Esthetics / orthodontics courses in india

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  • 1. ESTHETICSESTHETICS INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY Leader in continuing dental educationLeader in continuing dental education www.indiandentalacademy.comwww.indiandentalacademy.com www.indiandentalacademy.com
  • 2. TABLE OF CONTENTSTABLE OF CONTENTS  INTRODUCTIONINTRODUCTION  HISTORYHISTORY  ORIGIN OF ESTHETICS AND PERCEPTIONORIGIN OF ESTHETICS AND PERCEPTION  THE SEVEN PRINCIPLES OF ESTHETICSTHE SEVEN PRINCIPLES OF ESTHETICS  FACTORS OF ESTHETIC DENTOFACIAL COMPOSITIONFACTORS OF ESTHETIC DENTOFACIAL COMPOSITION  FACIAL COMPONENTFACIAL COMPONENT  DENTAL COMPONENTDENTAL COMPONENT  GINGIVAL COMPONENTGINGIVAL COMPONENT  PHYSICAL COMPONENTPHYSICAL COMPONENT  COLORCOLOR  SHADE GUIDESSHADE GUIDES  ESTHETICS IN COMPLETE DENTUREESTHETICS IN COMPLETE DENTURE  ESTHETICS IN REMOVABLE PARTIAL DENTUREESTHETICS IN REMOVABLE PARTIAL DENTURE  ESTHETICS IN FIXED PARTIAL DENTUREESTHETICS IN FIXED PARTIAL DENTURE  ESTHETICS AND IMPLANT PROSTHESISESTHETICS AND IMPLANT PROSTHESIS  BLEACHINGBLEACHING  SUMMARY AND CONCLUSIONSUMMARY AND CONCLUSION  REFERENCESREFERENCES www.indiandentalacademy.com
  • 3. A Thing Of Beauty Is A Joy ForeverA Thing Of Beauty Is A Joy Forever  The science of esthetics literally means “the science ofThe science of esthetics literally means “the science of beauty in nature and arts”beauty in nature and arts”  Beauty in itself is a combination of reality and personalBeauty in itself is a combination of reality and personal perception.perception.  Thus the science of esthetics remains inexact and aThus the science of esthetics remains inexact and a subjective domain.subjective domain.  Beauty can be classified broadly as:-Beauty can be classified broadly as:- Ideal beauty Human beautyIdeal beauty Human beauty Natural beauty Abstract beautyNatural beauty Abstract beauty The search for beauty can be traced to earliestThe search for beauty can be traced to earliest civilization.Before attempting to identify present daycivilization.Before attempting to identify present day concept of facial esthetics…..concept of facial esthetics….. www.indiandentalacademy.com
  • 4. Hence a brief view of our esthetic heritage will be presentedHence a brief view of our esthetic heritage will be presented herehere  PREHISTORIC:PREHISTORIC: The early man unfortunately had a very little time to contemplateThe early man unfortunately had a very little time to contemplate beauty…beauty… As early as 35,000 years ago Paleolithic man discovered that….As early as 35,000 years ago Paleolithic man discovered that…. Development of Egyptian civilization….Development of Egyptian civilization….  THE GREEK:THE GREEK: First culture to have expressed sensitively facial beauty-First culture to have expressed sensitively facial beauty- philosophy and sculpture.philosophy and sculpture. Philosophers like Plato and Aristotle-introduced “aesthetics” as thePhilosophers like Plato and Aristotle-introduced “aesthetics” as the study of beauty and philosophy of art.study of beauty and philosophy of art. They felt that beautiful creations respected certain geometricThey felt that beautiful creations respected certain geometric laws..laws..  AFTER THE GREEKS:AFTER THE GREEKS: Esthetic heritage owes much to classical Greeks butEsthetic heritage owes much to classical Greeks but Romans were the ones who profusely documented beauty.Romans were the ones who profusely documented beauty. www.indiandentalacademy.com
  • 5.  Interest in esthetics faded out in middle age (dark age)Interest in esthetics faded out in middle age (dark age)  Until renaissance in the 15Until renaissance in the 15thth century..century..  The leader of the movement to modernize and promoteThe leader of the movement to modernize and promote dentistry wasdentistry was PIERRE FAUCHARDPIERRE FAUCHARD (1678-1761) of France(1678-1761) of France  Introduction of mineral teeth in 1817 was followed byIntroduction of mineral teeth in 1817 was followed by manufacture of porcelain teeth.manufacture of porcelain teeth. Picture shows partial denture of about 1830,porcelain teeth of Fonzi’s design have been Soldered to a gold backing. One piece porcelain upper denture crafted by Dr John Scarborough, Lambertville, New Jersey 1868. www.indiandentalacademy.com
  • 6. Wooden dentures, 1538,carved by a buddist priest Carved ivory upper denture retained in the mouth by springs with natural human teeth cut off at the Neck and riveted at the base www.indiandentalacademy.com
  • 7.  Auroplasty , colored gutta-perchaAuroplasty , colored gutta-percha  Parkesin , a celluloid like materialParkesin , a celluloid like material  Cheoplasty an alloy of tin, silver and bismuthCheoplasty an alloy of tin, silver and bismuth  Rose pearl, collodionRose pearl, collodion  Pink hecolitePink hecolite  Even tortoise shells were used for esthetic effect.Even tortoise shells were used for esthetic effect.  In late 19In late 19thth century various techniques used in fixedcentury various techniques used in fixed prosthodontics were introduced.prosthodontics were introduced.  By 1970’s composite resins replaced acrylic resins andBy 1970’s composite resins replaced acrylic resins and silicate cements as permanent restorative material.silicate cements as permanent restorative material.  Acid etching/bonding radically changed cavityAcid etching/bonding radically changed cavity treatment by emphasizing conservation of toothtreatment by emphasizing conservation of tooth structurestructure  1970’s numerous veneering techniques were introduced1970’s numerous veneering techniques were introduced A set of vulcanite dentures worn by Gen. John J. (Blackjack) Pershing, commander of the American Expeditionary Forces in France during the First World War Set of complete dentures having palate of swaged Gold and porcelain teeth set in vulcanite. Dentures made of polymethyl methacrylate Celluloid upper denture 1880 www.indiandentalacademy.com
  • 8. The Origin Of Esthetics And Its Perception:-The Origin Of Esthetics And Its Perception:-  What is esthetics?What is esthetics?  The Dorland English dictionary describes it as- “The science ofThe Dorland English dictionary describes it as- “The science of beauty in nature and arts”beauty in nature and arts”  According to GPTAccording to GPT Esthetics 1. The branch of philosophy dealing with beautyEsthetics 1. The branch of philosophy dealing with beauty 2. In dentistry , the theory and philosophy that deal with beauty2. In dentistry , the theory and philosophy that deal with beauty and the beautiful , especially with respect to the appearance of a dentaland the beautiful , especially with respect to the appearance of a dental restoration , as achieved through its form or color. Those subjective andrestoration , as achieved through its form or color. Those subjective and objective elements and principles underlying the beauty and attractivenessobjective elements and principles underlying the beauty and attractiveness of an object , design and principleof an object , design and principle  Beauty in nature is the mirror of essential beautyBeauty in nature is the mirror of essential beauty essential beautyessential beauty (vegetables) natural beauty (minerals)(vegetables) natural beauty (minerals) human beautyhuman beauty  This approach will permit us to aim at the development of objectiveThis approach will permit us to aim at the development of objective criteria of beauty as well as..criteria of beauty as well as..  This is not to say that beauty is objective…This is not to say that beauty is objective…  Hence beauty is a combination ofHence beauty is a combination of realityreality andand perceptionperception www.indiandentalacademy.com
  • 9. Perception ?Perception ?  Is the organization of sensory dataIs the organization of sensory data (sight,touch,hearing,taste and smell stimuli) which are(sight,touch,hearing,taste and smell stimuli) which are brought to the intellect were an answer is developed inbrought to the intellect were an answer is developed in combination with results of previous experiences and beliefscombination with results of previous experiences and beliefs that are unconsciously interpreted.that are unconsciously interpreted.  In visual perception the rods and cones bring stimuli..In visual perception the rods and cones bring stimuli..  Scientific investigation in physiology and psychology ofScientific investigation in physiology and psychology of perception has resulted in formulation of certain principlesperception has resulted in formulation of certain principles or parameter of visual perception that provides basis for anor parameter of visual perception that provides basis for an introduction to the elements of esthetics that are a part ofintroduction to the elements of esthetics that are a part of natural and essential beauty.natural and essential beauty. www.indiandentalacademy.com
  • 10. ESTHETIC PRINCIPLES:-ESTHETIC PRINCIPLES:- COMPOSITION:COMPOSITION: The physiologic property of eye isThe physiologic property of eye is vision.Vision is possible if eye canvision.Vision is possible if eye can differentiate.Which is possible only if there isdifferentiate.Which is possible only if there is contrast.Increase in visibility is proportionalcontrast.Increase in visibility is proportional to increase in contrast.to increase in contrast. The relationship between object madeThe relationship between object made visible byvisible by CONTRASTCONTRAST is calledis called Composition.Composition. Terminologies in our field of interest areTerminologies in our field of interest are dental,facial and dentofacial composition.dental,facial and dentofacial composition. Dentofacial composition Dental composition www.indiandentalacademy.com
  • 11. UNITY:UNITY:  The prime requisite of composition is unity.The prime requisite of composition is unity.  It gives different parts of the composition the effect ofIt gives different parts of the composition the effect of the whole.the whole.  STATIC UNITY DYNAMIC UNITYSTATIC UNITY DYNAMIC UNITY - composed of irregular Plants and animals- composed of irregular Plants and animals and geometric shapesand geometric shapes E.g drops of water,snowE.g drops of water,snow Flake crystalsFlake crystals - Is passive and inert Active,living and- Is passive and inert Active,living and (without motion) growing(without motion) growing www.indiandentalacademy.com
  • 12. COHESIVE FORCES SEGREGATIVE FORCESCOHESIVE FORCES SEGREGATIVE FORCES  Elements that tend to unify Opposite of cohesive forcesElements that tend to unify Opposite of cohesive forces a compositiona composition  A border is a cohesive force They provide variety in unity….A border is a cohesive force They provide variety in unity…. as well as arrangement ofas well as arrangement of elements in a definiteelements in a definite form or according to aform or according to a principle.principle. www.indiandentalacademy.com
  • 13.  HOGARTHS line Of Beauty:HOGARTHS line Of Beauty:  Has long been considered an outstandingHas long been considered an outstanding example of unity with variety.example of unity with variety.  It is a line inscribed around a cone.It is a line inscribed around a cone.  The line is never the same at any pointThe line is never the same at any point along its course yet it never leaves thealong its course yet it never leaves the surface of the cone.surface of the cone.  This is absolute unity with absolute variety.This is absolute unity with absolute variety. www.indiandentalacademy.com
  • 14. SYMMETRY:SYMMETRY:  It refers to regularity in the arrangement of form and object.It refers to regularity in the arrangement of form and object. (Furtwangler,1964).(Furtwangler,1964).  It is and can be totally differentiated from balance in the sense that inIt is and can be totally differentiated from balance in the sense that in balance things that are farther from the center grow in importance andbalance things that are farther from the center grow in importance and weight..weight..  But in case of symmetry all the elements are alike with references toBut in case of symmetry all the elements are alike with references to there position in relation to a central point.there position in relation to a central point.  HORIZONTAL SYMMETRY RADIATING SYMMETRYHORIZONTAL SYMMETRY RADIATING SYMMETRY  Occurs when a design contains is a result of design of an objectOccurs when a design contains is a result of design of an object similar elements from left to extending from a central point andsimilar elements from left to extending from a central point and right in a regular sequence the right and left side are mirrorright in a regular sequence the right and left side are mirror imagesimages  Is psychologically predictable and Represents segregating forces thatIs psychologically predictable and Represents segregating forces that comfortable tends to be brings life and dynamism to acomfortable tends to be brings life and dynamism to a monotonous compositionmonotonous composition PRINCIPLE- SYMMETRY MUST BE INTRODUCED IN THE DENTOFACIALPRINCIPLE- SYMMETRY MUST BE INTRODUCED IN THE DENTOFACIAL COMPOSITION TO CREAT A POSITIVE PHYSIOLOGIC RESPONSECOMPOSITION TO CREAT A POSITIVE PHYSIOLOGIC RESPONSE www.indiandentalacademy.com
  • 15. Horizontal symmetry Radiating symmetryHorizontal symmetry Radiating symmetry www.indiandentalacademy.com
  • 16. ProportionProportion :: Dental esthetics and golden proportionDental esthetics and golden proportion (Edwin I. Levin JPD 40;3,(Edwin I. Levin JPD 40;3, 1978)1978)  The concept of beauty has most oftenThe concept of beauty has most often corresponded to a harmony in proportioncorresponded to a harmony in proportion  The true value of proportion in esthetics, isThe true value of proportion in esthetics, is its usefulness as a key tool in providing theits usefulness as a key tool in providing the unity-with-variety quotient in dentalunity-with-variety quotient in dental composition.composition.  Golden proportion has been used since timeGolden proportion has been used since time immemorial.immemorial.  It was extensively used in Greek architectureIt was extensively used in Greek architecture eg the Parthenon on the Acropolis of Athens.eg the Parthenon on the Acropolis of Athens.  Kepler called it theKepler called it the “DIVINE PROPORTION”.“DIVINE PROPORTION”.  The application of golden no. to dentistry wasThe application of golden no. to dentistry was first mentioned byfirst mentioned by LOMBARDI(1973)LOMBARDI(1973) andand developed bydeveloped by LEVIN(1978)LEVIN(1978).. Parthenon Square of the ancients Leonardo da Vinci www.indiandentalacademy.com
  • 17. www.indiandentalacademy.com
  • 18.  Proportion between teethProportion between teeth  In its simplest form it is the proportion between the larger partIn its simplest form it is the proportion between the larger part and smaller part.and smaller part.  When ratio between B and A is in the golden proportion, then B isWhen ratio between B and A is in the golden proportion, then B is 1.618 times larger than A.1.618 times larger than A. 0.618 1 A B 1 www.indiandentalacademy.com
  • 19. The grid has proved very usefulThe grid has proved very useful in prosthodontics in detectingin prosthodontics in detecting what is wrong estheticallywhat is wrong esthetically when the eye cannot.when the eye cannot. The number in the solid circleThe number in the solid circle refers to the width of the centralrefers to the width of the central incisor. There are 7 grids to acceptincisor. There are 7 grids to accept all widths of central incisor from 7all widths of central incisor from 7 to 10 mms in steps of 1/2 mm. Theto 10 mms in steps of 1/2 mm. The grid also shows a number in a dotedgrid also shows a number in a doted circle which refers to thecircle which refers to the width ofwidth of the smilethe smile Golden proportion calipers(1954), they always open to a constant golden proportion between the larger and smaller part Proportion between teeth and smile www.indiandentalacademy.com
  • 20. BALANCE:-BALANCE:-  It can be defined as the stabilization resulting fromIt can be defined as the stabilization resulting from exact adjustment of opposing forces.exact adjustment of opposing forces.  Our visual sense is used to maintain or induceOur visual sense is used to maintain or induce equilibrium-if not established leads to visual tension.equilibrium-if not established leads to visual tension.  To relieve tension or to reestablish balance 2 possibilitiesTo relieve tension or to reestablish balance 2 possibilities are left to the operator /viewer:-are left to the operator /viewer:- 1)1) move the causative element towards the line of forcemove the causative element towards the line of force until the magnitude of visual tension is totally relieved.until the magnitude of visual tension is totally relieved. 2)2) introduce an opposite element in the line of force tointroduce an opposite element in the line of force to promote equilibriumpromote equilibrium www.indiandentalacademy.com
  • 21. LINES:-LINES:- It has been stated that many factorsIt has been stated that many factors that have been a part of structural orthat have been a part of structural or biologic beauty depends on visualization ofbiologic beauty depends on visualization of lines.lines. Parallel lines are most harmonious as they doParallel lines are most harmonious as they do not exhibit conflictnot exhibit conflict Perpendicular suggest psychologicalPerpendicular suggest psychological relationship and strong segregative forcesrelationship and strong segregative forces Various lines exists in dentalVarious lines exists in dental composition:composition:  occlusal planeocclusal plane  incisal planeincisal plane  midlinemidline  tooth directiontooth direction www.indiandentalacademy.com
  • 22. DOMINANCE:-DOMINANCE:-  Just as unity is the prime requisite for a good composition,Just as unity is the prime requisite for a good composition, dominance is prime requisite for providing unitydominance is prime requisite for providing unity  dominance providesdominance provides static unity dynamic unitystatic unity dynamic unity ( monotonous) (vigorous)( monotonous) (vigorous)  Color,shape and lines are characters that create dominance.e.g..theColor,shape and lines are characters that create dominance.e.g..the central incisor must be the most dominant element in the dentalcentral incisor must be the most dominant element in the dental composition.Achieved by….composition.Achieved by….  TheThe mouthmouth is the dominant feature of the face.It dominates byis the dominant feature of the face.It dominates by virtue of its size,mobility and psychic association.virtue of its size,mobility and psychic association.  TheThe amount of dominanceamount of dominance to be given to the mouth by the dentalto be given to the mouth by the dental compositioncomposition depends on patients personality and strength ofdepends on patients personality and strength of background facial featuresbackground facial features www.indiandentalacademy.com
  • 23. FACTORS OF ESTHETIC DENTOFACIALFACTORS OF ESTHETIC DENTOFACIAL COMPOSITION AND THEiR CLINICALCOMPOSITION AND THEiR CLINICAL SIGNIFICANCESIGNIFICANCE:-:-  An organized systematic approach is required toAn organized systematic approach is required to evaluate,diagnose and resolve esthetic problems.evaluate,diagnose and resolve esthetic problems.  Two main aims of esthetic treatment:-Two main aims of esthetic treatment:- 1) create teeth in harmonious proportion to one another1) create teeth in harmonious proportion to one another 2) to create a pleasing teeth arrangement in harmony2) to create a pleasing teeth arrangement in harmony with the lips, gingiva and face of the patient.with the lips, gingiva and face of the patient.  These factors may be applied to or in treating bothThese factors may be applied to or in treating both edentulous and dentulous patients.edentulous and dentulous patients.  The various components of dentofacial complex are:The various components of dentofacial complex are:  FACIAL COMPONENTFACIAL COMPONENT  DENTAL COMPONENTDENTAL COMPONENT  GINGIVAL COMPONENTGINGIVAL COMPONENT  PHYSICAL COMPONENTPHYSICAL COMPONENT www.indiandentalacademy.com
  • 24. Facial ComponentFacial Component  The esthetic orientation of dental composition with the entireThe esthetic orientation of dental composition with the entire facial composition can be achieved by taking into considerationfacial composition can be achieved by taking into consideration the references.the references.  References:References:  An artist in his creation of facial form makes use ofAn artist in his creation of facial form makes use of established guidelines….established guidelines….  The dentist as an artist also has to consider a number ofThe dentist as an artist also has to consider a number of established guidelines and make use of available referencesestablished guidelines and make use of available references to orient his creation.to orient his creation.  The references can be classified as:The references can be classified as:  HorizontalHorizontal  VerticalVertical  Sagittal andSagittal and  PhoneticPhonetic www.indiandentalacademy.com
  • 25. Horizontal referencesHorizontal references  Horizontal perspective of face is provided by:Horizontal perspective of face is provided by: 1) Interpupillary line – Helps to evaluate orientation of:1) Interpupillary line – Helps to evaluate orientation of:  Incisal planeIncisal plane  Gingival margin andGingival margin and  MaxillaMaxilla 2)2) Commissural lineCommissural line 3) Occlusal line3) Occlusal line Vertical ReferencesVertical References  Facial midline serves to evaluate location and axis of the dental midlineFacial midline serves to evaluate location and axis of the dental midline and mesiolateral discrepancies in tooth position.and mesiolateral discrepancies in tooth position.  The interpupillary line and facial midline emphasize ‘T-effect’ in aThe interpupillary line and facial midline emphasize ‘T-effect’ in a pleasing smile.pleasing smile.  Axial inclination – Is the direction of the anterior teeth in relation toAxial inclination – Is the direction of the anterior teeth in relation to the central midline. All anterior teeth have a definite mesial inclination.the central midline. All anterior teeth have a definite mesial inclination. Deviation beyond the point of equilibrium can cause visual tension.Deviation beyond the point of equilibrium can cause visual tension. www.indiandentalacademy.com
  • 26. Axial inclination Horizontal andHorizontal and vertical referencesvertical references www.indiandentalacademy.com
  • 27.  Sagittal reference:Sagittal reference:  Soft tissue analysis at standardized positionSoft tissue analysis at standardized position helps in studying the profile of an individual.helps in studying the profile of an individual.  The contour of the upper and the lower lip.The contour of the upper and the lower lip.  Lip support.Lip support.  Lip protrusion.Lip protrusion.  Amount of prominence of chin.Amount of prominence of chin.  Recession or prominence of nose and its degree.Recession or prominence of nose and its degree. All help in diagnosis and treatment planning.All help in diagnosis and treatment planning.  E-line or esthetic line(Ricketts,1957)E-line or esthetic line(Ricketts,1957) – imaginary line– imaginary line connecting the tip of the nose to the most prominentconnecting the tip of the nose to the most prominent portion of the chin on the profile.portion of the chin on the profile.  Ideally upper lip is 1-2mm behind the lower lip andIdeally upper lip is 1-2mm behind the lower lip and lower lip is 2-3mm behind the E-line.lower lip is 2-3mm behind the E-line. www.indiandentalacademy.com
  • 28.  Phonetic reference:Phonetic reference:  Phonetic plays a part in determining maxillary central incisorPhonetic plays a part in determining maxillary central incisor design and position.design and position.  ‘‘F’ and ‘V’s sounds.F’ and ‘V’s sounds.  ‘‘M’ sounds.M’ sounds.  ‘‘S’ & ‘Z’ sounds.S’ & ‘Z’ sounds. E-lineE-line www.indiandentalacademy.com
  • 29.  Facial features:Facial features:  Presence of grooves perpendicular toPresence of grooves perpendicular to direction of pull of the muscles is adirection of pull of the muscles is a constant of facial anatomic features.constant of facial anatomic features.  Three important Facial grooves-Three important Facial grooves-  Nasolabial groove.Nasolabial groove.  Labial groove.Labial groove.  Mento-labial groove.Mento-labial groove.  Tooth visibility:Tooth visibility:  Vij & Brundo in 1972Vij & Brundo in 1972 made an interesting studymade an interesting study related to tooth exposure according to gender,related to tooth exposure according to gender, racial factors, age and lip length showsracial factors, age and lip length shows extreme variability of factors.extreme variability of factors. 1. Tooth exposure according to1. Tooth exposure according to gendergender appears toappears to be significantly important for females than forbe significantly important for females than for males.males.  Exposure in males 1.91mm.Exposure in males 1.91mm.  Exposure in females 3.40mm (of maxillaryExposure in females 3.40mm (of maxillary central incisors).central incisors). www.indiandentalacademy.com
  • 30. 2.2. Race-Race-tooth exposure shows an increase fromtooth exposure shows an increase from Blacks-Asians-Whites in maxillary central incisorsBlacks-Asians-Whites in maxillary central incisors and from Asians-Blacks-Whites for mandibularand from Asians-Blacks-Whites for mandibular central incisors.central incisors. 3.3. Liplength-Liplength-people with short upper lip exposepeople with short upper lip expose maxillary central incisors, whereas people with longmaxillary central incisors, whereas people with long upper lip expose mandibular central incisors.upper lip expose mandibular central incisors. 4.4. With ageWith age there is significant decrease in maxillarythere is significant decrease in maxillary tooth length exposure.tooth length exposure. www.indiandentalacademy.com
  • 31.  Components of smile:Components of smile: A pleasant smile is an expression of joy.A pleasant smile is an expression of joy.  The anatomy of smile(Matthews.T.G,JPD1978; 39:128-134)The anatomy of smile(Matthews.T.G,JPD1978; 39:128-134) smile expresses it self in oral region and eyes.smile expresses it self in oral region and eyes. Oral region-upper/lower lip -corner of mouth -anterior portion ofOral region-upper/lower lip -corner of mouth -anterior portion of cheekcheek -nasolabial groove -pthiltrum -red zone of lips-nasolabial groove -pthiltrum -red zone of lips  The relationship exists between teeth and lips during smileThe relationship exists between teeth and lips during smile and its harmonious integration in facial composition.and its harmonious integration in facial composition.  The smile can be classified as:The smile can be classified as: PassivePassive ActiveActive LaughLaugh Slight parting of theSlight parting of the lips showing incisallips showing incisal portion of theportion of the anterior teethanterior teeth Shows more teeth,Shows more teeth, some gingiva andsome gingiva and negative space withnegative space with lips slightly stretchedlips slightly stretched at the cornerat the corner Maximum exposure ofMaximum exposure of teeth and gums in anteeth and gums in an enlarged smile windowenlarged smile window www.indiandentalacademy.com
  • 32. Lip Lines:Lip Lines:  The amount of tooth exposure during smileThe amount of tooth exposure during smile depends on variety of factors…depends on variety of factors…  Upper lip lineUpper lip line helps to evaluatehelps to evaluate maxillary incisors exposed at rest andmaxillary incisors exposed at rest and during smile and a vertical position ofduring smile and a vertical position of the gingival margins during the smile.the gingival margins during the smile.  Classified as:Classified as:  Low, moderate and high.Low, moderate and high.  Smile can be “Toothy” or “gummy”.Smile can be “Toothy” or “gummy”.  Lower lip linesLower lip lines helps to evaluatehelps to evaluate buccolingual position of the incisalbuccolingual position of the incisal edges of the maxillary incisors andedges of the maxillary incisors and curvature of the incisal plane.curvature of the incisal plane. Smile line:Smile line: hypothetical curved linehypothetical curved line drawn along the edges of the fourdrawn along the edges of the four anterior maxillary teeth.anterior maxillary teeth.  the degree of curvature of the incisalthe degree of curvature of the incisal line is more pronounced for women thanline is more pronounced for women than men.men. Feminine type of smile lineFeminine type of smile line Masculine type of smile lineMasculine type of smile line Gummy smileGummy smile www.indiandentalacademy.com
  • 33. Moderate lip line High lip line Low lip line Preoperative Postoperativewww.indiandentalacademy.com
  • 34.  The incisal plane is said to have “Gull-wing”The incisal plane is said to have “Gull-wing” appearance.appearance.  A straight smile line is associated withA straight smile line is associated with wear and aging.wear and aging.  Upper lip curvature:Upper lip curvature:  Is expected to run upward from theIs expected to run upward from the central position to the corner of thecentral position to the corner of the mouth depending on the sequence andmouth depending on the sequence and degree of implication of facial muscles indegree of implication of facial muscles in the development of a smile.the development of a smile.  Negative Space:Negative Space:  Dark spaces that appear between theDark spaces that appear between the jaws, at the corner of the mouth orjaws, at the corner of the mouth or around the facial surfaces of thearound the facial surfaces of the posterior teeth during laughter and mouthposterior teeth during laughter and mouth opening.opening.  Lateral negative space.Lateral negative space.  Buccal negative space.Buccal negative space. Lateral negative space ( givesLateral negative space ( gives depth and mystery to the smile)depth and mystery to the smile) Absence of negative spaceAbsence of negative spacewww.indiandentalacademy.com
  • 35.  Smile symmetry:Smile symmetry:  Refers to the relative symmetric placement of theRefers to the relative symmetric placement of the corner of the mouth in the vertical plane.corner of the mouth in the vertical plane.  Perception of facial composition shows progressivePerception of facial composition shows progressive importance of parallelism of lines that must existsimportance of parallelism of lines that must exists between the commissural and the occlusal line.between the commissural and the occlusal line.  The esthetic evaluation of the smile symmetryThe esthetic evaluation of the smile symmetry relies on unconscious perception of involvedrelies on unconscious perception of involved crossing joints.crossing joints. www.indiandentalacademy.com
  • 36.  Smile dominance:Smile dominance:  In certain cases the most predominantlyIn certain cases the most predominantly striking feature of the face is the smile,striking feature of the face is the smile, these are “dominant smiles”:these are “dominant smiles”:  Guidelines for pleasant smile dominanceGuidelines for pleasant smile dominance are:are:  Dominance of the central element.Dominance of the central element.  Complimentary subsequent elements.Complimentary subsequent elements.  Pleasing relative proportions.Pleasing relative proportions.  Order in composition.Order in composition.  Dynamism of smile.Dynamism of smile.  Centralized element of unity.Centralized element of unity. www.indiandentalacademy.com
  • 37. Dental components:Dental components:  Facial midline is located in theFacial midline is located in the center of the face pependicular tocenter of the face pependicular to the interpupillary line.the interpupillary line.  It has been defined as vertical lineIt has been defined as vertical line drawn through the forehead, nosedrawn through the forehead, nose columella, dental midline and chin.columella, dental midline and chin.  Heartwell – defines it as anHeartwell – defines it as an imaginary vertical lines that doesimaginary vertical lines that does not necessarily coincide with facialnot necessarily coincide with facial midline.midline.  In a research conducted byIn a research conducted by Bodden,Miller and Jamison (1979) itBodden,Miller and Jamison (1979) it was statistically demonstratedwas statistically demonstrated that..that.. www.indiandentalacademy.com
  • 38.  Tooth proportion:Tooth proportion:  Tooth proportion is computed by:Tooth proportion is computed by: 1) Width of clinical crown1) Width of clinical crown Length of the clinical crownLength of the clinical crown Ideally, 75-80% for maxillary central incisors.Ideally, 75-80% for maxillary central incisors. = 65% too narrow e.g. implant crowns or after= 65% too narrow e.g. implant crowns or after periosurgery.periosurgery. = 85% too wide by attrition.= 85% too wide by attrition. 2) Average of width by length ratio –2) Average of width by length ratio – Wheelers 0.74 to 0.89 = 0.8Wheelers 0.74 to 0.89 = 0.8 3) Proportion determined by face form – various3) Proportion determined by face form – various theories have been proposed.theories have been proposed. Leon Williams described tooth form into square,Leon Williams described tooth form into square, tapering and ovoid depending on the face forms.tapering and ovoid depending on the face forms. www.indiandentalacademy.com
  • 39.  Berry postulated :Berry postulated :  mesiodistal width of toothmesiodistal width of tooth = 1/16= 1/16thth bizygomatic width.bizygomatic width. = 1/20= 1/20thth length of facelength of face  The geometric theory was challenged by Frush and FisherThe geometric theory was challenged by Frush and Fisher (1956). They introduced(1956). They introduced “Dentogenic theory”“Dentogenic theory” in which thein which the tooth selection is governed by – Sex, Personality and Age.tooth selection is governed by – Sex, Personality and Age. 4) Golden proportion:4) Golden proportion:  This implied that maxillary central incisors –This implied that maxillary central incisors – approximately 60% wider than lateral incisorsapproximately 60% wider than lateral incisors  Lateral incisors – 60% wider than mesial aspect ofLateral incisors – 60% wider than mesial aspect of the canine.the canine.  Lateral negative space also in golden proportion toLateral negative space also in golden proportion to half the width of the anterior segment.half the width of the anterior segment. www.indiandentalacademy.com
  • 40. SYMMETRY:SYMMETRY:  A dental symmetry relates to the right and left of the midline.A dental symmetry relates to the right and left of the midline.  Goal is to strike a pleasing balance between ideal and the deviation.Goal is to strike a pleasing balance between ideal and the deviation. Axial inclination:Axial inclination:  Is the direction of the teeth with respect to the central midline.Is the direction of the teeth with respect to the central midline.  There is a definite mesial inclination of all anterior teeth as well as theThere is a definite mesial inclination of all anterior teeth as well as the premolars and the first molars.premolars and the first molars. Tooth arrangement:Tooth arrangement:  Anterior teeth helps in achieving lip and associated muscle support, enables theAnterior teeth helps in achieving lip and associated muscle support, enables the fulfillment of esthetics, phonetics and function requirement.fulfillment of esthetics, phonetics and function requirement.  Tooth placement is usually obtained by 3 different methods – empirical,Tooth placement is usually obtained by 3 different methods – empirical, phonetic, and according to anatomic landmarks.phonetic, and according to anatomic landmarks.  Phonetic method has proved to be important means in determining the verticalPhonetic method has proved to be important means in determining the vertical dimension.dimension. www.indiandentalacademy.com
  • 41.  Use of anatomic landmarks:Use of anatomic landmarks:  Canine papilla canine line (CPC) – lineCanine papilla canine line (CPC) – line drawn from the tip of the caninedrawn from the tip of the canine invariably bisects the middle of theinvariably bisects the middle of the incisive papilla in 92% of the casesincisive papilla in 92% of the cases (Schiffman, 1984). The distance from(Schiffman, 1984). The distance from the line to the outer labial surface ofthe line to the outer labial surface of the central incisor is 10.2mm.the central incisor is 10.2mm.  Ortman et al,1979 – posterior borderOrtman et al,1979 – posterior border of incisive papilla is at an averageof incisive papilla is at an average distance of 12.48mm to the labialdistance of 12.48mm to the labial surface of the maxillary centralsurface of the maxillary central incisors.incisors.  Distance between base of the sulcus toDistance between base of the sulcus to the tip of maxillary incisors = 22mmthe tip of maxillary incisors = 22mm (Turbyfill W.F., Dourdakin J 1989).(Turbyfill W.F., Dourdakin J 1989). www.indiandentalacademy.com
  • 42.  Arch form:Arch form:  Square, Ovoid andSquare, Ovoid and Tapering.Tapering.  The harmoniousThe harmonious interrelationshipinterrelationship between the shape ofbetween the shape of the arch, dental archthe arch, dental arch form and teethform and teeth (Nelson triad) has(Nelson triad) has been used by manybeen used by many prosthodontists.prosthodontists. www.indiandentalacademy.com
  • 43.  GRADATION:GRADATION:  The two similar structures are placed atThe two similar structures are placed at different distances from the viewer the closestdifferent distances from the viewer the closest will appear the largest.will appear the largest.  The front-back phenomenon is determined byThe front-back phenomenon is determined by the arch form and the key tooth mostthe arch form and the key tooth most frequently the canine or the first premolar isfrequently the canine or the first premolar is the prerequisite for insuring the visualization ofthe prerequisite for insuring the visualization of the gradation.the gradation. DENTAL MORPHOLOGY –DENTAL MORPHOLOGY – 1.Texture-1.Texture- The characterization of the tooth surface is aThe characterization of the tooth surface is a function of two types of convexities and concavities.function of two types of convexities and concavities. -Anatomy grooves, facets, prominences that exists-Anatomy grooves, facets, prominences that exists in various degrees.in various degrees. -The perikymata, stippling and rippling that may-The perikymata, stippling and rippling that may affect the enamel surface.affect the enamel surface. 2. Shape of the tooth –2. Shape of the tooth – - average tooth outline – square, ovoid, tapering and- average tooth outline – square, ovoid, tapering and mixed (Proposed by Leon Williams 1914).mixed (Proposed by Leon Williams 1914). 3. Mesiodistal width –3. Mesiodistal width – This dimension is much more critical dimension thanThis dimension is much more critical dimension than inciso-gingival length for anterior tooth placement.inciso-gingival length for anterior tooth placement. www.indiandentalacademy.com
  • 44. 4. Incisogingival height:4. Incisogingival height:  The incisal edge of the maxillary central incisor is an importantThe incisal edge of the maxillary central incisor is an important determinant in creation of a smile.determinant in creation of a smile.  It serves to determine the proper tooth proportion and gingival level.It serves to determine the proper tooth proportion and gingival level.  Elongation of the incisal edge indicated in –Elongation of the incisal edge indicated in –  Incisal wear.Incisal wear.  Inadequate tooth display orInadequate tooth display or  Displeasing tooth or crown proportion.Displeasing tooth or crown proportion.  Shortening of the incisal edge may be require:Shortening of the incisal edge may be require:  To correct excessive tooth display.To correct excessive tooth display.  Displeasing tooth or crown portion orDispleasing tooth or crown portion or  To compensate for unesthetic elongation created by periodontalTo compensate for unesthetic elongation created by periodontal recession.recession.  Position of the incisal edge acts as the parameter upon which rest of thePosition of the incisal edge acts as the parameter upon which rest of the treatment is built.treatment is built.  AGE, GENDER & LENGTH & CURVATURE OF THE UPPER LIP WILLAGE, GENDER & LENGTH & CURVATURE OF THE UPPER LIP WILL DETERMINE THE INCISO-GINGIVAL LENGTHDETERMINE THE INCISO-GINGIVAL LENGTH  Average anatomic crown length for maxillary central incisors – 10.4 – 11.2mm.Average anatomic crown length for maxillary central incisors – 10.4 – 11.2mm. www.indiandentalacademy.com
  • 45.  The clinician should not base theThe clinician should not base the decision solely on esthetic factors butdecision solely on esthetic factors but also on the relation of the incisal edgealso on the relation of the incisal edge to the anterior guidance and phonetics.to the anterior guidance and phonetics. www.indiandentalacademy.com
  • 46. Zenith Point:Zenith Point:  Zenith points are the most apical point of the clinical crowns, which are theZenith points are the most apical point of the clinical crowns, which are the height of contour. There position are dictated by:height of contour. There position are dictated by:  Root form anatomy.Root form anatomy.  CEJ.CEJ.  Osseous crest, where gingiva is scalloped the most.Osseous crest, where gingiva is scalloped the most.  They are generally located just distal to a line drawn vertically through theThey are generally located just distal to a line drawn vertically through the middle of each anterior toothmiddle of each anterior tooth  ..  The lateral incisors are one exception as their zenith point are placed moreThe lateral incisors are one exception as their zenith point are placed more centrally or on the midline of the tooth.centrally or on the midline of the tooth.  Importance of zenith point –Importance of zenith point – when closing diastemas or changing the mesialwhen closing diastemas or changing the mesial or distal tilt position of the tooth.or distal tilt position of the tooth. (These are e.g. of moving zenith points horizontally)(These are e.g. of moving zenith points horizontally)  In cases where teeth needs to be shown longer or more taper at theIn cases where teeth needs to be shown longer or more taper at the gingival 1/3gingival 1/3rdrd Zenith point can be moved apicallyZenith point can be moved apically  Therefore, zenith point can enhance:Therefore, zenith point can enhance: 1.1. Perception of tooth axis.Perception of tooth axis. 2.2. Length.Length. By horizontal & verticalBy horizontal & vertical 3.3. Gingival shapes.Gingival shapes. AlterationsAlterationswww.indiandentalacademy.com
  • 47. Diastema closure Zenith point moved more horizontally Short teeth made to appear longer by Moving the zenith point apically www.indiandentalacademy.com
  • 48.  Contact Points (ICP) & InterdentalContact Points (ICP) & Interdental contact areas (ICA):contact areas (ICA):  A broad zone in which two adjacent teethA broad zone in which two adjacent teeth appear to touch –appear to touch – Interdental contactInterdental contact area.area.  TheThe 50-40-30 rule (Morley JA, 2000)50-40-30 rule (Morley JA, 2000) indicating relationship between anteriorindicating relationship between anterior teeth applies to 50% of the length ofteeth applies to 50% of the length of maxillary central incisors and is definedmaxillary central incisors and is defined asas ideal connector zoneideal connector zone. This needs that. This needs that 40% of the length of central incisors is40% of the length of central incisors is the ideal connector zone betweenthe ideal connector zone between maxillary lateral and central incisors andmaxillary lateral and central incisors and is 30% between laterals and canines.is 30% between laterals and canines.  The most incisal aspect of the contactThe most incisal aspect of the contact area is called asarea is called as Contact point.Contact point. After thisAfter this point, the two adjacent tooth divergespoint, the two adjacent tooth diverges and mesiodistal contact turns to incisaland mesiodistal contact turns to incisal edge.edge.  Line drawn to the anterior contact pointsLine drawn to the anterior contact points reinforces the curve of the incisal linereinforces the curve of the incisal line and the lower lip line (provides cohesiveand the lower lip line (provides cohesive forces to the dentofacial composition andforces to the dentofacial composition and the degree of curvature introducesthe degree of curvature introduces segregative forces in the composition).segregative forces in the composition). 50-40-30 rule Contact points Interdental contact areas www.indiandentalacademy.com
  • 49. Embrasures /Embrasures / Interdental spaces:Interdental spaces:  The conical portion of theThe conical portion of the contact area, thecontact area, the interproximal wall of theinterproximal wall of the adjacent teeth and theadjacent teeth and the interdental papilla formedinterdental papilla formed the interdental embrasure.the interdental embrasure.  As the dentition progressesAs the dentition progresses away from the midline, theaway from the midline, the size and volume of incisalsize and volume of incisal embrasure increases.embrasure increases.  Incisal embrasure betweenIncisal embrasure between CI is smallest in area andCI is smallest in area and shortest in angle.shortest in angle. www.indiandentalacademy.com
  • 50. GINGIVAL COMPONENTGINGIVAL COMPONENT  The gingiva begins at theThe gingiva begins at the mucogingival junction and finishes atmucogingival junction and finishes at the tooth collar. It is divided intothe tooth collar. It is divided into free and attached gingiva.free and attached gingiva.  Free gingiva is divided into –Free gingiva is divided into – marginal & interdental gingiva.marginal & interdental gingiva.  Gingival contour:Gingival contour:  The normality of the gingival contourThe normality of the gingival contour is judged according to 4 subsidiaryis judged according to 4 subsidiary factors.factors. 1.1. Embrasures.Embrasures. 2.2. Gingival zenith.Gingival zenith. 3.3. Gingival height – Class I & Class II.Gingival height – Class I & Class II. 4.4. Gingival symmetryGingival symmetry A gingival symmetry of CI requiresA gingival symmetry of CI requires special attention. Gingival symmetryspecial attention. Gingival symmetry between LI and canine is notbetween LI and canine is not mandatory.mandatory. www.indiandentalacademy.com
  • 51. Dento-gingival unit & Biologic widthDento-gingival unit & Biologic width  Unique anatomic feature concerned with attachment of gingiva to theUnique anatomic feature concerned with attachment of gingiva to the tooth.tooth. EpithelialEpithelial compartmentcompartment Gingival epitheliumGingival epithelium Sulcular epithelium –Sulcular epithelium – sulcus depth (avg.sulcus depth (avg. 0.69mm)0.69mm) Junctional epitheliumJunctional epithelium – 0.97mm– 0.97mm Connective tissueConnective tissue compartmentcompartment Represents fibrousRepresents fibrous attachment of the gingivaattachment of the gingiva to the hard tissue wall andto the hard tissue wall and support to the epitheliumsupport to the epithelium of the dentogingivalof the dentogingival junction.junction. DeterminedDetermined in a study byin a study by Garginlo et alGarginlo et al (1961)(1961) www.indiandentalacademy.com
  • 52.  InIn 1962 Cohen1962 Cohen defineddefined BiologicBiologic WidthWidth of supracrestal gingivalof supracrestal gingival tissue as those junctionaltissue as those junctional epithelium and connective tissueepithelium and connective tissue elements of dentogingival unit thatelements of dentogingival unit that occupy the space between the baseoccupy the space between the base of the gingival crevice and theof the gingival crevice and the alveolar crest. The total dimensionalveolar crest. The total dimension would be 2.04mm.would be 2.04mm.  By Nevin & Skurov –By Nevin & Skurov – Biologic width = supracrestal fibersBiologic width = supracrestal fibers + junctional epithelium + gingival+ junctional epithelium + gingival sulcus.sulcus.  It was better termed asIt was better termed as biologicbiologic zonezone by Kois = 3mm in health normalby Kois = 3mm in health normal gingivalgingival www.indiandentalacademy.com
  • 53. Physical ComponentsPhysical Components  The art of creating illusion consists of changingThe art of creating illusion consists of changing perception to cause an object to appear differentperception to cause an object to appear different from what it actually is. The use of optical conceptsfrom what it actually is. The use of optical concepts to create optical illusion may be best way to solve orto create optical illusion may be best way to solve or hide an esthetically difficult situation.hide an esthetically difficult situation.  The tooth may be made to appear smaller, larger,The tooth may be made to appear smaller, larger, wider, narrower, shorter, longer, younger, older,wider, narrower, shorter, longer, younger, older, masculine or feminine.masculine or feminine. www.indiandentalacademy.com
  • 54.  PRINCIPLES OF ILLUSION:PRINCIPLES OF ILLUSION: 1.1. Principle of illumination –Principle of illumination – shadows create depth and light createsshadows create depth and light creates prominence.prominence.  Unidirectional artificial light throws noUnidirectional artificial light throws no shadow therefore displays only length andshadow therefore displays only length and width.width.  Multidirectional light throws shadowsMultidirectional light throws shadows promoting a feeling of depth.promoting a feeling of depth. 2. Principle of line –2. Principle of line – Vertical lines accentuates length andVertical lines accentuates length and horizontal lines accentuates width.horizontal lines accentuates width.  This can be brought about by –This can be brought about by – Tooth ContouringTooth Contouring andand Color ManipulationColor Manipulation.. Limited to angles, natural grooves and prominences, incisal and gingival lines and incisal edges. Is best applied in there natural location-gingival inclines, interdental areas and selected tooth surfaceswww.indiandentalacademy.com
  • 55. ColourColour “An age is called dark, not because light fails to shine, but because“An age is called dark, not because light fails to shine, but because people refuse to see it”people refuse to see it” - James Michener- James Michener  THE PHYSICAL SPECIFICATIONS OF OBJECT COLORTHE PHYSICAL SPECIFICATIONS OF OBJECT COLOR  Light is a form of radiant energy consisting of electromagneticsLight is a form of radiant energy consisting of electromagnetics waves including UV, visible & IR lightwaves including UV, visible & IR light  When the light strikes an object, a range of possible interactions areWhen the light strikes an object, a range of possible interactions are seen.seen. 1.1. Reflection –Reflection – 2 types – diffused reflection and regular reflection.2 types – diffused reflection and regular reflection. 2.2. Refraction –Refraction – is bending of light waves as they pass from oneis bending of light waves as they pass from one medium to another.medium to another. 3.3. Deflection –Deflection – is the reflection of light from a surface in directionis the reflection of light from a surface in direction different from the entry of light.different from the entry of light. 4.4. Absorption –Absorption – is phenomenon in which light is absorbed fully oris phenomenon in which light is absorbed fully or partially by the object.partially by the object. 5.5. Scattering –Scattering – is the random deflection of light rays by fineis the random deflection of light rays by fine particles.particles. 6.6. Translucency –Translucency – is transmission and diffusion of light through anis transmission and diffusion of light through an object so that definite image beyond the object cannot be seen.object so that definite image beyond the object cannot be seen. Enamel more translucent than dentin.Enamel more translucent than dentin. www.indiandentalacademy.com
  • 56. 7.7. Transparent –Transparent – is the qualityis the quality of an object by which lightof an object by which light passes entirely through it.passes entirely through it. 8.8. Opacity –Opacity – quality of anquality of an object by which it absorbsobject by which it absorbs or completely reflects allor completely reflects all the light on its surface.the light on its surface. 9.9. Fluorescence –Fluorescence – is theis the capacity of an object to emitcapacity of an object to emit light waves after absorptionlight waves after absorption of light.of light. 10.10. Gloss –Gloss – is an optical propertyis an optical property associated with smoothassociated with smooth surface that producessurface that produces lustrous surface appearancelustrous surface appearance and thus increases theand thus increases the effects of color difference.effects of color difference. 11.11. MetamerismMetamerism – is phenomena– is phenomena in which the color of anin which the color of an object exposed to twoobject exposed to two different light sourcesdifferent light sources appears different underappears different under each conditions.each conditions. Shade viewed under different lighting conditions Under fluorescent light Under incandescent light www.indiandentalacademy.com
  • 57. Dimensions of color:Dimensions of color: www.indiandentalacademy.com
  • 58. HUE, CHROMA, VALUE & TRANSLUCENCYHUE, CHROMA, VALUE & TRANSLUCENCY 1) HUE1) HUE –– Is simply the colour tone i.e.Is simply the colour tone i.e. RED, BLUERED, BLUE, YELLOW etc., YELLOW etc. The term is synonymous with the term colour but is notThe term is synonymous with the term colour but is not colour itself.colour itself.  In Munsells words “it is that quality by which weIn Munsells words “it is that quality by which we distinguish one color family by another”.distinguish one color family by another”.  Six Hue families V, B, G, Y, O, R e.g.Six Hue families V, B, G, Y, O, R e.g.  Vita shape guide has a 4 hues.Vita shape guide has a 4 hues.  A – Reddish brown.A – Reddish brown.  B- Red yellow.B- Red yellow.  C- Grey.C- Grey.  D – Reddish grey.D – Reddish grey. 2) CHROMA2) CHROMA –– Is intensity or saturation of color tone (Hue) i.e.Is intensity or saturation of color tone (Hue) i.e. light blue or dark blue.light blue or dark blue.  In Munsells words- “it is the quality by which weIn Munsells words- “it is the quality by which we distinguish a strong color from a weak one”.distinguish a strong color from a weak one”.  Human teeth fall into yellow to yellow-red area ofHuman teeth fall into yellow to yellow-red area of Munsell colour order system.Munsell colour order system.  E.g. In HUE A of Vita shaped guide A1- lowestE.g. In HUE A of Vita shaped guide A1- lowest chroma, A4 – Highest chroma.chroma, A4 – Highest chroma. www.indiandentalacademy.com
  • 59. 33) VALUE (BRILLIANCE)) VALUE (BRILLIANCE):: Is the relative lightness (brightness) or darkness of theIs the relative lightness (brightness) or darkness of the hue.hue.  On a scale of black-whiteOn a scale of black-white  High value = white &High value = white &  Low value = darkLow value = dark  Midway between white & black is medium grey.Midway between white & black is medium grey.  Value is the only dimension of color that can exist byValue is the only dimension of color that can exist by itself.itself.  E.g. Hue A of Vita shadeE.g. Hue A of Vita shade A1-brightest; A4- darkestA1-brightest; A4- darkest 4) TRANSLUCENCY:4) TRANSLUCENCY: Is a 3-D representation of value.Is a 3-D representation of value.  It is best represented by value differences. HighlyIt is best represented by value differences. Highly translucent teeth tend to be lower in value…..translucent teeth tend to be lower in value…..  Translucency and value are most important parameters inTranslucency and value are most important parameters in shade selection.shade selection.  Value differences are easy to identify since they areValue differences are easy to identify since they are more rods than cones in the anatomy of human eye.more rods than cones in the anatomy of human eye.  Chroma = 1 / valueChroma = 1 / value ChromaChroma ↑↑ - value- value ↓↓  E.g. A4 has high chroma and low value shade.E.g. A4 has high chroma and low value shade.  A1 has low chroma and high value shade.A1 has low chroma and high value shade. www.indiandentalacademy.com
  • 60.  SPECTAL COLOURS:SPECTAL COLOURS:  Light passing through a prism is refractedLight passing through a prism is refracted (Sir. Issac Newton 1676) and light energy is(Sir. Issac Newton 1676) and light energy is dispersed into various wavelength of whitedispersed into various wavelength of white light.light.  Acronym – VIBGYOR (cones of the eyeAcronym – VIBGYOR (cones of the eye perceive only these wavelength of light –perceive only these wavelength of light – visible light spectrum).visible light spectrum).  390 – 800µ.390 – 800µ.  COMPLIMENTARY COLOURS:COMPLIMENTARY COLOURS:  Primary colorsPrimary colors::  Red, Yellow, BlueRed, Yellow, Blue  These colors cannot be formed by mixingThese colors cannot be formed by mixing other colors. They occur naturally byother colors. They occur naturally by themselves.themselves.  Secondary colorsSecondary colors::  Are formed by mixing primary colors.Are formed by mixing primary colors.  RED + Yellow = OrangeRED + Yellow = Orange  Yellow + Blue = GreenYellow + Blue = Green  Blue + Red = Violet.Blue + Red = Violet.  Complimentary colors:Complimentary colors: They look good together they enhanceThey look good together they enhance appearance of one and another.appearance of one and another. Red – Green; Yellow-Violet; & Blue-Orange.Red – Green; Yellow-Violet; & Blue-Orange.  E.g. A3 shade contains orange hue + blueE.g. A3 shade contains orange hue + blue stain.stain. www.indiandentalacademy.com
  • 61. Color perception:Color perception:  Perception of color involves many:Perception of color involves many:  Physical – wavelength of light.Physical – wavelength of light.  physiological – Reception of wavelength of light by the eye.physiological – Reception of wavelength of light by the eye.  Psychological - Interpretation of wavelength of light by brain.Psychological - Interpretation of wavelength of light by brain.  It is an immediate and unconscious sense influenced by light source, objectIt is an immediate and unconscious sense influenced by light source, object and observer.and observer. 1.1. Light source:Light source: has the colour of emitted light and is described in colourhas the colour of emitted light and is described in colour temperature (°Kelvin).temperature (°Kelvin). 2.2. The observer:The observer: The stimulus of light travels through cornea, lens, aqueousThe stimulus of light travels through cornea, lens, aqueous and vitreous humors and reaches cones and rods of the eyes.and vitreous humors and reaches cones and rods of the eyes. Cones – functions for day light vision and colour perception.Cones – functions for day light vision and colour perception. Rods – are sensitive to quantity of light received.Rods – are sensitive to quantity of light received. Binocular difference in colour perception:Binocular difference in colour perception: Colour perception differs between individuals.Colour perception differs between individuals. It also differs even in the same individual. This phenomena is called asIt also differs even in the same individual. This phenomena is called as binocular colour perception, it is perception variance between right eye andbinocular colour perception, it is perception variance between right eye and left eye.left eye. 3.3. The Object -The Object - www.indiandentalacademy.com
  • 62.  CONTRAST EFFECT:CONTRAST EFFECT:  The phenomenon of contrast effect canThe phenomenon of contrast effect can alter the perception of colour as well asalter the perception of colour as well as ability to evaluate colour in a clear,ability to evaluate colour in a clear, concise and objective way.concise and objective way.  There are 4 categories of contrastThere are 4 categories of contrast effect:effect:  Simultaneous contrast.Simultaneous contrast.  Areal contrast.Areal contrast.  Spatial andSpatial and  Successive.Successive. www.indiandentalacademy.com
  • 63. Simultaneous contrastSimultaneous contrast  Light & dark contrastLight & dark contrast  If surrounding background isIf surrounding background is dark, object appears bright anddark, object appears bright and vice versa.vice versa.  Clinical application –brightClinical application –bright shades for light toned patients,shades for light toned patients, dark shades for pigment toneddark shades for pigment toned patients.patients.  Hue & Chroma contrastHue & Chroma contrast  When two chromatic colours areWhen two chromatic colours are combined the perceived hue variescombined the perceived hue varies closer to the complimentary colour thancloser to the complimentary colour than to that of the background.to that of the background.  Clinical application – tooth shades fallClinical application – tooth shades fall predominantly into orange hue family.predominantly into orange hue family. So to see orange tones moreSo to see orange tones more discriminately we can precondition onediscriminately we can precondition one eye by first looking at a light blueeye by first looking at a light blue background prior to shade selectionbackground prior to shade selection procedure.procedure. www.indiandentalacademy.com
  • 64. 2) Areal contrast:2) Areal contrast:  Visual color perception is alsoVisual color perception is also influenced by size of objectinfluenced by size of object  Bright object will appear larger, andBright object will appear larger, and dark object will appear smaller.dark object will appear smaller. 3) Spatial contrast-3) Spatial contrast-  when same colors are observed inwhen same colors are observed in different positional relationships. Itdifferent positional relationships. It can be equated to brightness and sizecan be equated to brightness and size as well.as well.  An object i.e. more receded appears toAn object i.e. more receded appears to be smaller in size and not as bright.be smaller in size and not as bright. 4) Successive contrast4) Successive contrast –– when one colorwhen one color is observed after seeing another the afteris observed after seeing another the after effect of original color affects the coloreffect of original color affects the color perception of the second object.perception of the second object. www.indiandentalacademy.com
  • 65. Color specifications:Color specifications:  Color can be specified by using numbers and lettersColor can be specified by using numbers and letters so that they can be communicate and reproduced.so that they can be communicate and reproduced. There are two main methods:There are two main methods: 1.1. Colour order system.Colour order system. 2.2. Calorimetry.Calorimetry. • Color order system – a systematic way to arrange colour inColor order system – a systematic way to arrange colour in 3-D space.3-D space. • Chronicles of main colour order systemsChronicles of main colour order systems:: YearYear System nameSystem name FounderFounder 19051905 Munsell systemMunsell system MunsellMunsell 19161916 Oswald systemOswald system OstwaldOstwald 19471947 OSA-UCS systemOSA-UCS system Members in optical Society ofMembers in optical Society of AmericaAmerica 19551955 DIN systemDIN system RichterRichter 19681968 Natural colour system (NCS)Natural colour system (NCS) Haid and SinikHaid and Sinik 19621962 Caloroid Color systemCaloroid Color system MemisicsMemisicswww.indiandentalacademy.com
  • 66. Shade GuidesShade Guides  Shade matching tools are called as color standards or shade guides.Shade matching tools are called as color standards or shade guides.  Tooth color standards – dental shade guides.Tooth color standards – dental shade guides.  Color standards for oral soft tissues – gingival shade guides.Color standards for oral soft tissues – gingival shade guides.  facial prosthesis – facial shade guides.facial prosthesis – facial shade guides.  History:History:  Hall designed and made porcelain shade guide using the principles whichHall designed and made porcelain shade guide using the principles which were later used to develop Vita pan shade guide.were later used to develop Vita pan shade guide.  Miller L.L. demonstrated that Vita classic shade guide was too low in chromaMiller L.L. demonstrated that Vita classic shade guide was too low in chroma and too high in value compared to the natural tooth samples.and too high in value compared to the natural tooth samples. CERAMIC MADE COLOR STANDARDSCERAMIC MADE COLOR STANDARDS 1.1. Vita pan classicVita pan classic 2.2. Chromascop andChromascop and 3.3. Vitapan 3D shade masterVitapan 3D shade master 4.4. Vintage Halo shade guide (Shofu dental)Vintage Halo shade guide (Shofu dental) Vita pan ClassicVita pan Classic – in this hue is categorized according to group or families:– in this hue is categorized according to group or families: A – Orange (A1,A2,A3,A3.5,A4)A – Orange (A1,A2,A3,A3.5,A4) B – Yellow. (B1,B2,B3,B4)B – Yellow. (B1,B2,B3,B4) C – Yellow/Grey (C1,C2,C3,C4)C – Yellow/Grey (C1,C2,C3,C4) D – Orange / Grey (D2,D3,D4)D – Orange / Grey (D2,D3,D4) www.indiandentalacademy.com
  • 67. Vita pan classic Vita pan 3D shade master Chromoscop system www.indiandentalacademy.com
  • 68.  Chromoscope system:  Instead of letters to identify shade numbers were used:Instead of letters to identify shade numbers were used:  100 – White.100 – White.  200 – Yellow.200 – Yellow.  300 – Orange.300 – Orange.  400 – Grey400 – Grey  500 – Dark.500 – Dark.  Vitapan 3D shade masterVitapan 3D shade master – is a unique departure from conventional lettering and– is a unique departure from conventional lettering and numbering categorization, it is based upon pioneer work of Miller and furthernumbering categorization, it is based upon pioneer work of Miller and further developed by McLaren.developed by McLaren.  L – Tendency towards yellow hue.L – Tendency towards yellow hue.  R – Tendency towards red hue.R – Tendency towards red hue.  Within the group the tabs are arranged according to chorma (vertically) andWithin the group the tabs are arranged according to chorma (vertically) and hue (horizontally)hue (horizontally)  Vitapan classic and the chromoscop system communicates chroma by a system ofVitapan classic and the chromoscop system communicates chroma by a system of increasing numbers.increasing numbers.  Vitapan Classic –Vitapan Classic – 1 to 41 to 4 11↓↓ 44↑↑ In ChromaIn Chroma  Chromoscop system 10 to 40Chromoscop system 10 to 40 1010↓↓ 4040↑↑  3D master3D master 1 to 31 to 3 11↓↓ 33↑↑  Vita pan classic and chromoscop system addresses value through chroma. 1 to 4 andVita pan classic and chromoscop system addresses value through chroma. 1 to 4 and 10 to 40 -10 to 40 - ↑↑ in chroma andin chroma and ↓↓ in value.in value.  Vitapan 3D shade master addresses –VALUE first.Vitapan 3D shade master addresses –VALUE first. 1 to 5 – 1 is brightest – High value.1 to 5 – 1 is brightest – High value. 5 is darkest – Low value.5 is darkest – Low value. www.indiandentalacademy.com
  • 69.  Value based versus hueValue based versus hue based shade guides:based shade guides:  Value based shade guidesValue based shade guides more accurate as are eyesmore accurate as are eyes are more sensitive toare more sensitive to changes inchanges in lightness/darkness andlightness/darkness and chroma than subtle changeschroma than subtle changes in hue.in hue.  Thus VALUE becomes aThus VALUE becomes a dominant parameter.dominant parameter. Resin made color standards.Resin made color standards. E.g.E.g.  Esthet-X – DentsplyEsthet-X – Dentsply  Miris – Coltene / WhaltdentMiris – Coltene / Whaltdent  Tetric Ceram – IvoclarTetric Ceram – Ivoclar VivadentVivadent  Venus – Hereaus KulzerVenus – Hereaus Kulzer  Vit-I –Escence – UltradentVit-I –Escence – Ultradent www.indiandentalacademy.com
  • 70.  Technology based shade guideTechnology based shade guide systems:systems: 11.Shofu shade eye.Shofu shade eye – Ex – 1998 1– Ex – 1998 1stst introduced in literature by Goldsteinintroduced in literature by Goldstein and later by Yamamoto.and later by Yamamoto. Single point source spectrophotometer.Single point source spectrophotometer. 2.2. ShadescanShadescan – 2000– 2000 Robert reported the application of thisRobert reported the application of this technology.technology. It is a computer aided digital and video camera vision technologyIt is a computer aided digital and video camera vision technology to analyze dental images and infer color and translucency.to analyze dental images and infer color and translucency. Uses – RGB, Digi Camera V/s Spectrophotometer used by otherUses – RGB, Digi Camera V/s Spectrophotometer used by other systems.systems. 3.3. Spectroshade systemSpectroshade system – 2001 described by Cherkar– 2001 described by Cherkar (MHT International, Newton, PA)(MHT International, Newton, PA) Uses – spectrophotometer data for analysis of shade with 3 lakhUses – spectrophotometer data for analysis of shade with 3 lakh points of reference which is then formatted using computerpoints of reference which is then formatted using computer imaging (Shofu Shade Eye measures only single point source ofimaging (Shofu Shade Eye measures only single point source of reference).reference). Chroma meter (Shofu, MentoChroma meter (Shofu, Mento Park, CA)Park, CA) Cynovad (Cortex machine,Cynovad (Cortex machine, Monreal, CanadaMonreal, Canada)) www.indiandentalacademy.com
  • 71.  Shofu shade eye-EXShofu shade eye-EX  Shade scanShade scan  Spectro shade systemSpectro shade system www.indiandentalacademy.com
  • 72.  Shade guides for oral soft tissues:Shade guides for oral soft tissues: 1)1) Lucitone 199 (Dentsply trubyte)Lucitone 199 (Dentsply trubyte) 4 glossy shade types4 glossy shade types  Original (OR)Original (OR)  Light (LT)Light (LT)  Light reddish pink (LRP)Light reddish pink (LRP)  Dark (DARK)Dark (DARK) 2) Ivoclar Plus Gingiva indicator (Ivoclar V)2) Ivoclar Plus Gingiva indicator (Ivoclar V) 4 shades –4 shades –  Pink (P)Pink (P)  Fibred light pink (US-L)Fibred light pink (US-L)  Fibred pink (US-P)Fibred pink (US-P)  Preferred shade (Pref)Preferred shade (Pref) 3) IPS gingival (Ivoclar)3) IPS gingival (Ivoclar) 5 regular shades – G1 – G55 regular shades – G1 – G5 4 gingival modifiers – GM1 – GM44 gingival modifiers – GM1 – GM4 1 Gingival opaque shade – GO1 Gingival opaque shade – GO 4) Gummy gingiva indicator set (Shofu Dental)4) Gummy gingiva indicator set (Shofu Dental) 3 reddish shades – light, medium, dark3 reddish shades – light, medium, darkwww.indiandentalacademy.com
  • 73. Esthetics in Complete denture  Dental esthetics and beauty of smile are of prime importance in today's society. The edentulous patient is no exception.  Prior to 1909,tooth form was based on…  Origin of dentogenic concept took place in Swiss dent foundation in 1952.  Dentogenics means art, practice and techniques used to achieve the esthetic goal in dentistry.  Thus introduction to Dentogenic restoration was the introduction to SPA factor. www.indiandentalacademy.com
  • 74. From her finger tips to her smile… A women is feminine Before dentogenics conventional and False gender After, dentogenics and feminine Before dentogenics conventional and Neuter gender From his hands to his mouth….. A man is masculine After, dentogenic and masculine www.indiandentalacademy.com
  • 75.  SEX FACTORSEX FACTOR ((John P FrushJohn P Frush , Roland D Fischer JPD, Roland D Fischer JPD 6:161-172, 1956)6:161-172, 1956)  Roundness, smoothness, and softness is typical of women.Roundness, smoothness, and softness is typical of women.  Cuboidal, vigorous appearance is typical of men.Cuboidal, vigorous appearance is typical of men.  Incisal edges of maxillary anterior teeth of females followedIncisal edges of maxillary anterior teeth of females followed by the curve of lower lip.by the curve of lower lip.  Sex interpretation by tooth position:Sex interpretation by tooth position:  Central incisors.Central incisors.  Lateral incisors andLateral incisors and  Canine.Canine. www.indiandentalacademy.com
  • 76. Softer type interpretation of feminity Vigorous feminine interpretation of tooth form The depth of evaluation requires a study well Beyond face form alone Denture constructed according to dentogenic concept Reflect the sex, personality and age of the patient www.indiandentalacademy.com
  • 77.  A basic tooth form which expresses masculine charactersticsA basic tooth form which expresses masculine characterstics shows vigor, boldness, and hardness.shows vigor, boldness, and hardness.  The central incisorsThe central incisors -we can move one of the central incisor from the starting position-we can move one of the central incisor from the starting position out at the cervical endout at the cervical end -second most vigorous position is to move one central incisor bodily-second most vigorous position is to move one central incisor bodily anterior to otheranterior to other -third position is combined rotation of two CI with distal surface-third position is combined rotation of two CI with distal surface forward, one incisor depressed at the cervical end and the otherforward, one incisor depressed at the cervical end and the other depressed incisallydepressed incisally Tooth form helps in determining the Degree of masculinity, less vigorous mold Vigor and strong masculinity can be projected by a Brawny harshness in surface design www.indiandentalacademy.com
  • 78. Depth grindingDepth grinding  We always need the feeling of depth, the third dimension for realism.  Used for women – spheroidal shape.  For men cuboidal shape.  Done only on mesial surface of central incisors.  For delicate look – less depth grinding.  Vigorous look – severe depth grinding.  Average look – between delicate and vigorous appearance. Positioning of lateral incisor imparts A quality of feminine softness A hardened smile for the vigorous male can Be achieved by rotating the lateral incisor mesially Depth grinding accentuates the third dimensional depth necessary For true dentogenic restorationwww.indiandentalacademy.com
  • 79. PersonalityPersonality Factor (John P Frush , Roland D Fischer JPD 6:441-449 1956)  The comprehensive use of personality depends onThe comprehensive use of personality depends on our manipulation of tooth shape, colour, position andour manipulation of tooth shape, colour, position and matrix (visible denture base) of these teeth.matrix (visible denture base) of these teeth.  3 divisions of personality spectrum:3 divisions of personality spectrum: 1.1. DelicateDelicate – meaning fragile, frail, opposite to– meaning fragile, frail, opposite to robust.robust. 2.2. Medium pleasingMedium pleasing – normal, moderately robust,– normal, moderately robust, healthy and of intelligent appearance.healthy and of intelligent appearance. 3. Vigorous - opposite of delicate, hard and aggressive in appearance, the extreme male animal, muscular type almost primitive, ugly Most men are found to be towards vigorous end Of spectrum most women are found to be towards Delicate end of spectrum, both may still be Within the broad medium personality band www.indiandentalacademy.com
  • 80. The type of central and lateral incisor and cuspid which wouldThe type of central and lateral incisor and cuspid which would Be used for the youthful, good-looking model type of patientBe used for the youthful, good-looking model type of patient CI considerably more coarse and are for ample bodied,obese women Robust form of sculpturing make them universally acceptable For men and women by further shaping Teeth on left have been shaped to appear soft on right They have been shaped to appear hard, outline form can be changed by grinding The effect of age is added by abrasion of incisal Edges, use of diastemas,,gingival erosion , Manipulation of interdental papillae. www.indiandentalacademy.com
  • 81. Delicate contours of the sculpted giraffe are the same Delicate contours of the teeth Medium character in the personality in the sculpture IIama Same medium pleasing character of these teeth Vigorous type of sculpting as represented by the bull and The teeth of the same vigorous quality www.indiandentalacademy.com
  • 82. AGE FACTOR (John P Frush , Roland D Fischer JPD 7:5-13 1956)  Dignity of advancing age should beDignity of advancing age should be appropriately portrayed in the denture byappropriately portrayed in the denture by careful – tooth colour selection and moldcareful – tooth colour selection and mold refinement.refinement.  With age:With age:  Increase in the interincisal distance andIncrease in the interincisal distance and increased visibility of mandibular teeth.increased visibility of mandibular teeth.  Wearing off of incisal edges.Wearing off of incisal edges.  Wearing away off of contact points andWearing away off of contact points and migration creates spaces between teeth.migration creates spaces between teeth.  Smile line looses its sharpness in older age.Smile line looses its sharpness in older age. www.indiandentalacademy.com
  • 83. Changing cuspid tip with ageChanging cuspid tip with age Variable long axis becomes accentua With age Interdental papillae youth Middle age Advanced age Youth middle age advanced age www.indiandentalacademy.com
  • 84. Dynesthetic interpretation of the DentogenicDynesthetic interpretation of the Dentogenic concept (concept (John P FrushJohn P Frush , Roland D Fischer JPD 7:5-, Roland D Fischer JPD 7:5- 13 1956)13 1956)  Dynesthetic is a compound word. TheDynesthetic is a compound word. The prefix dyn is the combining form, from theprefix dyn is the combining form, from the Greek wordGreek word dynamicsdynamics meaning powermeaning power  Dynesthetic techniques are rules whichDynesthetic techniques are rules which concerns the three important divisions ofconcerns the three important divisions of denture fabricationdenture fabrication  1) Tooth1) Tooth  2) Its position2) Its position  3) Its matrix (visible denture base)3) Its matrix (visible denture base) www.indiandentalacademy.com
  • 85. Considerations in DynestheticsConsiderations in Dynesthetics  MOLD: selection of an acceptable personality mold involves itsMOLD: selection of an acceptable personality mold involves its subsequent treatment for abrasion, erosion, depth grinding,subsequent treatment for abrasion, erosion, depth grinding, masculinity, or feminity, shaping and polishingmasculinity, or feminity, shaping and polishing Progressive abrasion of artificial tooth as Age progresses, cut made for normal abrasion Tooth modified to simulate erosion Depth perception increased by depth grinding , cut made On the labial mesial line angle of the artificial teeth Masculine femininewww.indiandentalacademy.com
  • 86.  Lip supportLip support  Labio versionLabio version  MidlineMidline  Smile lineSmile line Lip support is mainly by central incisor Position A is for maximum mechanical Stability. Position B, C, D represent the Progressive dynesthetic positioning of the Central incisors for pleasing lip support An acceptable midline (solid line) The broader curve of this smiling line indicates An older dental composition Speaking line is correct because a portion of the Lateral incisor show when the patien speaks seriously The sharp curve of this smiling line is youthful www.indiandentalacademy.com
  • 87.  Impression stageImpression stage  Registration stageRegistration stage  Teeth selection and arrangementTeeth selection and arrangement  Characterization ofCharacterization of denture basedenture base www.indiandentalacademy.com
  • 88. Classification of errors in dental estheticsClassification of errors in dental esthetics (Lombardi R.E,JPD;32:501-513,1974)(Lombardi R.E,JPD;32:501-513,1974)  Inharmonious dentofacial ratioInharmonious dentofacial ratio A)A) Shade disharmonyShade disharmony B)B) Compositional incompatibilityCompositional incompatibility 1. static denture in dynamic mouth1. static denture in dynamic mouth 2.Inharmonious strength or weakness2.Inharmonious strength or weakness of dental composition compared toof dental composition compared to background featuresbackground features a. Weak mouth with strong facea. Weak mouth with strong face b. strong mouth with weak faceb. strong mouth with weak face  Intrinsic dental disharmonyIntrinsic dental disharmony 1. Space allocation error1. Space allocation error 1 Inadequate vertical space1 Inadequate vertical space allocationallocation 2 excessive vertical space allocation2 excessive vertical space allocation 3 excessive horizontal space3 excessive horizontal space allocationallocation 2. Structural line errors2. Structural line errors 1 elevated occlusal plane1 elevated occlusal plane 2 occlusal plane drops down2 occlusal plane drops down posteriorlyposteriorly 3 asymmetrical occlusal plane3 asymmetrical occlusal plane 3. Unnatural lines3. Unnatural lines 1 Reverse smiling line1 Reverse smiling line 2 unnatural axial inclination2 unnatural axial inclination 3 cuspless posterior teeth3 cuspless posterior teeth 4 gradation errors4 gradation errors 5 Age-Sex-Personality disharmony5 Age-Sex-Personality disharmony 4. Single –line errors4. Single –line errors 1. Vertical deviation1. Vertical deviation 2. Horizontal deviation2. Horizontal deviation 3. Line conflict3. Line conflict 5. Imbalance5. Imbalance 1. Midline errors1. Midline errors 2.Imbalance of direction2.Imbalance of direction 3. Artifact error3. Artifact error 4. Diastema error4. Diastema error www.indiandentalacademy.com
  • 89. Esthetics in removal partial dentureEsthetics in removal partial denture  Unaesthetic RPD can be avoided with appropriateUnaesthetic RPD can be avoided with appropriate diagnosis and design using conventional clasping ordiagnosis and design using conventional clasping or attachment aided prostheses.attachment aided prostheses.  Classification overviewClassification overview www.indiandentalacademy.com
  • 90. Principles of DesignPrinciples of Design  A prudent treatment plan involves analysis of patients dentition andA prudent treatment plan involves analysis of patients dentition and supportive tissue that will influence the partial denture componentsupportive tissue that will influence the partial denture component selection and anticipate estheticsselection and anticipate esthetics  Kennedy Class I, II, large Class IV are considered tooth tissueKennedy Class I, II, large Class IV are considered tooth tissue supported indicatingsupported indicating  Flexible direct retainer assembliesFlexible direct retainer assemblies  Mesioocclusal rest on posterior distal extension abutmentMesioocclusal rest on posterior distal extension abutment  Indirect retainers to limit rotationIndirect retainers to limit rotation  Kennedy Class III, and Small class IV are considered toothKennedy Class III, and Small class IV are considered tooth supported.supported.  No additional support from tissue is generally neededNo additional support from tissue is generally needed  Clasp assemblies are more rigidClasp assemblies are more rigid  Indirect retainers usually not indicated.Indirect retainers usually not indicated.  Examination of patientExamination of patient  ClinicalClinical  Radiographic diagnosisRadiographic diagnosiswww.indiandentalacademy.com
  • 91. Use of surveyorUse of surveyor  Surveyor may be used for diagnostic cast analysis. SurveySurveyor may be used for diagnostic cast analysis. Survey objectives includeobjectives include  Determination of acceptable path of insertion to eliminate interferenceDetermination of acceptable path of insertion to eliminate interference with placement and removal…..with placement and removal…..  Identification of proximal tooth surface to be made parallel to act asIdentification of proximal tooth surface to be made parallel to act as guide planes.guide planes.  Location and measurements for undercut and suitable esthetic claspLocation and measurements for undercut and suitable esthetic clasp placement.placement.  Delineation of height of contourDelineation of height of contour  Recording cast positionRecording cast position  An esthetic determination of survey is establishing one path ofAn esthetic determination of survey is establishing one path of placement to minimize the retentive element and acrylic resin orplacement to minimize the retentive element and acrylic resin or denture base display.denture base display.  Area of retention should be selected to enhance esthetic values ofArea of retention should be selected to enhance esthetic values of RPD.RPD.  Anterior modification space – path of placement should be selectedAnterior modification space – path of placement should be selected to minimize excessive modification of adjacent abutment teeth.to minimize excessive modification of adjacent abutment teeth.  Anterior tissue undercut may dictate a posteriorly directed path ofAnterior tissue undercut may dictate a posteriorly directed path of placement….placement….  Rest of highly esthetic anterior region should be………..Rest of highly esthetic anterior region should be………..www.indiandentalacademy.com
  • 92. Specific clasp types and estheticSpecific clasp types and esthetic considerationsconsiderations  The use of conventional clasping in esthetic region of theThe use of conventional clasping in esthetic region of the mouth can present difficulties with patient acceptance.mouth can present difficulties with patient acceptance. Proper surveying and mouth preparation may circumventProper surveying and mouth preparation may circumvent complications.complications.  Clasp may approach undercut fromClasp may approach undercut from Suprabulge region ↓ Placing it in this matter will improve esthetic results and diminish torquing forces applied to the tooth by the clasp Infrabulge region ↓ Provides better esthetics but may have limitations owing to anatomic considerations -Height of vestibule -Position of frena -Bony prominences www.indiandentalacademy.com
  • 93. Circumferential claspCircumferential clasp  Suprabulge claspSuprabulge clasp  Used for tooth supported abutments in posteriorUsed for tooth supported abutments in posterior region of mouth.region of mouth.  Retention arm and reciprocal armRetention arm and reciprocal arm  Due to relative size of this clasp use of clasp aboveDue to relative size of this clasp use of clasp above height of contour for reciprocal clasp should beheight of contour for reciprocal clasp should be limited in esthetic region of the mouth.limited in esthetic region of the mouth. I, Y, T / modified T-bar claspI, Y, T / modified T-bar clasp  I Clasp – infrabulge approach optimizes estheticsI Clasp – infrabulge approach optimizes esthetics (especially in patients with high lipline).(especially in patients with high lipline).  Is placed approximately one tooth distal to theIs placed approximately one tooth distal to the abutment teeth.abutment teeth. www.indiandentalacademy.com
  • 94. T/Y bar claspT/Y bar clasp  Achieves undercut engagement of 0.25mm on eitherAchieves undercut engagement of 0.25mm on either M/D surfaces of the teeth.M/D surfaces of the teeth.  Only one tip of Y or T clasp is placed in the retentiveOnly one tip of Y or T clasp is placed in the retentive undercut, other provides support only.undercut, other provides support only.  Removal of anterior arm of T bar clasp produces aRemoval of anterior arm of T bar clasp produces a MODIFIED T BAR CLASPMODIFIED T BAR CLASP - provides better esthetic- provides better esthetic results while using in the distal undercut.results while using in the distal undercut.  Functional advantage – reduces the torque andFunctional advantage – reduces the torque and distal tipping of the tooth.distal tipping of the tooth. RPI bar clasp (by Kratochvil modifiedRPI bar clasp (by Kratochvil modified by KROL)by KROL)  Consist ofConsist of  Mesioocclusal restMesioocclusal rest  Proximal plateProximal plate  I barI bar  RPI clasp fulfills all requirements of a conventionalRPI clasp fulfills all requirements of a conventional clasp yet demonstratesclasp yet demonstrates  Minimum tooth coverageMinimum tooth coverage  Limited metal displayLimited metal display  An infrabulge approachAn infrabulge approach  Disadvantage – In adequate vestibular depth,Disadvantage – In adequate vestibular depth, anatomic structures like frenum.anatomic structures like frenum. www.indiandentalacademy.com
  • 95. Mesial groove reciprocal clasp (MGR) by McCartneyMesial groove reciprocal clasp (MGR) by McCartney (JPD, 1982)(JPD, 1982)  Is indicated for maxillary distalIs indicated for maxillary distal extension RPDs when canine serves asextension RPDs when canine serves as abutment teeth. Facial bracing isabutment teeth. Facial bracing is important because unlike premolars theimportant because unlike premolars the mesiolingual contour of the canine doesmesiolingual contour of the canine does not usually permit enough surface tonot usually permit enough surface to resist distal movement.resist distal movement. Camouflaging of RPD clasps:Camouflaging of RPD clasps:  Includes addition of acrylic resin orIncludes addition of acrylic resin or resin composites veneers to RPD claspsresin composites veneers to RPD clasps  Difficulty is in the difference betweenDifficulty is in the difference between their ability to flex and theirtheir ability to flex and their coefficient of thermal expansioncoefficient of thermal expansion  Other concerns-Other concerns-  Effect of intra oral forces ofEffect of intra oral forces of masticationmastication  Adjustibility of veneered claspsAdjustibility of veneered clasps  Additional bulk of claspAdditional bulk of clasp www.indiandentalacademy.com
  • 96. Retention enhancementRetention enhancement  Composite resinsComposite resins  ConservativeConservative  Cost effectiveCost effective  Minimally invasive methodMinimally invasive method  Enhancing retentionEnhancing retention  In-vitro studies by Tietge JD et al (1992, IJP)In-vitro studies by Tietge JD et al (1992, IJP)  I-bar produced wear in the resin but stainless steel round claspI-bar produced wear in the resin but stainless steel round clasp did not.did not.  Donna L. Dixon et al (1990, JPD) showed the use of partialDonna L. Dixon et al (1990, JPD) showed the use of partial coverage porcelain laminate bonded to a tooth enhancecoverage porcelain laminate bonded to a tooth enhance retention which solved the problems associated withretention which solved the problems associated with composite resin and full surface laminate.composite resin and full surface laminate. Rest seatRest seat  Traditionally incisal rest advocated on mandibular anteriorTraditionally incisal rest advocated on mandibular anterior teeth. They are unaesthetic , may interfere with occlusionteeth. They are unaesthetic , may interfere with occlusion and may increase torquing forces on the teeth.and may increase torquing forces on the teeth.  Bonded resin composite or metal rest seats have shown toBonded resin composite or metal rest seats have shown to provide satisfactory esthetics alternative to incisal rests.provide satisfactory esthetics alternative to incisal rests. Flange designFlange design Artificial teethArtificial teeth www.indiandentalacademy.com
  • 97. Attachments for removable partial denture:Attachments for removable partial denture:  The demands for highly esthetic dentures providesThe demands for highly esthetic dentures provides the catalyst for attachment RPD. The estheticthe catalyst for attachment RPD. The esthetic expectation of a patient should be the primaryexpectation of a patient should be the primary directive for attachment use.directive for attachment use.  TypesTypes  PrecessionPrecession  SemiprecessionSemiprecession  IntracoronalIntracoronal  ExtracoronalExtracoronal Extra coronal - Dolbo, Act system - SA Swiss anchor - Stern ERA, Stern RV - Hader vertical - ASC-52 ball attachment - ORS (DE) attachment Intra coronal - Stern G/A, G/L type 7 - Swiss McCollum & Crismani attachment - Schatzmann, Biloc, Plasta and Score attachment www.indiandentalacademy.com
  • 98. Esthetics in Fixed Partial DentureEsthetics in Fixed Partial Denture  To the patients the cosmetics of anterior fixedTo the patients the cosmetics of anterior fixed prosthodontics are usually more important than theprosthodontics are usually more important than the functional and technical aspects of the restoration.functional and technical aspects of the restoration.  A logical sequence of diagnosis and treatmentA logical sequence of diagnosis and treatment planning is required.planning is required. Diagnostic wax-upDiagnostic wax-up  Of proposed FPD can be invaluable in determining theOf proposed FPD can be invaluable in determining the esthetic criteria for a treatment plan.esthetic criteria for a treatment plan.  It allows for opportunity to observeIt allows for opportunity to observe  Abutment tooth pontic relationshipAbutment tooth pontic relationship  Pontic ridge relationshipPontic ridge relationship  Evaluate exact edentulous space.Evaluate exact edentulous space.  Edentulous area badly resorbed ……Edentulous area badly resorbed ……  Frequent orthodontic treatment best solution for …….Frequent orthodontic treatment best solution for …….  May indicate endodontic treatment…….May indicate endodontic treatment……. www.indiandentalacademy.com
  • 99.  Once diagnostic process has beenOnce diagnostic process has been completed treatment option may becompleted treatment option may be selected from following choices.selected from following choices.  Retainers:Retainers:  Partial coveragePartial coverage  CementedCemented  Resin bondedResin bonded  Porcelain veneersPorcelain veneers  Complete coverageComplete coverage  All metalAll metal  All ceramicAll ceramic  Metal ceramicMetal ceramic – MarginsMargins  LocationLocation  MaterialMaterial  Metal collar marginMetal collar margin  Disappearing metal marginDisappearing metal margin  Porcelain marginPorcelain margin – Porcelain metal junctionPorcelain metal junction  Other considerationsOther considerations  Cantilever FPDCantilever FPD  ImplantsImplants  SplintingSplinting  Use of telescopic crown as abutmentUse of telescopic crown as abutment •PonticPontic -Design-Design -Edentulous ridge form-Edentulous ridge form -Material-Material www.indiandentalacademy.com
  • 100. RetainersRetainers  When selecting a retainers esthetics is one theWhen selecting a retainers esthetics is one the three important factors to be considered, othersthree important factors to be considered, others being biologic and functional factors.being biologic and functional factors.  These are also important to consider as it does littleThese are also important to consider as it does little good to have a beautifully esthetic restoration thatgood to have a beautifully esthetic restoration that fails because the biologic and functional issues arefails because the biologic and functional issues are not taken care off.not taken care off. Partial coverage retainersPartial coverage retainers 1.1. Cemented – Metal onlay, inlays, ¾ crownCemented – Metal onlay, inlays, ¾ crown www.indiandentalacademy.com
  • 101. 2. Resin bonded retainers2. Resin bonded retainers - Is currently the most widely usedIs currently the most widely used partial coverage retainerpartial coverage retainer www.indiandentalacademy.com
  • 102. 3. Porcelain veneer3. Porcelain veneer - It is no doubt one of the mostIt is no doubt one of the most esthetic of all the partialesthetic of all the partial coverage retainer.coverage retainer. - The porcelain veneers thatThe porcelain veneers that fits and is bonded to thefits and is bonded to the tooth correctly has adequatetooth correctly has adequate strength to survive moststrength to survive most clinical conditions as singleclinical conditions as single tooth restoration.tooth restoration. - This problem is magnifiedThis problem is magnified when porcelain pontics arewhen porcelain pontics are attached to porcelain veneersattached to porcelain veneers with porcelain connectors.with porcelain connectors. - This type can be used only ifThis type can be used only if - Minimum or no occlusal forcesMinimum or no occlusal forces - Patient compliance in avoidingPatient compliance in avoiding biting of hard food andbiting of hard food and - Wearing occlusal splintsWearing occlusal splints www.indiandentalacademy.com
  • 103. Complete coverage retainersComplete coverage retainers  Full veneer retainers are most popular and most universallyFull veneer retainers are most popular and most universally used of all retainers for FPD. They usually fall in 3used of all retainers for FPD. They usually fall in 3 categoriescategories – All metalAll metal – All ceramicAll ceramic – Metal ceramicMetal ceramic  All metalAll metal - Not particularly esthetic- Not particularly esthetic  AllAll ceramicceramic – Are no doubt exceptionally esthetic but the– Are no doubt exceptionally esthetic but the primary drawback has been their strength and the fact thatprimary drawback has been their strength and the fact that they are limited to single unit anterior replacement with lessthey are limited to single unit anterior replacement with less than the normal occlusal forces.than the normal occlusal forces.  Improvements includeImprovements include – Upgrading a fabrication techniqueUpgrading a fabrication technique – Development of stronger ceramic systemsDevelopment of stronger ceramic systems – Ability to internally etch the restorationAbility to internally etch the restoration – Limit crack propagation with crownLimit crack propagation with crown – Better cementsBetter cements – Ability to achieve more life like estheticsAbility to achieve more life like esthetics  Electroforming / GalvanoceramicsElectroforming / Galvanoceramics – Involves thin (0.2mm) gold metallic substructure for porcelainInvolves thin (0.2mm) gold metallic substructure for porcelain restoration.restoration. www.indiandentalacademy.com
  • 104.  Light absorptionLight absorption  Metal of PFM prevents lightMetal of PFM prevents light transmissiontransmission  All ceramics / natural teeth allow theAll ceramics / natural teeth allow the light transmissionlight transmission  This narrows the gap betweenThis narrows the gap between restoration that looks like “Caps” andrestoration that looks like “Caps” and the restoration that looks like teeth.the restoration that looks like teeth. www.indiandentalacademy.com
  • 105. Metal ceramic restorations:Metal ceramic restorations:  By far the most commonly used as itBy far the most commonly used as it has proven to be a very satisfactoryhas proven to be a very satisfactory compromise between function, successcompromise between function, success and esthetics.and esthetics.  Some of the variables should beSome of the variables should be considered in metal ceramic retainers.considered in metal ceramic retainers. A) Margin locationA) Margin location  Studies (Silness 1970) hasStudies (Silness 1970) has shown that gingival apparatusshown that gingival apparatus is generally healthier whenis generally healthier when artificial materials remainsartificial materials remains supragingival.supragingival.  Margins are placedMargins are placed subgingivallysubgingivally – For esthetic reasonFor esthetic reason – For wall height forFor wall height for resistance and retentionresistance and retention – Extension beyond existingExtension beyond existing caries or restorationcaries or restoration www.indiandentalacademy.com
  • 106. B) Margin materialB) Margin material  3 different approaches to metal ceramic crown3 different approaches to metal ceramic crown marginsmargins 1)1) Classical metal collar marginClassical metal collar margin Metal collar placed subgingivally have produced goodMetal collar placed subgingivally have produced good esthetic results. They require superior techniques foresthetic results. They require superior techniques for margin preparation, retraction impression techniquesmargin preparation, retraction impression techniques and soft tissue management in interim phase.and soft tissue management in interim phase. 2)2) Metal porcelain margin.Metal porcelain margin. The metal and porcelain and precisely at the crownThe metal and porcelain and precisely at the crown margin. Has several drawbacks.margin. Has several drawbacks. 3) All ceramic margin.3) All ceramic margin. Accomplished by removing all metal backup to theAccomplished by removing all metal backup to the internal line angle. Studies have shown that margins ofinternal line angle. Studies have shown that margins of equal clinical acceptability with metal margins can beequal clinical acceptability with metal margins can be created with different porcelain application techniques.created with different porcelain application techniques. Repair or correction of porcelain margins possible whichRepair or correction of porcelain margins possible which is not possible in cast metal margins.is not possible in cast metal margins. Studies by Gardner F.M., Tillman McComb’s et al, JPDStudies by Gardner F.M., Tillman McComb’s et al, JPD 1977 has shown that restorations were cemented to the1977 has shown that restorations were cemented to the abutment teeth, all ceramic margins have equal orabutment teeth, all ceramic margins have equal or possibly greater strength than metal collar margins.possibly greater strength than metal collar margins.www.indiandentalacademy.com
  • 107.  E. Goldstein and Van B. HagwoodE. Goldstein and Van B. Hagwood suggested that margin selection forsuggested that margin selection for metal ceramic retainers:metal ceramic retainers: 1.1. Is to use metal collar in estheticallyIs to use metal collar in esthetically non-critical areas.non-critical areas. 2.2. All ceramic margins in patients estheticAll ceramic margins in patients esthetic zone or patients with high estheticzone or patients with high esthetic demands.demands. 3.3. Combination metal porcelain marginsCombination metal porcelain margins should be avoided whenever possible.should be avoided whenever possible. www.indiandentalacademy.com
  • 108.  Porcelain metal junctionPorcelain metal junction  Obviously the most esthetic choice is toObviously the most esthetic choice is to cover the entire metal coping withcover the entire metal coping with porcelain.porcelain.  Disadvantage – Disastrous results onDisadvantage – Disastrous results on opposing dentition particularly if it isopposing dentition particularly if it is natural tooth structure or metal alloy.natural tooth structure or metal alloy.  Most esthetically necessary area forMost esthetically necessary area for complete coverage mandibular premolarscomplete coverage mandibular premolars and first molars.and first molars.  In case of maxillary premolars andIn case of maxillary premolars and molars from functional and estheticmolars from functional and esthetic perspective the porcelain metal junctionperspective the porcelain metal junction should end on lingual slope of bucco-should end on lingual slope of bucco- occlusal surface.occlusal surface.  Location of porcelain metal junction orLocation of porcelain metal junction or maxillary anterior crownsmaxillary anterior crowns  Since porcelain contact in lateralSince porcelain contact in lateral protrusive movements with opposingprotrusive movements with opposing mandibular incisors and canine ismandibular incisors and canine is unavoidable, the best solution isunavoidable, the best solution is recreation of patients natural incisalrecreation of patients natural incisal guidance in the porcelain prosthesis.guidance in the porcelain prosthesis. www.indiandentalacademy.com
  • 109.  Other considerations:Other considerations:  Cantilever FPD:Cantilever FPD:  Ideal choice for single missingIdeal choice for single missing tooth is a single implant.tooth is a single implant.  A conservative alternative wouldA conservative alternative would be a cantilever FPD involving onebe a cantilever FPD involving one or more abutment teeth.or more abutment teeth.  Highly desirable estheticallyHighly desirable esthetically especially in areas adjacent toespecially in areas adjacent to sound attractive teeth.sound attractive teeth.  ImplantImplant  SplintingSplinting www.indiandentalacademy.com
  • 110. PONTICSPONTICS  Pontic Design:Pontic Design:  There are several pontic designs are available for FPD.There are several pontic designs are available for FPD. - Conical / bullet- Conical / bullet - Ridge lap- Ridge lap -Hygienic-Hygienic - Modified ridge lap- Modified ridge lap -Saddle-Saddle - Ovate- Ovate Esthetics edentulous ridge anatomy and patients ability to maintain adequateEsthetics edentulous ridge anatomy and patients ability to maintain adequate hygiene must be considered during pontic design selection.hygiene must be considered during pontic design selection.  To optimize the esthetics aTo optimize the esthetics a MODIFIED RIDGE LAP (BY STEIN) ANDMODIFIED RIDGE LAP (BY STEIN) AND OVATE PONTICOVATE PONTIC are considered as pontics of choice.are considered as pontics of choice.  Both design work well as they provide natural appearing emergence profile.Both design work well as they provide natural appearing emergence profile.  For favourable esthetic outcome certain requirements are necessary:For favourable esthetic outcome certain requirements are necessary:  Pontic must have proper inciso/occlusogingival length in relation to thePontic must have proper inciso/occlusogingival length in relation to the abutment tooth.abutment tooth.  Excessively open interproximal embrassure (Black triangles) must beExcessively open interproximal embrassure (Black triangles) must be avoided.avoided.  Proper labiolingual/ buccolingual relationship with abutment teeth shouldProper labiolingual/ buccolingual relationship with abutment teeth should be obtained creating proper emergence profile.be obtained creating proper emergence profile. Pontic Design Material www.indiandentalacademy.com
  • 111.  To achieve these three requirements properTo achieve these three requirements proper ridge tissue form is imperativeridge tissue form is imperative  Seibert classified maxillary anterior ridgeSeibert classified maxillary anterior ridge defects.defects.  Class I – Horizontal loss of tissue withClass I – Horizontal loss of tissue with normal vertical ridge height.normal vertical ridge height.  Class II – Vertical loss of tissue withClass II – Vertical loss of tissue with normal horizontal ridge height.normal horizontal ridge height.  Class III – combination of Class I & ClassClass III – combination of Class I & Class II (occurs most often).II (occurs most often).  To compensate for maxillary anterior ridgeTo compensate for maxillary anterior ridge defect various treatment options are:defect various treatment options are: 1. Surgical site augmentation using autogenic or1. Surgical site augmentation using autogenic or allogenic graft of hard and soft tissue.allogenic graft of hard and soft tissue. 2. Adjustment of contact point.2. Adjustment of contact point. 3. Reduction of embrassure space to create a3. Reduction of embrassure space to create a papillary illusion.papillary illusion. 4. Use a pink/gingival ceramic.4. Use a pink/gingival ceramic. 5. Too severe defect – RPD should be considered.5. Too severe defect – RPD should be considered.www.indiandentalacademy.com
  • 112.  Modified ridge lap:Modified ridge lap:  Most popular type.Most popular type.  Convex basal surface in labiolingualConvex basal surface in labiolingual direction and concave in mesiodistaldirection and concave in mesiodistal direction which rests on small area ofdirection which rests on small area of alveolar ridge.alveolar ridge.  Pin point contact on facial slope of thePin point contact on facial slope of the ridge.ridge.  According to Stein – ideal ponticAccording to Stein – ideal pontic design.design.  Ovate Pontic:Ovate Pontic:  Used in two types of clinicalUsed in two types of clinical situations:situations:  Healed edentulous ridge.Healed edentulous ridge.  New extraction site.New extraction site. www.indiandentalacademy.com
  • 113. Esthetics and ImplantEsthetics and Implant prosthesisprosthesis  Long term success rates forLong term success rates for osseointegrated dental implants have beenosseointegrated dental implants have been well documented. However, estheticwell documented. However, esthetic restoration of dental implants has laggedrestoration of dental implants has lagged behind.behind.  The original Branemark protocol requiresThe original Branemark protocol requires the several mm of titanium to be exposedthe several mm of titanium to be exposed above the soft tissue.above the soft tissue.  However, early Swedish implants – wereHowever, early Swedish implants – were the borders of the restoration were apicalthe borders of the restoration were apical to the lip and smile line and did notto the lip and smile line and did not present an esthetic problem.present an esthetic problem.  www.indiandentalacademy.com
  • 114. Esthetic management of patients in transitionalEsthetic management of patients in transitional phases:phases:  Stage I –Stage I –  Following stage I – patients often object toFollowing stage I – patients often object to the lack of esthetics from not wearing theirthe lack of esthetics from not wearing their removable appliance for the initial healingremovable appliance for the initial healing period as prescribed in some implantperiod as prescribed in some implant techniques.techniques.  In maxillary arch it may be advantageous toIn maxillary arch it may be advantageous to place denture immediately following surgery.place denture immediately following surgery. The relined denture can act as surgicalThe relined denture can act as surgical compression stent and stabilize the flap post-compression stent and stabilize the flap post- operativelyoperatively  In mandibular arch……..In mandibular arch……..  For single tooth replacement a transitionalFor single tooth replacement a transitional acrylic resin RPD can be placed or aacrylic resin RPD can be placed or a transitional fixed restoration may be bondedtransitional fixed restoration may be bonded to adjacent natural teeth or replacementto adjacent natural teeth or replacement tooth may be luted on to orthodontic bandtooth may be luted on to orthodontic band during the integration phase.during the integration phase.www.indiandentalacademy.com
  • 115.  Stage II:Stage II:  Provisional fixed bridge work has manyProvisional fixed bridge work has many advantages when used after stage II surgicaladvantages when used after stage II surgical procedure.procedure.  Helps to evaluate the esthetics, toothHelps to evaluate the esthetics, tooth position, lip support, pontic location, verticalposition, lip support, pontic location, vertical dimension and control gingival margin priordimension and control gingival margin prior to construction of final restoration.to construction of final restoration.  It prevents tissue growth over theIt prevents tissue growth over the abutment and prevents debris accumulationabutment and prevents debris accumulation in the area of abutment retaining screwin the area of abutment retaining screw  Provides patient with a degree ofProvides patient with a degree of psychologic confidence.psychologic confidence.  Oral hygiene procedure can be reinitiated atOral hygiene procedure can be reinitiated at early stage.early stage.  After stage II healing:After stage II healing:  Soft tissue around abutment in the stage 2Soft tissue around abutment in the stage 2 postoperative period can recede comfortably.postoperative period can recede comfortably.  At this point additional procedure can beAt this point additional procedure can be carried out e.g. tissue contouring /carried out e.g. tissue contouring / augmentation.augmentation. www.indiandentalacademy.com
  • 116.  Soft tissue management:Soft tissue management:  Gingival grafts for tissueGingival grafts for tissue augmentation or to provideaugmentation or to provide vestibular augmentation can bevestibular augmentation can be done at the time of stage IIdone at the time of stage II surgery.surgery.  Gingival papillaGingival papilla  Gingival recontouring.Gingival recontouring. Level and contour of tissues inLevel and contour of tissues in implant area can differ fromimplant area can differ from that of the adjacent naturalthat of the adjacent natural dentition. Surgical correction isdentition. Surgical correction is indicated.indicated. www.indiandentalacademy.com
  • 117.  Gingival augmentation:Gingival augmentation:  Buccal dimension of the tissue over an implant siteBuccal dimension of the tissue over an implant site is an important aspect of the esthetic restoration.is an important aspect of the esthetic restoration. Ideal donor site is connective tissue from under aIdeal donor site is connective tissue from under a palatal flap.palatal flap.  This procedure:This procedure:  Adds tissue bulk to provide good gingival stability.Adds tissue bulk to provide good gingival stability.  Prevent recessionPrevent recession  allows for any necessary soft tissue contouring.allows for any necessary soft tissue contouring.  Treatment of severely resorbed edentulousTreatment of severely resorbed edentulous ridge:ridge:  limited lip supportlimited lip support  Improper contouring of gingival marginImproper contouring of gingival margin  Speech problemSpeech problem  Difficulty in managing the tissue heightDifficulty in managing the tissue height discrepancy adjacent to natural teethdiscrepancy adjacent to natural teeth  This can be adequately restored by usingThis can be adequately restored by using conventional crown and bridge type restoration onconventional crown and bridge type restoration on natural teeth and a hybrid type appliance onnatural teeth and a hybrid type appliance on edentulous area.edentulous area. www.indiandentalacademy.com
  • 118. BLEACHINGBLEACHING  Ask the average person how theyAsk the average person how they would like to improve their smile andwould like to improve their smile and the answer would most often be “withthe answer would most often be “with whiter and brighter teeth”whiter and brighter teeth”  Teeth may stain and discoloredTeeth may stain and discolored  Even before birthEven before birth  Almost always with ageAlmost always with age  And may also be because of genetic,And may also be because of genetic, environmental ,medical or dental factorsenvironmental ,medical or dental factors www.indiandentalacademy.com
  • 119. Treatment modalitiesTreatment modalities:: Bleaching vital teeth:Bleaching vital teeth:  Office bleaching/power bleachingOffice bleaching/power bleaching  35% hydrogen peroxide in liquid /gel form35% hydrogen peroxide in liquid /gel form  Laser assisted bleachingLaser assisted bleaching  With an argon laser, a carbon dioxide laser orWith an argon laser, a carbon dioxide laser or combination of both.combination of both.  Home bleachingHome bleaching  10% carbamide peroxide10% carbamide peroxide Non vital tooth bleachingNon vital tooth bleaching  Sodium per borate and 30%-35% hydrogen peroxideSodium per borate and 30%-35% hydrogen peroxide used alone or in combinationused alone or in combinationwww.indiandentalacademy.com
  • 120. Summery and conclusionSummery and conclusion  The perceptual principles of dental esthetics enableThe perceptual principles of dental esthetics enable us to enhance patients appearance.us to enhance patients appearance.  The change in dentistry from need based dentistryThe change in dentistry from need based dentistry to elective dentistry has made a significant impactto elective dentistry has made a significant impact on the profession and the public perception ofon the profession and the public perception of dentists. It is estimated that up to one half of thedentists. It is estimated that up to one half of the dentistry accomplished at this time is elective.dentistry accomplished at this time is elective. Much of this treatment is what could be consideredMuch of this treatment is what could be considered to be esthetic dentistry including bleaching,to be esthetic dentistry including bleaching, bonding, veneers, tooth colored inlays and onlays,bonding, veneers, tooth colored inlays and onlays, non metallic crowns and fixed prosthesis,non metallic crowns and fixed prosthesis, orthodontics and surgical procedures, and manyorthodontics and surgical procedures, and many other procedures.other procedures.  Dentists must be proactive in their patientDentists must be proactive in their patient educational activities to stimulate patients to desireeducational activities to stimulate patients to desire these elective procedures.these elective procedures. www.indiandentalacademy.com
  • 121. REFERENCES:REFERENCES:  Ascheim , DaleAscheim , Dale: Esthetic Dentistry , a clinical approach to techniques and: Esthetic Dentistry , a clinical approach to techniques and materials.2materials.2ndnd edition , Mosby 2001edition , Mosby 2001  Burckett PJ, Christensen LC.Burckett PJ, Christensen LC. Estimating age and sex by usingEstimating age and sex by using color, form and alignment of anterior teeth.color, form and alignment of anterior teeth. J Prosthet Dent.J Prosthet Dent. 1988;59:175-9.1988;59:175-9.  Brigante RF.Brigante RF. Patient assisted esthetics. J Prosthet DentPatient assisted esthetics. J Prosthet Dent 1981;46:14.1981;46:14.  John P. Frush, Ronald D Fisher :Introduction to Dentogenic Restorations , Journal of Prosthetic Dentistry ,5:587-595,1955.  John P. Frush, Ronald D FisherJohn P. Frush, Ronald D Fisher :The Dynesthetic interpretation of Dentogenic:The Dynesthetic interpretation of Dentogenic concept, Journal of Prosthetic Dentistry. 8:559-581, 1958.concept, Journal of Prosthetic Dentistry. 8:559-581, 1958.  John P. Frush, Ronald D FisherJohn P. Frush, Ronald D Fisher :How dentogenic restoration interpret sex:How dentogenic restoration interpret sex factor,JPD.6:160-172,1956factor,JPD.6:160-172,1956  John P. Frush, Ronald D Fisher:John P. Frush, Ronald D Fisher: How dentogenic interpret the personalityHow dentogenic interpret the personality factor,JPD,6:441-449,1956factor,JPD,6:441-449,1956  John P. Frush, Ronald D Fisher:John P. Frush, Ronald D Fisher:the age factor in dentogenics,JPDthe age factor in dentogenics,JPD  Galip Gurel, Science & art of porcelain laminate veneersGalip Gurel, Science & art of porcelain laminate veneers  www.indiandentalacademy.com
  • 122.  Goldestein RE. Aesthetics in dentistry. Bc Decker inc., 1998.Goldestein RE. Aesthetics in dentistry. Bc Decker inc., 1998.  . Hirshberg SM. The relationship of hygiene to embrasure and pontic design. AA. Hirshberg SM. The relationship of hygiene to embrasure and pontic design. AA preliminary study. J Prosthet Dent. 1972; 27:26-38preliminary study. J Prosthet Dent. 1972; 27:26-38  .Levin EI. Dental esthetics and the golden proportion. J Prosthet Dent. 1978.Levin EI. Dental esthetics and the golden proportion. J Prosthet Dent. 1978 Sep;40(3):244-52.Sep;40(3):244-52.  Lombardi R. Visual perception and dental esthetics. J Prosthet Dent 1973;Lombardi R. Visual perception and dental esthetics. J Prosthet Dent 1973; 29:352-382.29:352-382.  Lombardi RE. A method for the classification of errors in dental esthetics. JLombardi RE. A method for the classification of errors in dental esthetics. J Prosthet Dent 1974; 32:501.Prosthet Dent 1974; 32:501.  Lombardi RE. Factors mediating against excellence in dental esthetics. JLombardi RE. Factors mediating against excellence in dental esthetics. J Prosthet Dent. 1977 Sep;38(3):243-8.Prosthet Dent. 1977 Sep;38(3):243-8.  Martone AC. Anatomy of facial expressions and its prosthodontic significance.Martone AC. Anatomy of facial expressions and its prosthodontic significance. J Prosthet Dent 1962; 12:1020-1041.J Prosthet Dent 1962; 12:1020-1041.  Matthews TG. The anatomy of smile. J Prosthet Dent 1978; 39:128-134.Matthews TG. The anatomy of smile. J Prosthet Dent 1978; 39:128-134.  Rufenacht CR. Fundamentals of esthetics Illinois Quientessence1992Rufenacht CR. Fundamentals of esthetics Illinois Quientessence1992  Shillingberg etal. Fundamentals of fixed prosthodontics. Quintessence.Shillingberg etal. Fundamentals of fixed prosthodontics. Quintessence.  Matthews TG. The anatomy of smile. J Prosthet Dent 1978; 39:128-134.Matthews TG. The anatomy of smile. J Prosthet Dent 1978; 39:128-134.  Rufenacht CR. Fundamentals of esthetics Illinois Quientessence1992Rufenacht CR. Fundamentals of esthetics Illinois Quientessence1992  Shillingberg etal. Fundamentals of fixed prosthodontics. Quintessence.Shillingberg etal. Fundamentals of fixed prosthodontics. Quintessence.  Weinberg LA. Esthetic and the gingiva in full coverage. J Prosthet Dent 1960;10:737-744.Weinberg LA. Esthetic and the gingiva in full coverage. J Prosthet Dent 1960;10:737-744.www.indiandentalacademy.com
  • 123. Thank youThank you For more details please visitFor more details please visit www.indiandentalacademy.comwww.indiandentalacademy.com www.indiandentalacademy.com