide is one option. Not all zirconia materials have the same translucency and strength. The material and design selected for front and back teeth may therefore differ.

Today, single-piece aesthetic monolithic zirconia restorations requiring no porcelain layer are preferred. Their advantages include an absence of colour change over time and, most importantly, an absence of porcelain fracture. Highly translucent Class 5 aesthetic zirconia materials are preferred in the front region.

Planning determines how much tooth tissue must be removed, and an appropriate impression is taken. After design and production, the restoration is checked in the mouth for marginal fit, contact with adjacent teeth, colour and bite. Adjustments or trial fittings are performed when necessary. Tooth preparation is irreversible, so the decision is made with tooth preservation in mind.

Gaps between teeth may be related to tooth size and jaw structure, as well as missing teeth, tooth position or changes in gum health. Not every gap indicates disease. If gaps have appeared recently or are becoming wider, their cause should be assessed first. Simply closing a gap may not address the underlying problem.

The treatment plan considers the width of the gap, tooth proportions, the bite and the individual’s expectations together. Orthodontic treatment may be considered if the teeth need to be repositioned. In suitable cases, the situation can be addressed in a short time with aesthetic crowns made using digital planning. Tooth volume can be redistributed across the other teeth using aesthetic crowns, and the gaps can be closed in a balanced way.

The planned change can be examined using photographs and impressions or scans. In suitable cases, a temporary preview or model can help assess the new tooth proportions. Treatment is then carried out according to the selected method. Restorative procedures take the remaining tooth structure into account.

Factors affecting the recurrence of gaps differ according to the treatment chosen. Retention may be needed after orthodontic treatment; with restorations, marginal fit and the surrounding tissues are monitored. The decision is therefore not based solely on before-and-after appearance; an intraoral assessment and long-term care are planned together.

Crowding can occur when there is insufficient space for the teeth in the jaw or when they are positioned differently. Teeth may appear rotated, overlapping or displaced forwards or backwards. Assessment is not limited to the appearance of the front teeth; the way the upper and lower teeth bite together, jaw relationships, gum health and the ability to clean the teeth are also examined.

Orthodontics is the treatment aimed at changing tooth position. Fixed appliances or, in suitable cases, clear aligners may be used. The appropriate method depends on the types of movement required and the tissues supporting the teeth. In some situations, additional procedures may be needed to create space. Digital design helps assess the current position and possible changes; it does not move teeth on its own.

In suitable cases, the situation can be addressed in a short time with aesthetic crowns made using digital planning. Tooth volume can be redistributed across the other teeth using aesthetic crowns.

Tooth wear means the loss of tooth tissue over time. Clenching and grinding, acidic foods and drinks, reflux of stomach acid into the mouth, and certain habits may contribute. Several causes can occur together. Because the degree and progression vary, the cause and existing tissue loss must first be established.

Teeth may become shorter, incisal edges irregular and chewing surfaces flatter, or sensitivity may develop. However, not every instance of wear requires extensive restoration. Photographs, impressions and examination findings can be used for monitoring. Diet, clenching and general health factors are also assessed where necessary.

Monolithic zirconia restorations made with CAD/CAM systems and without a porcelain layer are harder than natural teeth and can completely stop wear.

Treatment is planned together with control of factors that increase wear. Composite adjustments may be considered for limited tissue loss; more extensive loss may require restorations such as onlays, veneers or crowns. Selection depends on remaining tissue and the bite. When lost tooth height needs adjustment, the change is also assessed for compatibility with the chewing system.

Restoration does not mean the cause of wear disappears automatically. Continued clenching or acid exposure can also damage new restorations. Protective appliances, habit changes or assessment by an appropriate physician may be planned when needed. Both teeth and restorations are monitored at reviews.

A gummy smile means prominent gum display when smiling. This appearance alone does not indicate disease, and natural differences exist between individuals. Visible tooth length, gum level, upper lip movement and jaw structure may all contribute. Assessment therefore considers more than the amount of visible gum.

Excess gum coverage of the tooth surface, gum enlargement and pronounced lip movement may require different approaches. Alongside photographs and intraoral examination, the relationship between the gums and underlying bone is assessed. Orthodontic or jaw-related assessment may sometimes be necessary. Correct planning requires identifying the tissues responsible for the appearance.

Adjusting gum levels or lengthening the clinical crown may be considered in suitable cases. Simply removing gum tissue is not sufficient or appropriate for every gummy smile. Bone position and tooth-supporting tissues determine the limits of treatment. Several contributing factors may require assessment across different disciplines.

Healing and monitoring of gum levels are important after treatment. Changes in appearance vary with the individual and selected method. Treatment need, possible risks and alternatives are discussed together; before-and-after photographs do not mean another person will achieve the same result.