The cover article in the August issue of JADA—"The Role of Cosmetic Dentistry in Restoring a Youthful Appearance" by Jeff Morley, D.D.S.—is by itself a conundrum.
As I read it, I have the impression that the measure of "youthful appearance" is the length of the 12 incisors. Further, the need for youthful appearance is stressed for the elderly. I believe this is misdirected. Stress should be put on the need to preserve the length of teeth in youth, for it is in youth that pathological wear and tear starts.
Although excellent restorative technique is essential to creating "youthful appearance," as I see it, the causes of abrasion and attrition must first be obviated. Otherwise, any and all attempts to restore length to teeth will be defeated. If malfunctional tooth-to-tooth contacts persist, all restorations eventually will be just as vulnerable to attrition and abrasion as were the teeth at the onset. It is not merely the vertical dimension that should concern us as therapists, but also the trajectories of functional jaw-to-jaw movement, including lateral and posterior-anterior directions, that result in severe tooth wear.
Aberrant jaw functions commonly start early in life and are exacerbated later in adulthood. If we are to be more complete dentists, and not merely fill and drill, as the author implored, it is important to learn how to diagnose and correct occlusal malfunctions first. This matter of occlusal malfunction relates to neuromuscular functional analysis, besides tooth-to-tooth relationship.
