Who Should Adjust Mandibular Incisal Edges, and When?
There is frequently an increase in tooth length required when esthetic changes are made to the maxillary anterior teeth to improve tooth display, proportion, or incisal edge form. This esthetic change will impact the incisal edge contact to the lower anterior teeth. To improve the edge contacts and function to the newly designed maxillary anterior teeth, a plasty procedure of the mandibular anterior incisal edges is often required. I recommend having the dental laboratory create a diagnostic wax-up of the new maxillary incisal edges for both direct composite or indirect restorations.
There are two approaches to adjusting the lower anterior incisal edges:
- The laboratory can adjust the cast of the mandibular incisal edges, trying to idealize not only the esthetic changes of the maxillary teeth, but also the functional changes to the lower incisal edges.
- The laboratory only waxes the maxillary anterior teeth and returns the case to the clinician to adjust the lower cast.
For the most predictable outcome and to increase the efficiency of the clinical procedures, I suggest that the clinician adjust the mandibular cast. By adjusting the cast before treating the patient, the clinician is the aware of how much and where the adjustments are needed. If the laboratory technician makes the adjustment, the areas may be identified with a marking pen, but the amount of reduction is difficult to communicate.
When should the adjustment occur? The mandibular incisal edges adjustment can be initiated at different stages of treatment including the:
- Mock-up stage,
- Provisional stage (maxillary provisionals made for the diagnostic wax-up), or
- After insertion of the final restorations or direct composite bonding.
If the adjustments are made at the time of mock-up or provisionalization, the need for slight modifications should be anticipated at the time the final restorations are inserted.
Esthetics is much more than cosmetic changes made to alter appearance. To learn more, view the free lesson: Looking at Faces From an Esthetic Viewpoint.