In an earlier article, I went over the importance of creating beautiful anterior temporaries to help build your practice and inspire confidence in your patients. Like many procedures, there can be times when a patient comes back because they are unsatisfied and want the temporaries modified. In this situation you can always remove the temporary and make the necessary adjustments but it's much easier to adjust the length and contour intra-orally.

The patient that I'm going to use as an example is pictured above. He suffered a traumatic bike accident that left his anterior teeth fractured, and they needed to be lengthened for proper esthetics. My treatment plan for him included extending the length of both centrals and laterals to make them level with the occlusal plane. In addition, this patient's centrals and right lateral were endodontically treated prior to my treatment and he was being treated orthodontically to address an occlusal issue with the lower anteriors.

Once the orthodontist had the lower anteriors in position, I was able to prepare the teeth and place the temporaries. As you can see in the second photo, the temporary lines up with the occlusal plane and the canines beautifully.

However, he immediately started experiencing phonetic issues, particularly with his "s" sounds. When this happens I typically don't adjust anything for at least four weeks since there is typically a rapid phonetic adaptation to alterations in anterior tooth position. After four weeks the phonetic issue, a lisp, hadn't subsided and the patient kept mentioning that he felt the teeth were "too big."

When a patient is having speech issues it is important to identify if the problem is from the incisal edge position or lingual contour, in his case it is due to tooth length. It will now be necessary to reduce the length and test phonetics as they are shortened. The challenge is to reduce the length and maintain a pleasing incisal plane as it is easy to make mistakes in the amount of reduction, especially when sitting behind the patient as the teeth are being adjusted. I like to use a black marking pen to preview the adjustment by blacking the incisal edges on one side of the mouth, leaving the other side as a visual control.

Once I'm satisfied with the length on that side, I repeat the process on the other side. Then it is a matter of reducing the teeth so the reduction just removes the black line. I generally perform the reduction with a straight handpiece and large coarse porcelain polishing wheels to remove the black marks, followed by using discs to refine the form and embrasures.

In this particular case, I didn't only shorten and reshape the centrals and laterals, but the canines and premolars as well to maintain an esthetic contour. During the final shaping phase, I prefer to stand in front of the patient while they are seated in an upright position. Using this trick allows me to look directly at the patient and get a much better visual of the patient's esthetics compared to sitting behind them.


Commenter's Profile Image Sharon Goodwin
March 13th, 2013
If the patient is lisping do you find that it is due to a cingulum taht is too bulky? Conversely is a whistle caused by a lack of contour in the cingulum? What phonetic difficulties are most obvious from aberrant tooth length? I know F and V are the determinants of correct incisal edge length but how do they manifest if the tooth lengths are not congruent with the vermilltion border of the lower lip? Thank you!!
Commenter's Profile Image John Sweeney
March 13th, 2013
I have found also that sometimes the lower teeth are bumping the lingual of the upper anterior teeth when speaking or making s sounds. Before adjusting anything, I put some articulating paper between the anterior teeth and have them say a few words with the s sound. I almost always find that that the lower anteriors are slightly bumping the lingual of the anterior teeth when they have speech issues with the temps or new crowns.. Making minor adjustments to the lingual of the upper anteriors usually solves the problem when this is found. I learned this on one of Frank's courses on the digital platform. It has been a life saver....
Commenter's Profile Image Cindy Folsom
March 14th, 2013
I know that many of my colleagues are excited and happy that they incorporate Cerec technology into their practices. Of course, there are pros and cons to all choices in life. While some excellent dentists may not venture into using Cerec for esthetic cases like the one described above, it is common for posterior teeth, of course. Sitting in the Occlusion Seminar at Spear Education today, I was reminded of the value of the "test drive" that a well-designed acrylic temporary provides in discovering what will be successful in a given patient, both for occlusion and for esthetics.
Commenter's Profile Image DR Derry Rogers
March 19th, 2013
The ability to deliver successful aesthetic results is predicated on the ability of the clinician to diagnose through the use of an aesthetic blueprint....namely aesthetically pleasing provisionals. It enables us to treat all manner of patients from the demanding princesses to those with traumatic injuries and to deliver dental health and happiness to all. This protocol has been the domain of Frank for many years and I am sure many of us can thank him for teaching us this so that we have been able to resolve the demands of aesthetically driven clients.