aesthetics, veneers, bleaching, nonvital ,vital bleaching, microabrasion, macroabrasion, advances in bleaching, indirect veneers, diastema, midline closure, additional conservative esthetic procedure, vital tooth , nonvital tooth, laminates

1. Guided by Dr Chetan patil
Presenter Dr Asha K

2.  INTRODUCTION
 ARTISTIC ELEMENTS – SHAPE OR FORM
- SYMMETRY AND PROPORTIONALITY
- POSITION AND ALIGNMENT
- SURFACE TEXTURE
- COLOR
- TRANSLUCENCY
 CONSERVATIVE ALTERATIONS - TOOTH CONTOURS AND
CONTACTS
- SHAPE OF NATURAL
TEETH
- EMBRASURES
- CORRECTION OF

3.  CONSERVATIVE TREATMENT FOR DISCOLORED TEETH-
EXTRINSIC
-
INTRINSIC
 BLEACHING TREATMENTS – NONVITAL
- VITAL
 MICROABRASION AND MACROABRASION
 VENEERS – DIRECT
- INDIRECT
 Conclusion
 References

4.  Restorative dentistry is a blend of art and science , conservative
esthetic dentistry truly emphasizes the artistic component .
 Significant improvements in the tooth coloured restorative
materials and adhesive techniques have resulted in numerous
conservative esthetic treatment possibilities.
 Children and teenagers are especially sensitive about
unattractive teeth. When teeth are discolored, malformed,
crooked or missing, there is often a conscious effort to avoid
smiling and patients try to "cover up" the teeth.
 Correction of these types of dental problems can produce
dramatic changes in appearance, which often result in improved
confidence, personality, and social life .

5. • The shape of the teeth largely determines their esthetic
appearance.
• A basic knowledge of normal tooth anatomy is
fundamental to the success of any conservative esthetic
dental procedure
COSMETIC CONTOURING : minor modification of
existing tooth contours, referred as cosmetic contouring.
• Can effect a significant esthetic change
• Reshaping enamel by rounding incisal angles
- opening incisal embrasure
- reducing prominent facial line
angles

6. Creating illusion of width

7.  The overall esthetic appearance of a human smile is largely
governed by the symmetry and proportionality of the teeth that
constitute the smile.
 Asymmetric teeth or teeth that are out of proportion to the
surrounding teeth disrupt the sense of balance and harmony
essential for optimal esthetics.

8.  A dental caliper should be used in conjunction with any
conservative esthetic dental procedure that will alter the
mesiodistal dimension of the teeth
 By first measuring and recording the widths of the interdental
space and the teeth to be augmented, the appropriate amount of
contour to be generated with composite resin addition can be
determined . In this manner, symmetric and equal tooth contours
can be generated .
Particular attention also must be paid to
• Incisal and gingival embrasure forms
• Mesial contours of both central incisors
must be mirror image of one another

9.  Anterior teeth must be in proper proportion to one another to
achieve maximum esthetics. The quality of proportionality is
relative and varies greatly depending on other factors .
 one long-accepted theorem of the relative proportionality of
maxillary anterior teeth typically visible in a smile involves the
concept of the golden proportion .

10. GOLDEN PROPORTION
 Originally formulated as one of Euclid's elements, it has been relied
upon through the ages as a geometric basis for proportionality in the
beauty of art and nature .
 Esthetics depends on proportion and an object is considered
beautiful if it is properly proportioned.
 A smile when viewed from the front ,is considered to be esthetically
pleasing if each tooth in that smile is approximately 60% of the
apparent mesiodistal width of the tooth immediately to it.
 The exact proportion of the distal tooth to the mesial tooth is 0.618

11.  When a line is bisected in the golden proportion,the ratio of the
smaller section to the longer one is the same ratio of the larger
section to the whole line.

12.  According to Dr Stephen Marquardt – the height of the central
incisor is in the golden proportion to the width of the two central
incisor
 The golden ratio is a mathematically constant ratio between the
larger and smaller length
 The ratio is approximately 1.618:1 in terms of proportion ,the
smaller tooth is about 62% the size of the larger one

13.  For a smile to be considered perfect or near to it,the upper 6
anterior teeth should follow the golden rule of proportion.
 The lateral incisor should be 60%the width of the central
incisor and the canine 60% that of the lateral incisors.
 It states that the width proportion between two adjacent
teeth as viewed from frontal should remain constant
progressing successively distally.
 In other words each becomes smaller by a fixed percentage
as you move back in the mouth.

14.  According to the study by Preston ,only 17 % of
population naturally exhibits smiles that meet golden
proportion
 According to a survey of dentist by Ward , a recurring
esthetic dental proportion of 70% is preferred when
teeth are of normal dimension.
width to length ratios
 An accepted theorem maintains that the ideal width-
to-length ratio should be 0.75 -0.80
The recommended width to length ratio for achieving
esthetically pleasing maxillary incisors are
maxillary central incisors – 0.80
maxillary lateral incisors – 0.75

15. The overall harmony and balance of a smile depend largely
on proper position of teeth and their alignment in the arch.
Malposed or rotated teeth disrupt the arch form and may
interfere with the apparent relative proportions of the teeth

16.  The surfaces of natural teeth typically break up light and reflect it
in many directions.
 Anatomic features should be closely examined and reproduced
to the extent that they are present on surrounding surfaces.
 Young teeth characteristically exhibit significant surface
characterization
 older individuals tend to possess a smoother surface texture
caused by abrasional wear

17.  Color is undoubtedly the most complex and least understood
artistic element.
 Three fundamental elements of colour are Hue , Value , Chroma
Hue – intrinsic quality or shade of the colour
Value – relative lightness or darkness of a hue . Determined by
amount of white or black in a hue
Chroma – intensity of any particular hue

18.  Gradation of color – gingival region typically darker (thinner
enamel).
 Canines slightly darker than incisors.
 Individuals with darker complexions usually appear to have lighter
teeth because of the contrast that exists between teeth and the
surrounding facial structures.
 Exposed root surfaces are particularly darker because of the
absence of overlying dentin.

19.  Degree of translucency is related to how deeply light penetrates
into the tooth or restoration before it is reflected outward.

20.  Illusions of translucency also can be created to enhance the
realism of a restoration.
 Color modifiers (tints) can be used to achieve apparent
translucency and tone down bright stains or characterize a
restoration.
After an intra enamel preparation and acid etching ,violet
color modifier was applied to the prepared facial surface to
reduce the brightness and intensity of underlying yellow
teeth

21.  Dr. Peter Dawson states,
"Esthetics and function go hand in hand. The better the esthetics,
the better the function is likely to be and vice versa.“
 occlusion
 Anterior guidance, in particular, must be maintained and occlusal
harmony ensured when treating areas involved in occlusion.
 good gingival health.
 Emergence angles of the restorations must be physiologic and
not impinge on gingival tissues.

22.  Many unsightly tooth contours and diastemas can be corrected or
appearances can be greatly improved by several conservative
methods.
 OBJECTIVES –improve esthetics
- preserve as much healthy tooth structure as
possible
- consistent with the acceptable occlusion and
health of surrounding tissue.
 These procedures include reshaping natural teeth , correcting
embrasure and closing diastemas.

23. • Some esthetic problem can be corrected very
conservatively without the need for tooth preparation
and restoration.
• Consideration should always be given to reshaping and
polishing the natural teeth to improve their appearance
and function.

26.  The presence of space or diastemas between anterior teeth is a
common feature of adult dentition
 It distorts the pleasing smile as concentration of the observer is
not on the overall dentition ,but on the diastema.

27.  Transition between deciduous and permanent dentition in the
normal development of the dentition
 Enlarged labial frenae
 Regular deleterious behaviour
 Unbalanced muscular function
 Dentoalveolar discrepancies – most common
 Tongue and lip habits
 Pathologies (partial agenesis, supernumerary teeth , palatal cleft )

28.  Esthetic parameter
 Tooth proportion
 Tooth to tooth proportion
 Incisal edge position
 Occlusion
 Gingival esthetics and architecture
 Papilla preservation

29. Orthodontic Restorative
direct
Indirect
• Excessive interproximal space presents a dynamic
challenge.
• Diastema closure must establish proper tooth proportion that
are as close to ideal as possible.

31.  One of the main frequent reason patient seek dental treatment.
 Even patients with teeth of normal color request teeth whitening
procedure
 Treatment option include removal of stains, bleaching, micro
abrasion, veneering and placement of porcelain crowns.

35. Classification of Tooth Discoloration
Abbot-1997
 Extrinsic discolouration
 Intrinsic discolouration
 Combination of both

53.  The oxidation, reduction reaction that takes place b/n coloring
substance ( reducing agent ) & bleaching substance( oxidising agent)
 The oxidation reduction reaction that takes place in the bleaching
process is called the “Redox reaction”

54.  REDOX REACTION – The oxidizing agent releases free radicles with
unpaired electrons thereby becoming reduced.
 The discolored molecule within the tooth accept the unpaired electrons
& become oxidized, with reduction in discoloration.
 SATURATION POINT: The whitening action slows down beyond a
point during the treatment, this is called as the saturation point.

56.  Commonly used ,Oxidizing agent
 5-35% concentration
 Clear, colourless, odorless, low mol wt-34
 Two types –organic & inorganic
 The products of H2O2 are Strong oxidiser ,when H2 atoms
are substituted with metals (inorganic peroxide) or organic
radicals (organic peroxide)
 Stored properly, shelf life of 3-4 months
 Handle carefully – ischemia – chemical burn.
 Can be used alone /mixed with sodium perborate

61. Melon, banana , mint

64.  Non vital bleaching –in office nonvital bleaching technique
- walking bleach technique
 Vital bleaching –in office vital bleaching technique
- dentist prescribed ,home applied technique
 Laser assisted tooth bleaching
 Over the counter products

74. BLEACHING AGENTS:
 Hydrogen peroxide
- Superoxol (30% H2O2)
- Pyrozone (25% H2O2 and ether)
 Sodium perborate-saline / H2O2
 Superoxol has twice as much as oxygen as sodium perborate

75.  The walking bleach technique is an in office bleaching procedure
that does not require the use of heat and employs sodium
perborate as the bleaching agent.
 The bleaching process is slower and continues till the patient
reports back for the subsequent appointments for assessment
and cessation of the treatment.

76. INDICATION
 Discoloration of pulp
chamber
 Dentin discoloration
 Discoloration not amenable
to extracoronal bleaching
CONTRAINDICATION
 Superficial enamel
discoloration
 Defective enamel formation
 Severe dentin loss
 Presence of caries
 Discolored composited

79. Barrier:2 mm thick
 Labial CEJ as a guide for barrier placement
 CEJ curves in an incisal direction on proximal sides
 Flat barrier leaves the proximal dentinal tubules unprotected – cervical
resorption
79

80. • Proximal view – ski
slope
• Facial view – bobsled
tunnel
• shape of the barrier
was kept as ‘bobsled
tunnel’ when viewed
from facial aspect. The
significance of this
shape is that it blocks
all the dentinal tubules
which run from pulp
chamber to external
tooth surface apical to
the level of epithelial
attachment so that the
bleaching agent stays
within the cavity and
hence prevents
external root
resorption

83.  Home bleaching without dental supervision.
 Haywood outlines the detailed history of the FDA’s influence on
home bleaching
These includes – tray systems
- trayless sytems (chewing gums , tooth
pastes,bleaching strips)
- paint on products
 These products primarily work by removing extrinsic surface stain
only.

84.  Are much more resistant to bleaching .
 It requires prolonged treatment duration of several months
 In general the results of bleaching yellow, yellow-brown, and
brown stains are more favorable than those with blue-gray to gray
stains.
 No one bleaching technique is effective in all cases often,with
vital bleaching ( in office technique + the dentist prescribed ,home
applied technique)
 Has better results than either technique used alone.

85.  To bleach the discolored tooth from the inside as well as from the
outside with a 10% carbamide peroxide solution retained in a
custom‐fitted tray.
 The major advantage of this technique is that the nonvital
discolored tooth can be bleached together with the adjacent vital
teeth.
 PREPARATION - Deliver a custom‐fitted tray and 10% carbamide
peroxide solution to the patient.
 Give instructions on how to insert the bleaching gel into the cavity
and into the tray.
 Have the patient return to the office, once the teeth have whitened

87.  Case selection – complete root canal obturation , intact remaining tooth
structure
 Evaluate radiographically
 Polish the tooth with prophylaxis paste
 Apply petroleum jelly to gingival tissues
 Isolation with rubberdam
 Re-establish the access cavity
 Removal of guttapercha up to the level of alveolar bone
 Seal the orifice with at least 2 mm intra coronal barrier over GP upto
CEJ
 Seal the orifice with at least 1 mm intracoronal barrier over GP
 Clean the access cavity & place a cotton pellet in chamber to avoid food
lodgement

88.  Shade selection is done
 Check the fitting of the tray
Instruction to the patient for home bleaching
 Bleaching syringe can directly placed into the chamber before
seating the tray or extra bleaching material can be placed into the
tray space corresponding to the tooth with open chamber
 After bleaching tooth is irrigated with water, cleaned & again a
cotton pellet is placed in the empty space
 Reassessment of the shade after 4- 7 days
 After the desired shade is obtained initially temporary restoration &
later permanent restoration for access cavity

89.  Technique has been introduced using lasers for extracoronal bleaching
 Types of lasers employed
 argon laser that emits a visible blue light
 carbon-dioxide laser that emits invisible infrared light
 Diode laser
 These lasers can be targeted to stain molecules
 With the use of a catalyst, rapidly decompose hydrogen peroxide to
oxygen and water

90. ARGON LASER:
Laser is delivered to chemical agent
480nm WL, Blue light, absorbed by dark colour
Action is to stimulate the catalyst in the chemical
Adv:
No thermal effect,
 Less dehydration enamel,
 Less time(10sec/tooth)

91. CARBON DIOXIDE LASER
Invisible infrared light, energy is emitted in the form of heat
Wave length- 10,600 nm
Directly interacts with catalyst/peroxide and with argon laser removes
the stains regardless of the tooth color
DIODE LASER(GALLIUM ALUMINIUM ARSENIC)
True laser produced from a solid state source
Wave length – 980 nm
It is ultra fast 3-5 sec to activate the bleaching agent
Adv: Produce no heat

94.  In 1984 McCloskey reported the use of 18% hydrochloric acid
swabbed on teeth for the removal of superficial fluorosis stain.
 Subsequently, in 1986, Croll modified the technique to include
the use of pumice + hydrochloric acid to form a paste applied with
a tongue blade.
 Croll further modified the technique - reducing the concentration
of the acid to approximately 11%
 By increasing the abrasiveness of the paste using silicon carbide
particles (in a water-soluble gel paste) instead of pumice.

96.  An alternative technique for the removal of localized,superficial
white spots (not subject to conservative, remineralization therapy)
and other surface stains or defects is called macroabrasion.
 12-fluted composite finishing bur or a fine grit finishing diamond in
a high-speed handpiece to remove the defect.

100.  Mayekar (2001)
 Laminate maintains colour. Usually requires no Tooth Preparation
 Veneer- change in colour, requires Preparation (endodontically
treated teeth and tetracycline stained teeth)

101. Indication
 Single or multiple discolored
teeth
 Presence of diastema
 Fractures
 Teeth with abnormal shape
and form- peg laterals
 Lingual positioned teeth
 Enamel defects/
hypocalcification
 Improper surface texture
 multiple carious lesions
 Poor restoration
Contraindication
 Teeth with defective enamel
formation- insufficient crown
material
 Young permanent teeth
 Severe periodontal
involvement
 severe crowding
 Poor oral hygiene
 Labial version
 Excessive interdental
spacing

107. FULL VENEER WITH WINDOW
PREPARATION
 Ben-Amar suggested a design that extends to
gingival crest and terminates at the facio -incisal
angle.
 Recommended for most direct & indirect method
Indications-
 To preserve functional lingual & incisal surfaces of
anterior teeth
 To prepare maxillary canines in patients with
canine guided occlusion in high occlusal stresses

108. FEATHER EDGE
Boksman and colleagues and Garber
recommended
 recommended for patients with normal overbite
Disadvantages
 weak veneer, high risk of experiencing ceramic
chipping, and difficulty with seating of the veneers,
marginal
discoloration and poor marginal adaptation

109. BUTT JOINT PREPARATION
Advantages
 masking of the otherwise noticeable incisal finish line,
 thicker ceramic and reinforcement of incisal edge, and
 positive seating of ceramic veneers,
 allow translucency of incisal edges and a more natural
appearance

110. PALATAL CHAMFER
 According to Garber
 Design extending subgingivally & includes all of incisal
surface.
Indications-
 When crown length has to be ↑
 When the incisal defect is severe & restoration is
necessary
 Where seating is accurate & more esthetic demand
Advantages-
 Tooth preparation is within the Enamel , no temporary
restoration is necessary
 Improves the esthetics along the incisal edges

112.  Direct veneers area placed on small localized defects / intrinsic
discolorations which are surrounded by sound enamel
Indication - less no of teeth involved
 - localized defects
 - young permanent teeth
 - diastema
 Materials used - microfill, nanohybrid composite resins
DIRECT PARTIAL
VENEERS

114. Advantages – economic
 - single visit
 - useful in young pt & localized defects
 - repairable
Disadvantages– more chair side time
 - more labour
 - tech sensitive
 - operator skill require

115. DIRECT COMPOSITE FULL
VENEER
Indications – diastema
 - grossly stained & pitted
 - gross enamel hypoplasia of anterior teeth
Advantages – less tech sensitive
 - last longer
 - effective for multiple veneers
Disadvantages – expensive
 - require special tooth preparation

116. Steps _ Reduction of tooth by coarse round end diamond bur-
 0.5 – 0.75mm – mid facially, tapering down to a depth of about
0.2 – 0.5 mm along gingival margin at proximal side, the
preparation should be facial to the contact point
 heavy chamfer at gingival crest
In diastema- proximal preparation are extended from the facial
onto the
mesial surface , terminating at the mesio lingual line angle

117.  Processed composite
 Feldspathic porcelain
 Cast or pressed ceramic

118.  Indication – teeth are inherently undercontoured
- when interdental spaces or open incisal embrasures
are present.
No prep veneers can be problematic
 They made thinner , more prone to fracture
 Interproximal areas are difficult to access for proper finishing
 If case selection is not done properly , normal teeth results to an
overcontoured veneers ,which results in impingement of gingival
tissue

119. ETCHED
PORCELAIN
VENEERS

123.  Enamel has different thicknesses at the gingival, middle and
incisal 1/3rds of the facial surface of the tooth.
 They can be 0.3-0.5 mm at the facial gingival third, upto 0.6-1.0
mm at the middle third and 1.0-2.1 mm at the incisal third.

127. PROXIMAL REDUCTION
 It is an extension of facial preparation
 Using a round end tapered diamond bur continue reduction into
proximal area being sure to maintain adequate reduction especially at
line angles.
 The reduction should extend into the contact area, but it should stop
just short of breaking the contact .
127
PROXIMAL REDUCTION USING ROUND END TAPERED DIAMOND BUR

133.  There are two basic techniques for the placement of the incisal
finish line.
1. The first terminates the prepared facial surface at the incisal
edge. There is no incisal reduction or prep of the lingual
surface and it can be in the form of a window or intra-enamel
preparation or the feathered incisal preparation.
2. In the second technique, the incisal edge is slightly reduced
and the porcelain overlaps the incisal edge, terminating on the
lingual surface

135. INCISAL REDUCTION
 Facio-lingual thickness of the tooth, the need for esthetic
lengthening, and occlusal considerations will help to
determine the design of the incisal edge.
 For most of the patients coverage of the incisal edge is
preferred as it provides a vertical stop that aids in proper
seating of the veneer.
 J.S. Clyde and A.Gilmour
(Porcelain Veneers : A Preliminary Review BDJ 1988;
164:9, 9-14)
There are 4 techniques for incisal preparation

137.  In third
(incisal bevel preparation) :
the incisal edge is reduced and a
bevel is given at the expense of
labial surface and incisal edge to a
depth of 0.5- 1.0mm
 fourth: intra- enamel or window
preparation design .
This is given to protect the veneer
Incisal bevel
preparation
Intra- enamel or
preparation
window

139. B) Incisal Butt-Joint Preparation
•Prepare 0.5 mm depth cut grooves in the incisal edge.
• Using the tapered diamond remove the remaining incisal tooth
structure.
• Then round the facial incisal line angle leaving a butt-joint
margin along the lingual incisal edge.
•The incisal reduction should be 0.5 mm-1.0 mm
• This type of preparation is done in order to increase the length
of tooth.
•The length can be increased from 0.5 to 2mm only.

140. C. Incisal Lingual Wrap Preparation
 Prepare 0.5 mm depth cuts in the incisal surface of tooth.
 Reduce the incisal surface in a manner similar to incisal butt-
joint preparation
 Reduce- mesial incisal & distal incisal corners an additional
0.5 mm
 Using a diamond bur, extend the incisal chamfer to the palatal
surface. This palatal chamfer should be a straight line mesial to
distal.
 All incisal edges should be rounded.
 The lingual chamfer line on the wrap around preparation
should be above or under the centric lingual contacts to avoid
occlusal contact on the interface between porcelain and tooth
structure.

141. •Contact should be either all on porcelain or on tooth
structure.
•The incisal wrap prep is a popular option for several
reasons.
• It can be used in most patients, easily fabricated by the
technician & easily handled by the dentist due to positive
seating on delivery
Incisal Lingual Wrap
Preparation

142. LINGUAL REDUCTION
 Create the lingual finish line using a round end tapered
diamond bur.
 Chamfer is 0.5mm deep
 It should be 1/4th the way down the lingual surface,
preferably 1.0mm from the centric contact,
connecting two proximal finish lines.
 Placement of the lingual finish line for laminate veneer will
depend on…
 Thickness of tooth
 patient’s occlusion

143. The special nature of the palatinal side of the anterior teeth plays
an extremely important role by increasing the longevity of the
porcelain veneer or the bonded ceramic restoration.

145. Finishing the preparation
 The final step in the preparation is the production of a smooth
enamel surface, achieved with fine diamond bur carried across the
enamel with a light sweeping motion, followed by polishing with
small diameter, waterproof, flexible discs.
 The discs are also used to round off sharp angles left in the
preparation.
 The path of insertion for veneers is in the labial or incisal-labial
direction. All undercuts and unsupported enamel in relation to this
path must be removed.

146. 12 fluted tungsten carbide bur
30- micron round end tapered
finishing bur
¾-inch fine garnet disc Enhance point used for final finishing

147. Final check and adjustments before impressions:
Margins
Gingival chamfer
Occlusion
Unless there is 0.5 mm or more supra gingival margin,
thin braided retraction cord should be placed beneath the
gingival crest.
Dentin considerations:
 If during the course of tooth preparation an “island” of
dentin is exposed but the chamfer margin remains in
enamel, the exposed dentin should be sealed with two
thin coats of a dentin bonding adhesive cured
independently

152. CEMENTATION:
 Bonded with low viscosity composite
resins- 0. 5 mm
CURING
Veneer should be cured for a minimum of 40 to 60
seconds, each form facial and lingual direction for a total
exposure time of 80 to 120 seconds.
etching rinsing drying

153. PATIENT INSTRUCTION SHEET
First 72 Hours
First 72 hours
The resin bonding process takes at least 72 hours to cure.
Extremes in temp (either hot or cold) should also be avoided.
Alcohol and some medicated mouthwashes have the potential to
affect the resin bonding material during this early phase and should
not be used.
Mouth rinses:
Acidulated fluoridated mouth rinses can damage the surface finish
of your laminates and should be avoided.
Stannous fluoride also should be avoided.
Chlorhexidine antiplaque mouth rinses may stain laminates, but the
stain can be readily removed by a hygienist.

155.  Another esthetic alternative for veneering teeth is the use of
pressed ceramics, such as IPS Empress.
 Unlike etched porcelain veneers that are fabricated by stacking
and firing feldspathic porcelain, pressed ceramic veneers are
literally cast using a lost wax technique

156.  Failures of esthetic veneers occur because of breakage,
discoloration, or wear.
 light cure composite are most commonly used.
 Small chipped areas on veneers often can be corrected by
recontouring and polishing .
 Hydrofluoric acid gel is used to etch the fractured porcelain.
 It is available as 10% buffered concentration that can be used for
intra oral porcelain repairs.
 Followed by silane coupling agent ,adhesive ,composite is cured .

157.  J Zanolla 1, Abc Marques 1, D C da Costa 1, A S de Souza 2, M
Coutinho 1
PMID: 27997982 DOI: 10.1111/adj.12494
Objective -vital bleaching with 10% carbamide peroxide gel on the
microhardness of human dental enamel.
Conclusion: The results of this meta-analysis showed no significant
changes in enamel microhardness when using the 10% carbamide
peroxide bleaching gel over periods of 7, 14, and 21 days.

158. 24 CARAT
Advanced zero sensitivity tooth whitening
system
 24 carat pure white smile is a revolutionary ,state of art teeth
whitening gel
 Its advanced zero sensitivity formula eliminates sensitivity
 The optimized pH gel consist of the active carbamide peroxide
suspended in a high tack , high viscosity gel , reduces treatment
time.
 Composition – carbamide peroxide ,edta , citric acid ,propylene
glycol, Carbopol, glycerine, potassium nitrate and spear mint oil
 Maximum of 12 application is recommended.

159.  Objective: This in-vitro study aims to study the stress distribution
within the ceramic veneer-tooth system with two incisal
preparation designs—butt joint (BJ) and feathered edge (FE), and
to correlate these findings to the results of our previous published
load-to-failure study.
 Conclusion: Parallel to the results of our earlier load-to-failure
published study, both incisal preparation designs affect stress
distribution within the ceramic veneer-tooth system. BJ
photoelastic model demonstrated a more uniform distribution
compared with FE photoelastic model.
 Clinical Significance: BJ incisal preparation design has more
uniform stress distribution than FE preparation design within the
ceramic veneer-tooth system.

160.  Conservative esthetic procedures help dentist to restore a wide
range of esthetic challenges ranging from surface malformation to
discoloration of varying complexities.
 An understanding of the various artistic elements in smile
designing is important for a clinician to be able to satisfy the
patients expectation .
 The inherent advantages and limitations of each of these
procedures- correction of diastema, bleaching treatments,
microabrasion and macroabrasion to veneers are to be taken into
consideration in order to realise their optical clinical performance.

161.  Sturdevants - art and science of operative dentistry 5th edition
 Esthetic and cosmetic dentistry for modern dental practice :
update 2011 –DCNA
 Aesthetics in dentistry –Goldstein 3 rd edition
 The science and art of porcelain laminate veneers – galip gruel

162. Thank