Evolution of Aesthetic Dentistry

One of the main goals of aesthetic dentistry is to mimic teeth and design smiles in the most natural and aesthetic manner based on the specific needs of the patient. This article is an overview of the evolution of aesthetic dentistry over the past 100 years from a historical point of view and highlights advances and clinical interventions that contributed to the signs and art of aesthetic dentistry. The roots of aesthetic dentistry traced back to ancient civilisations. The Egyptians, Greeks and Romans are the ones who experimented with dental prosthesis and tooth whitening using a variety of materials and techniques. In the 18th and 19th centuries, advancements in dental science led to the use of porcelain for dental restorations. Dentists began creating dentures and crowns that were not only functional but also more visually appealing. The quest to improve the appearance of the face and teeth dates back to ancient history. In the 18th century, spurred by the pioneering work of the likes of Pierre Fauchard, dentistry developed as a separate medical discipline, facilitating specialised treatment of functional and aesthetic dental deficiencies. While preventive measures, tooth replacement materials and partial as well as complete denture fabrication techniques were constantly advanced afterwards, it was the 20th century that saw the most significant breakthroughs in aesthetic dentistry. The late 20th and 21st century bought about technological revolutions such as computer-aided design (CAD) and computer-aided manufacturing (CAM) in aesthetic dentistry. Until recently, a misconception prevailed among people that the concept of dental aesthetics was limited to alterations in teeth alone. Any changes in the pre-existing ‘Lip-Gingival-tooth’ relationship were thought to require orthodontic therapy in conjunction with orthognathic surgery or aggressive periodontal procedures. However, much of this has been changed with the introduction of software-based tissue plastic surgery. The essentials of a smile usually involve the teeth, the gingival scaffold and lip framework. Applying proper colour while restoring or replacing teeth with dental materials has always been a challenge in aesthetic dentistry. Clark, in 1931, was the first to attempt to organise tooth colours. In the same year, the Commission Internationale de l’Eclairage (CIE) developed a system to quantify colour and calculate tristimulus values, which represent how the human visual system responds to a given colour. The CIE Lab system, introduced in the year 1976 and 1978, was the first to express colour by numbers and calculate differences in relation to visual perception. Colour measuring instruments are increasingly popular in aesthetic dentistry such as spectrophotometer, colorimeter, spectroradiometer and digital image analysis techniques. To achieve the desired colour perception, tooth whitening is a simple and conservative procedure. Most of the tooth bleaching products contain hydrogen peroxide in 5%–35% used in an in-office procedure and 3%–7.5% used in a home bleaching procedure. Tooth sensitivity is the most common adverse effect of tooth whitening, which is seen to be minimised by application of a desensitising agent prior to the procedure. In case of malformed or damaged teeth, bonding of adhesive restorations is performed by the discovery of acid etching by Michael Bunocore (1955). Aesthetic prosthodontics uses an approach that helps to solve more complicated problems such as missing teeth or a missing part of the maxillary or mandibular jaws that both fixes not only the problem from a functional standpoint, but also helps the patient to look and feel better. It also requires harmony and balance. Designing the smile in the most natural aesthetic manner is considered one of the main goals of the dental treatment; the satisfaction with the results is dependent on the specific needs of the patient and the dentist’s version. Matching of the colour is also an essential criterion in delivering maxillofacial prosthesis, and acrylic resin and silicone are added to obtain the final colour. In a study, Ranabhatt et al. compared instrumental colourimetric and photometric techniques of shade matching with the chair-side trial-and-error methods and found the chair-side method to be more reliable. The restoration of an aesthetic implant is similar to that of a naturally existing tooth in all aspects. Dental implants are useful for individuals with tooth loss due to their high survival rate. Regardless of good survivability, complications due to peri-implant disorders are persistent. Peri-implantitis is considered an irreversible, progressive tissue disorder in the region of implant placement and is often accompanied by decreased osseointegration, bone reabsorption, increased pocket formation and purulence. The invention of computer-assisted diagnostic, treatment-planning, design and restoration fabrication technologies had a significant impact on aesthetic dentistry through digitisation and simplification of key clinical and laboratory steps. A dental CAD-CAM device that included both an optical scanner and a numerically controlled milling machine was first demonstrated in 1985. In the current scenario, the diagnostic treatment plan and design in aesthetic dentistry have been revolutionised by CAD-CAM, ranging from single-unit to complete arch prosthesis. There are several software programs that integrate all diagnostic, treatment-planning, design and digital manufacturing steps in 1 system. Natural tooth-and-smile algorithm libraries facilitate aesthetic outcomes that are superior to hand-built wax-ups or computer-generated shapes. Designing teeth and smiles based on dynamic facial and lip analysis increases predictability and aesthetic outcomes. New digital smile design software also incorporates digital-planning and treatment process. Current smartphones and other mobile electronic devices have the ability to make three-dimensional (3D) face scans. Merging such scans with other diagnostic information in a specific aesthetic design application platform allows the clinician and dental technician to design cases even on mobile devices. In the future, machine learning and artificial intelligence will automate most, if not all, aesthetic evaluation, planning designs and treatment processes to provide customised dental care that is truly patient-centred, natural-looking and in harmony with facial and other features. Among the most noteworthy advancements over the past decade are the establishment of dental research and universal aesthetic rules and guidelines based on the assessment of natural aesthetic parameters, anatomy and physiognomy; the development of tooth whitening and advanced restorative as well as prosthetic materials and techniques, supported by the pioneering discovery of dental adhesion; the significant progress in orthodontics and periodontal as well as oral and maxillofacial surgery; and most recently, the implementation of digital technologies in the 3D planning and realisations of truly natural, individual and aesthetic smiles. The future of aesthetic dentistry is to reconnect with nature and to develop tools that replicate and create the variations found in natural beauty, independent of the skill set of a clinician or dental technician and accessible to every individual patient. Aesthetic dentistry is part of any clinical speciality area and has seen tremendous progress over the last 100 years, especially with the application of digital tools and workflows that facilitate a customised 3D interdisciplinary approach to smile design and treatment execution. The evolution of aesthetic dentistry reflects the broader advancements in dental science and technology. From ancient tooth replacements to modern digital innovations, the field has continually adapted to meet the changing needs and desires of patients. As technology continues to advance, the future of aesthetic dentistry promises even more remarkable improvements, ensuring that the quest for a beautiful smile remains ever at the forefront of dental care.