For Esthetics "Cuspid Zero"

Some words in our vocabulary are almost impossible to define. The American philosopher Charles Taliaferro said, "There may be indefinitely many things that exist for which we do not have any successful definition. Consciousness might be a candidate, insofar as some philosophers are right in thinking we may never have a good or at least problem-free definition." Ask a poet to describe love or maybe Neil deGrasse Tyson to explain science. In the end, we most likely would be left with more questions than specific answers. In dentistry, esthetics is our challenge. Encyclopædia Britannica defines aesthetics as "the philosophical study of beauty and taste. It is usually closely related to the philosophy of art, which is concerned with the nature of art and the concepts in terms of which individual works of art are interpreted and evaluated." Those words—philosophy, interpreted, and evaluated—are what leave the door open to "indefinitely many things."

Esthetics, for the most part, are subjective. In dentistry, we use many metrics and tools to communicate the esthetic needs of our patients. Photography, facial analyzers, lip dynamics, incisal edge display, facial features, material selections, and even digital facial diagnostics all play a part, but in the end, isn't the patient's acceptance what truly matters? And in today's world, many other challenges exist. Most experts in the field tell us that the 1 mm to 4 mm of incisal display is what makes a case "esthetic." The patient's lip dynamic, which in the past was always a reference point and adjusted with normal aging, faces other variables in today's world, such as the use of cosmetic facial and lip augmentation with surgery and injectables such as Botox and Restylane, to name a few. Clearly, we need to keep evolving our metrics to keep up with the successful outcomes and desires of our patients.

Over the years, our incisal reference point—or using the centrals as a measuring point—has shifted to the cuspids. We are probably all familiar with the phrase "Cuspid at Zero," referring to the cuspid display during normal repose lip position. Because the lip dynamic can now be so easily altered, its role is mostly seen in the area of the centrals. Utilizing the cuspids or their lack of display during repose should help us to develop the horizontal reference length and plane of the maxillary arch. If the cuspid display is more than 1 mm in length past the reposed lip, the maxillary arch will appear too long. On the contrary, if the cuspids are -1 mm to -2 mm in repose, meaning 1 mm to 2 mm apical to the vermillion border, this is a sign that they can be lengthened. This reference point will help establish the horizontal plane from the length of the centrals to the posterior occlusal planes. 

In the end, although defining a universal concept of esthetics may be challenging—and recognizing that our patients may have a differing view—our tools and evolving metrics will aid in more successful communication with our patients and more successful results.

Peter Pizzi, MDT, CDT
Editor-in-Chief
ppizzi@aegiscomm.com