Esthetics & Function: Incisal Edge Pitch

December 8, 2017 Lee Ann Brady DMD

The incisal edge anatomy of anterior teeth is quite complex. This complexity is fundamental to the esthetics of the tooth, as well as the function of incisors. How do we re-create the full anatomic form of the tooth in ceramics and composite? 

Components of Incisal Edge Anatomy Function and Esthetics: Pitch

When the full anatomic form is not precisely recreated, this can lead to esthetic and functional challenges. To successfully mimic this form, the clinician can rely on three components of incisal edges (from a lateral perspective): 1 pitch and 2 bevels.

We can visualize the pitch as the flat top of the incisal edge.

Pitch

Dimensions: Labio-lingual width of at least 1mm that increases from attrition or parafunction in edge to edge position.

Characterization: Pitch is not always parallel to the horizon and its relative position is dependent on the inclination of the incisor. Incisors are inclined just a little bit further to the labial at the incisal edge and the pitch has an upward slant toward the lingual.

Esthetics: The tooth shape and inclination results in an incisal edge esthetic of thinner enamel at the labio-incisal junction. It also creates the highly desirable visual translucence. Leveling the pitch to the horizon can change light reflection which is critical to esthetics of the tooth.

Restorative Approach: Often in ceramics we create a pitch that is level to the horizon and has decreased width of the pitch. This can compromise the esthetics of the translucency, but that can be gained back using stains.

Challenge: The challenge with this shape change in ceramics is that patients often sit in edge to edge position during parafunction. Insufficient pitch width may result in the patient experiencing functional challenges, not finding a comfortable spot to rest and increased parafunctional movement.

I’ll expand on understanding the two bevels in my next incisal edge anatomy blog …

What aspects of incisal edge anatomy do you find most challenging? Let us know in the comments!

 

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Incisal Edge Anatomy

November 30, 2017 Lee Ann Brady DMD

Anterior teeth have a complex incisal edge anatomy that creates both the esthetic appearance of the tooth and the function of the upper and lower incisors against one another.

Often in both ceramics and in composite we do not recreate the full anatomic form of the tooth. This results in both esthetic and functional challenges for the patient.  When we look at incisal edges from a lateral perspective there are three components, the pitch and two bevels. The Pitch is the flat top of the incisal edge. On both the labial and the lingual the transition zone between the pitch and these surfaces is a bevel. One is referred to as the leading edge and one is referred to as the trailing edge.

The Pitch has dimension or labio-lingual width, usually at least 1mm. This width increases as the patient shortens the tooth from Attrition, if they parafunction in an edge to edge position. The pitch is not always parallel to the horizon, but it’s relative position depends on the inclination of the incisor. When the incisors are optimally inclined, just slightly further to the labial at the incisal edge the pitch is slanted upward toward the lingual. This creates the incisal edge esthetic effect of thinner enamel at the labio-incisal junction and creates visual translucence. If the pitch is level to the horizon it changes light reflection and the appearance of the tooth. These two factors together is often what changes in restorative material.

We create a pitch that is level to the horizon, and then to gain translucence we decrease the width of the pitch, sometimes to a knife edge.

The challenge with this, is that patients sit in edge to edge position often to incise food and some for parafunction. If there is insufficient width to the pitch they may experience functional challenges.

The bevels on both sides have a variable width, but can be between a portion of a millimeter to multiple millimeters long. The bevels get longer in patients who grind their teeth in an excursive pathway pattern. Patients who parafunction edge to edge can often eliminate the bevel, making it easier to shear off enamel on the labial or lingual side of the tooth, or chip the edge enamel. The bevel functionally is a transition zone to create smooth functional movement as we pass from excursive movements onto the pitch. The Intercuspal stops on lower incisors is often on or gingival to the bevel.

Whether we are finalizing an equilibration or finalizing the occlusion on composites or ceramics perfecting the anterior guidance requires both pitch and bevel surfaces, it is a perfect example of the marriage between form and function.

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Little Guys Matter

August 1, 2017 Glenn Kidder DDS

Why Focusing on the Lower Anterior Teeth in Restorations is Important for Esthetics and Function

If you ignore the lower anterior teeth in a restoration, you may be sacrificing a significant amount of potential case benefits.

The process of improving dental techniques is one of constant refinement throughout our careers. We build upon techniques and begin to see our blind spots with each new case.

This blog is about specificity and detail-oriented technique. Excellent clinical dentistry balances the patient’s desire to improve their smile esthetics with effectively conveying the overall importance of planned changes to their health.

Incorporate the approach I discuss below into your restorative work and you’ll see the benefits extend widely to both final case esthetics and patient satisfaction. After all, those twin goals entwine throughout everything we do in the dental practice.

Restore Lower Anterior Teeth for Esthetics and Function

Have you ever noticed cases in various dental publications where nice restorative work has been completed on the upper anterior teeth, but the lower incisors were completely ignored? Oftentimes the lower anterior teeth (the little guys) are crowded, uneven, worn, and/or damaged.

This discordant aspect is visually jarring and detracts from the perceived beauty of the final result. The pristine nature of the upper anterior teeth throws the correspondingly less appealing look of the lower anterior teeth into greater relief.

The little guys are important for esthetics and function. They show considerably more on speech as we age, something very few patients realize. They are also critical for distribution of forces as we move into protrusive and excursions. The Pankey Institute recognizes the importance of lower anterior teeth as a vital aspect of complete dental care.

This is a periodontal case where a simple equilibration substantially improved esthetics and force distribution. Patients really appreciate an enhanced smile. They immediately feel better function and stability.

What commonly overlooked areas or techniques do you use to improve restoration esthetics and function? We’d love to hear from you in the comments!

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Glenn Kidder DDS

Dr. Glenn M. Kidder has served on the visiting faculty at the Pankey Institute in Key Biscayne, Florida for the past 23 years. He facilitates several courses which deal with occlusion, TMJ disorders, splint therapy, and equilibration in restorative dentistry. He also serves as the Essential II Coordinator in the Department of Education at Pankey. He is past president of the Greater Baton Rouge Dental Association. He was instrumental in the start up of The Greater Baton Rouge Community Clinic which has provided over five million dollars of free medical and dental care to the working uninsured in the Baton Rouge area. He is past president of Cortana Kiwanis where he has 33 years of perfect attendance. He has been married for 35 years to Stacey Kidder, a psychotherapist. They have three sons who are LSU graduates—two are dentists. Dr. Kidder is in private practice in Baton Rouge, Louisiana where his practice is limited to the treatment of temporomandibular joint and occlusal disorders. He is a Diplomate with The American Board of Orofacial Pain, a Fellow in The Academy of General Dentistry, a Fellow in The Pierre Fauchard Academy, a Fellow in The International College of Dentists and is a 32 year member of the American Equilibration Society. He is an assistant clinical instructor in the Department of Prosthodontics at LSU School of Dentistry.

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