Pacific Coast Society of Orthodontists Bulletin Spring 2018 - 46

Presentation Summary

Doctors

4-5-6 Global Diagnosis
Dr. Christine Hong
PCSO Bulletin Columnist

Dr. William Robbins
Co-director of the Texas Academy
of Aesthetic Dentistry,
San Antonio, TX

Presented by Dr. William Robbins at the PCSO
Annual Session, , Oct. 14, 2017
Dr. Robbins graduated from the University of
Tennessee Dental School in 1973 and completed
three years of general practice residency. He has
co-authored two textbooks, Fundamentals of
Operative Dentistry: A Contemporary Approach
and Global Diagnosis: A New Vision of Dental
Diagnosis and Treatment Planning. He is a past
president of the American Board of General Dentistry, the Academy of Operative Dentistry, the
Southwest Academy of Restorative Dentistry, and
the American Academy of Restorative Dentistry.
Dr. Robbins spent the first 25 years of his career
in academics and the past 20 years in clinical
practice.
Global diagnosis is a systematic approach for
looking at that more complex, interdisciplinary
patient whom we all enjoy treating. So, what is
an interdisciplinary patient? Dr. Robbins defines
the term as a patient with the gingiva and/or
"landscape" in the wrong place.
Each of the numbers of the 4-5-6 Global
Diagnosis approach has a meaning.
The 4 refers to the four global diagnoses that
dictate all interdisciplinary treatment planning:
1.
2.
3.
4.

Short or hyperactive upper lip
Short clinical crown
Dentoalveolar extrusion
Skeletal discrepancy

As a dentist, there are only five things that we
can treat. The global diagnosis system tells us
why any or all of the five things are wrong.

1. The "landscape," with an emphasis on the
upper lip
 Average lip length, measured in repose from
base of nose to inferior border of the maxillary lip, in females 25 to 30 years of age is 20
to 22 mm. In young males, it is 22 to 24 mm.
 Lip mobility. The average translation of the lip
from repose to full smile is 6 to 8 mm.
 The lip lengthens with age (1 mm per decade
starting at age 40). This is because the volume
of the lips is lost due to a decrease in fluid and
collagen.
▪ Anne was treated for hyperactive upper lip.
▪ Dr. Robbins' daughter Amber was diagnosed with VME and has a short upper lip.
She does not have any functional problems
and has no need for crown lengthening;
Botox is useful in these patients.
2. Teeth
 The average central incisor is 10 to 11 mm long
and 75% to 80% as wide as it is tall.
 Three etiologies:
1. Microdontia
2. Attrition
3. Altered passive eruption
3. Gingiva
There are two components to the normal eruption process. Active eruption is the growth of the
tooth out of the alveolus and through the gingiva
into the mouth. Passive eruption is the normal
apical migration of the gingiva up the anatomic
crown, until it stabilizes 1 to 2 mm from the CEJ.
The passive eruption process is essentially complete at age 15; this is the appropriate time to
start performing the esthetic crown lengthening
procedure.

PCSO Bulletin  Spring 2018

Table of Contents for the Digital Edition of Pacific Coast Society of Orthodontists Bulletin Spring 2018