Bioesthetics is the study or theory of the beauty of living things in their natural forms and functions.
The goal of treatment is to have a beautiful, predictable, non-wearing dentition. (left photo)
Natural, unworn dentition of a 52-year-old female
Natural unworn dentition of a 83 year old male.
The principles of Bioesthetics are based on the research and teachings of Dr. Bob Lee. Prior to becoming a dentist, Dr. Lee was a biologist, which gave him a unique view of dentistry. According to Dr. Lee, for any muscle activity to occur (as in Mandibular movement) sensory input is required, ie: sensory in – motor out (Fig. 2).
Fig. 2
He also taught that enamel was a sensory tissue (its embryological origin is stomadaeal epithelium) and its sensory input is what guides the mandible to closure (Fig. 3).
Fig. 3
When dysfunctional sensory inputs are eliminated, the input to the central nervous system results in a functional, predictable, non-wearing dentition (Fig. 4).
Fig. 4 Functional requirements are a seated condyle, anterior tooth contact and anatomical posterior teeth.
If we establish the biologic form that achieves normal function, the result is natural beauty, hence bioesthetics (Fig 5).
Fig. 5 Natural form consists of longer centrals, shorter rounded laterals and longer pointed cuspids
Bioesthetic treatment consists of taking a centric relation record (Fig. 6).
Centric occlusion Fig 6. Centric relation.
The models are modified by removing tooth structure in the posterior teeth (negative coronoplasty), making sure not to flatten the natural dental anatomy. Then tooth structure is added to the anterior teeth with wax (positive coronoplasty) to achieve anterior coupling while in centric relation (Fig. 7).
Fig. 7 Negative and positive coronoplasty to achieve tooth contact in centric relation.
Fig. 8 case completed by Joe Wilson, DDS Belen, NM and Esthetic Dental Arts Lab Albuquerque, NM
This is then transferred to the mouth using flowable composites (Fig. 8).
Additive composite techniques.
In cases with advanced wear, a centric relation record is taken and a new vertical is established. The case is then waxed to this new vertical and transferred to the mouth for a comprehensive reconstruction using porcelain (Fig. 9).
Pre-treatment Fig. 9 Post-treatment
Fig. 9 case completed by Lyndon L. Liebelt, DDS, Albuquerque, NM and Esthetic Dental Arts Lab, Albuquerque, NM
For stability, we also need to take into consideration adequate airway and medications that affect the CNS.