The periodontal factor in esthetic smile design--altering gingival display

The periodontal soft and hard tissues are an important determinant of restorative smile esthetics. Management of the periodontal tissues that "frame" each tooth is crucial to esthetic smile design. This article describes a four-step technique that makes it possible to sculpt the position of the labial gingival margin to provide additional crown height or length, a process the author describes as smile sculpting. This periodontal smile sculpting can aid in determining the pre-restorative treatment profile for teeth and create a blueprint for the restorative dentist to enhance a patient's final esthetic treatment results. Crucial to understanding this process is an appreciation of the periodontal principles that govern smile design, especially the periodontal biologic width and the influence of the underlying hard tissue bony architecture in defining the periodontal envelope from which the teeth emerge.