esthetic consideration in treatment planning

1. ESTHETIC CONSIDERATIONS IN
TREATMENT PLANNING.
BY: DR AYESHA SAJID

3. FACIAL HEIGHT

4. LIP LENGTH
Average Length of upper lip is in
Adult female = 20mm to 22mm
Adult male = 22 to 24 mm

5. SYMMETRY

6. INCISAL PLANE

7. POSTERIOR OCCLUSAL PLANE
 The buccal cusp tips of the maxillary posterior
teeth should provide a visual progression from
the canine cusp tips, with no step up or step
down.
 It is important not to create a canted posterior
occlusal plane
 It can be recorded same way as incisal plane

8. BUCCAL CORRIDOR
“Spacebetwwenthebuccalsurfacesofmaxillary
posteriorteethandcheek”
 Excessive Space
Constricted maxillary arch
 Inadequate Space
Bulky posterior restorations

9. LOWER LIP
In full smile, the incisal edges of the maxillary anterior teeth
ideally are cradled by the lower lip.

10.  If a significant space is present b/w the lower lip
and maxillary incisal edges during smile
 Overcome it by Increasing incisal edge length
 Incisal edges of the maxillary anterior teeth are
hidden by lower lip during full smile
 Cause is over eruption of maxillary anterior
teeth, vertical maxillary excess or both

11. UPPER LIP
In full smile, the upper lip should ideally translate
up to the gingival line

12. GINGIVAL ZENITH

13. LIP ASYMMETRY
 Upper Lip Lower Lip

14. INCISAL EDGE PLACEMENT OF MAXILLARY
CENTRAL INCISORS
 In full smile the incisal edges of maxillary anterior teeth should
be cradled by lower lip
 In full smile,the buccal cusps tips of posterior maxillary teeth
should provide a visual progression from the canine cusp with no
step up or step down.
 In gentle repose (have the patient say “M” or “Emma” and ask
them to let their lips lightly fall apart), approximately 3 to 4 mm
of the incisal edges of the maxillary central incisors should be
displayed in the female & 1mm to 2mm in males
 The average length of maxillary central incisor is 10mm to 11mm

15. FACIAL CONTOUR OF MAXILLARY INCISORS
The gingival half of the maxillary central incisor is parallel to
and continuous in contour with the surface of the gingival
tissue overlying the alvelous.
The incisal half of the central incisor is tapered back for ease
during lip closure and speech.

16. INTERPROXIMAL CONTACT AREA
The interproximal contact between the maxillary
central incisors is in the incisal third of the teeth.
The interproximal contact between the central and
lateral incisors is at the junction of the incisal and
middle thirds.
If it extends far too incisally its creates a closed
unnatural incisal embrasure.
If it doesn’t extends far enough gingivally results in
open gingival embrasure or black triangle.

17. INCISAL EMBRASURES
The incisal embrasures increase from maxillary
central incisor to canine
it is minimal between the maxillary central incisors
the incisal embrasure between the maxillary central
and lateral incisors is more pronounced,
between the lateral incisors and canines is the most
pronounced.

18. HALO EFFECT
The natural incisal edge anatomy of the maxillary
incisor commonly imparts a thin,
white, opaque “halo effect” at the incisal edge that
frames the incisal translucency.

19. FACIAL CONTOUR OF MAXILLARY INCISORS
 Facial surface of the maxillary incisors should
not be rounded mesiodistally but rather should
should be flat,with resulting bold mesial and
distal line angles and deep facial embrasures

20. OUTLINE FORM OF MAXILLARY CANINES
 The distal half of maxillary canine should not be seen when
viewed from front
 Principle of gradation
Canine is the most common offender

21. LINGUAL CONTOUR OF MAXILLARY INCISORS
 What is a lisp?
 How can it be corrected?
Increasing the lingual concavity
Changing the length of maxillary central incisor

22. INDIVIDUAL TOOTH LENGTH AND PROPORTION
The average length of maxillary central incisor is
10mm to11mm
The ratio of height to width in maxillary central incisor
1.2 to 1.0

23. TOOTH TO TOOTH PROPORTIONS
Golden proportions
Central incisor is 1.618 times wider than lateral incisor
Lateral incisor is 1.618 times width of canine
Natural proportions
Width of maxillary central incisor to that of lateral incisor is 1.2 to 1.0

24. LAW OF FACE
The face of a tooth is that portion of facial surface
bound by transitional line angle when viewed from the
front
To make an anterior tooth appear wider, the
transitional facial line angles are moved into the
interproximal facial embrasures
To make it appear narrower, the transitional line
angles are moved closer to tooth midline

25. COLOUR AND SHADE MATCHING

26. Hue : hue enables the distinction and differentiation
among different colors. hue refers to the origin of
the colors we can see.
Value : the dimensions of value refers to lightness or
darkness of a color.
Chroma : chroma is related to variation in strength of
the same color.

27.  Compatibility: a material will be most compatible
with a tooth when it has shades that mimic both
dentin and enamel.
 Stability: when comparing composite resins and
dental ceramics, resins are less colour stable after
aging.
 Interactions:
Layering is essence of tooth anatomy as layers of
enamel and dentin of different thickness interact
creating a polychromatic appearance.

28. COLOUR MATCHING TOOLS-DENTAL SHADE
GUIDE

29. VITA CLASSICAL A TO D ARRANGEMENT

30. VITA CLASSICAL VALUE SCALE ARRANGEMENT
Represents a light to dark arrangement
From 1(B1) to 16 (C4)
Tooth whitening efficacy

31. VITA TOOTH GUIDE 3-D MASTER
 Step 1 :The lightness is determined using all tabs
 Total of 29 are reduced to
2 (group 1), 3 (groups 0 & 5),7( group 2,3,4)

32. Step 2 select Chroma
From selected value group remove middle tab
M and spread out like fan ,select one of the 3
shades

33.  Step 3 determine Horizontal hue variations
Check whether the natural tooth is more yellowish
or more reddish than sample shade selected

34. VITA LINEAR GUIDE 3-D MASTER
 Group selection
Middle tabs from each group 0M2 to 5M2
 Fine tuning
Within the group selected 0-1,2,3,4,5

35. VITA BLEACHGUIDE 3D MASTER

36. SHADE MATCHING CONDITIONS
 check colour vision
 use colour corrected lights
CRI 90 or above
Light intensity is 1000 to 1500 lux
 controls surrounding/viewing conditions
Neutral gray environment

37. GUIDELINES FOR SHADE MATCHING
 Perform at the beginning.
 Tooth should be cleaned with toothpaste/pumice.
 Correct viewing distance is 25-35cm
 Tooth should be observed perpendicular to its labial
surface with eyes aligned at same as teeth
 Light should be 45 degree angle to the tooth
 Shade tab positioning (same plane as that of tooth to
be matched OR vertically or horizontally in between
maxillary and mandibular teeth)
 Shade matching duration ( ideally the glances at the
target shade should last only between 5 to 7 s)

38. COLOUR MATCHING INSTRUMENTS

40. FIVE DIMENSIONS OF COLOR
 Chromaticity
One hue (universal dentin)
Different chroma levels
 Value
Lower value (older tooth biotype)
Higher value (younger tooth biotype)
 Intensives :spots,small clouds,snowflakes,horizonal bands
 Opalescents:blue and amber hue of incisal halo at the interproximal
level and free enamel margin.
 Characterizations
Dentin :mamelon and band
Enamel: margin,stain,cracks