Planejamento de tratamento estético restaurador: parâmetros a serem considerados e desafios da prática clínica

Abstract

The analysis and planning of aesthetic restorative treatments are essential steps in clinical practice and should be performed carefully to avoid the occurrence of failures. The objective of this study is to present parameters for the analysis and aesthetic planning of the smile, as well as to present possibilities for the management of clinical failures through conservative techniques. Among the various parameters that should be considered, two should be highlighted: evaluation of the central incisor length/width ratio and exposure of the maxillary central incisor incisal edges when the patient has a resting lip. With this information, it is possible to determine the position that the central incisor should take, also considering the gender and age of the patient. Knowing the characteristics of the smile allows systematizing the use of tools and applying them adding naturalness to the treatments. One of these tools is the modified aesthetic gauge developed and demonstrated in this study, which allows the simple combination of dental proportion and incisal exposure, making it easy to visualize the correct treatment indication to obtain a harmonic smile. Once performed, restorative treatments require preservation and maintenance. In some cases, failures can occur and repair is an interesting alternative to conservative treatment, avoiding replacement and wear of healthy dental tissue. Two cases are presented illustrating conducts facing different clinical situations: I. the composite resin repair procedure that delayed the replacement of fractured ceramic laminates, thus increasing the longevity of existing restorations, showing that replacement need not be the first treatment option in the presence of failure and that these can be managed conservatively, avoiding or postponing the need for reintervention or replacement. II. ceramic laminate fragment bonding procedure, which was effective and facilitated clinical management, without the need for invasive intervention, with excellent cost/benefit, functionality, and aesthetics after 5 years. In this scenario, it is important to: make a correct diagnosis and define the treatment, considering the technical domain of the professional and the human individuality. Proper planning involves the analysis of aesthetic parameters and the use of tools to facilitate the indication and execution of the correct technique. Still, the treatments involve risks and benefits that should be clarified to the patient, including the consideration of not performing unnecessary treatments. Management of possible failures must give priority to health through minimally invasive and conservative clinical practice.