L’estetica dentale: denti belli a qualunque età

Le aspettative del paziente nei confronti dell’opera del proprio dentista sono mirate non solo ad ottenere nuovamente una funzione perduta, ma anche a conquistare un’estetica soddisfacente. L’intervento del dentista riguarda non più il solo dente, ma tutta l’area del sorriso; quindi la costruzione protesica non è più solo finalizzata ad un risultato meccanico o di pura sostituzione dei denti mancanti, ma anche ad un risultato estetico.
Per ottenere ciò è fondamentale la collaborazione tra il medico dentista e l’odontotecnico che deve trasformarsi in un singolare pittore, lavorando la porcellana e trasformandola fino a farla divenire da opaca e fredda a vibrante e vitale.
Si comprende come quest’arte debba tener conto del “mondo dei particolari”, delle piccole cose fatte di raccordi sottili ed impalpabili, della capacità di creare un insieme di cromatismi che attribuiscano al dente il connotato della veridicità e quindi sfidi chiunque a distinguere un dente finto da un dente naturale. Per creare un dente in porcellana che sia bello e vero al pari di uno naturale è indispensabile donare al dente “profondità”: i denti in ceramica devono avere, infatti, un’anima, quasi come se ci fossero due fonti di luce: una al di dentro e l’altra al di fuori del dente stesso.
Bisogna, pertanto, costruire un dente che sia quanto più tridimensionale possibile e, per la sua costruzione, è necessario apporre un insieme di masse colorate capaci, di volta in volta, di farsi attraversare dalla luce, di rinfrangerla o di assorbirla, e ciò a vari livelli di profondità, nello spessore del dente ed in modo diverso a seconda delle differenti zone prese in considerazione.
Nessun dente, dal punto di vista di sostanza materica, è mai uguale ad un altro: è, appunto, quest’anima tridimensionale che attribuisce veridicità e naturalezza ad un elemento in porcellana. Si comprende come i vari strati che formano la sostanza materica determinino anche il colore esterno dell’elemento dentario.
In un dente esiste una dominante-colore che va individuata generalmente nell’arancio tendente al giallo, rare volte anche al rosso. Ma il problema più grosso per l’odontotecnico è definire e scorporare la quantità di grigio presente, perché è proprio il grigio sovente a condizionare il risultato finale.
Altro elemento fondamentale, perché un sorriso “rifatto” risulti naturalissimo, è la superficie attraverso la quale è possibile giocare molte carte nella risoluzione estetica di un caso: ad esempio con una concavità concentriamo la luce, con una convessità la disperdiamo, con una linea la indirizziamo, con triangoli e solchi ne interrompiamo il fluire. Tuttavia è opportuno considerare l’elemento dentale nell’insieme della scenografia che lo circonda, vale a dire i tessuti gengivali, le labbra e le linee del viso. Infatti, una gengiva gonfia, di colore scuro, oppure una discontinuità dell’osso alveolare, condizioneranno negativamente l’aspetto estetico. Ecco perché è importante fare una diagnosi estetica al paziente in prima visita, con la ceratura estetica, cioè prendendo le impronte delle due arcate ed altre impronte di precisione, montandole poi su un apparecchio detto articolatore, da cui si possono individuare i futuri parametri terapeutici e le correzioni da apporre.

La ricostruzione protesica

È importante che una ricostruzione protesica tenga conto di una documentazione fotografica, in quanto alcuni pazienti in avanti con l’età, richiedono allo specialista il sorriso dei loro vent’anni; altre volte la documentazione fotografica antecedente la lesione è fondamentale per chi ha perso un dente sul davanti e vuole riprodurlo con le sue peculiarità, ad esempio un incisivo leggermente accavallato oppure con uno spazio interdentale accentuato. Ciò facilita il processo di accettazione del sé.
Si comprenda da tutto quanto esposto, seppure in linee ampie e generali, come l’estetica protesica sia una scienza con le sue regole e le sue tecniche operative al di fuori di ogni improvvisazione ed estemporaneità e come avere un bel sorriso sia frutto di impegno e certosino lavoro di collaborazione tra medico dentista e odontotecnico.

Elio Bava
Medico chirurgo
Specialista in odontoiatria e protesi dentaria

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