In a previous article I discussed that altering mandibular incisal edge morphology to accommodate new incisal edge morphology in maxillary anterior restorations, can result in the loss of opposing tooth contact in maximum intercuspal position (MIP). To accommodate for this lost contact, the mandibular anterior teeth may erupt to reestablish contact. In order to prevent this from happening, I advise reestablishing contact by changing the morphology of the palatal aspect of the maxillary anterior teeth.
Prior to adjusting the lower anterior incisal edges, it is critical that you evaluate their relationship and contacts to the palatal aspect of the maxillary anterior teeth. Do they touch in MIP? If during the pre-treatment evaluation there is contact, I advise that you reestablish post-insertion. If in the initial evaluation there is no contact, such as in a Class II skeletal relationship, it may not be necessary.
To establish or reestablish anterior tooth contact in full intercuspation after adjusting lower incisal edges, there are three restorative options you may consider to change the morphology of the palatal aspect of the maxillary anterior teeth. The option you choose will be dependent on the degree of change and the overall outcome goal. They are:
- Bond composite
- Extend the veneer restoration further onto the palatal aspect
- Change from a veneer to a crown restoration
Keep in mind that creating an ideal esthetic outcome is generally the overall goal in the restorative treatment process, but it cannot be done at the expense of establishing or reestablishing ideal function.