In modern era preview before the outcome is of utmost importance.Therefore dentistry became more easy and advanced with the modern tools used for smile designing.

1. PRESENTED BY- DR.AYUSHI KHANDELWAL
MDS 2nd YEAR
1

2. CONTENTS:
 Introduction
 Definitions and
classification
 Esthetic diagnosis and
treatment planning
 Esthetic sequencing
 Perceptual aspects – the
art of illusion
 Process of smile design
and analysis
 Esthetic contouring
 Introduction of Veeners
 Conclusion 2

3. INTRODUCTION
• The focus of dentistry in the present times is not only the
prevention and treatment of diseases but on meeting the
demands for better esthetics. When it comes to re-creating a
patient’s smile, it is not as simple as placing veneers or crowns on
teeth that are whiter and brighter than the patient’s existing
dentition .
• The smile is an important reflection of one’s self along with
communicating a variety of emotions to those around us and it is
unique to each individual person.
3

4. INTRODUCTION
• In fact, there are many factors that must be carefully
considered and evaluated in creating a smile that is
esthetically pleasing to the doctor and the patient.
• And even with digital technology having a widespread effect
on so many things, including restorative dentistry, as well as
allowing for digital simulations of a patient’s final smile,
there are many factors and principles that must be
evaluated by the treating doctor.
4

5. INTRODUCTION
• Creating an ideal smile may require orthodontics,
orthognathic surgery, periodontal surgery, cosmetic
dentistry, oral surgery, and plastic surgery.
• Likewise, it cannot be stressed enough that if indirect
restorations will be a part of the final treatment plan,
involving the dental technician that will be doing the
final restorations, should be consulted early in the
process as they can bring an invaluable component to
helping the clinician and patient achieve the desired
final result.
5

6. Esthetics (adj. 1798)
 The branch of philosophy dealing with beauty.
 In dentistry, the theory and philosophy that deal with beauty
and beautiful, esp. with respect to the appearance of a dental
restorations, as achieved through its form and or color. Those
subjective and objective elements and principles underlying the
beauty and attractiveness of an object, design or principle.
Dental Esthetics
 The application of the principles of esthetics to the natural or
artificial teeth and restorations. (GPT 1999)
DEFINITIONS:
6

7. ESTHETIC DENTISTRY
 Can be defined as the art and science of dentistry applied to
create or enhance beauty of an individual within functional and
physiological limits.
Cosmetic dentistry
 is application of the principles of esthetics and certain
illusionary principles, performed to signify or enhance beauty of an
individual to suit the role he has to play in his day-to-day life or
otherwise.
Smile designing
 Is a process whereby the complete oral hard and soft tissues are
studied and evaluated and certain changes are brought about which
will have a positive influence on the overall esthetics of the face. These
changes are governed by the principles of esthetic dentistry
7

8. GOALS OF SMILE DESIGNING
• The goal of an esthetic makeover is to develop a peaceful
and stable masticatory system, where the teeth, tissues,
muscles, skeletal structures and joints all function in
harmony (Peter Dawson).
• It is very important that when planning treatment for
esthetics cases, smile design cannot be isolated from a
comprehensive approach to patient care.
• Achieving a successful, healthy and functional result
requires an understanding of the interrelationship among
all the supporting oral structures, including the muscles,
bones, joints, gingival tissues and occlusion.
8

9. PATIENTS DESIRE AND EXPECTATION
• One of the most important parts that must be
considered before any treatment is begun is the
clinician must take the time to discuss and discover the
patient’s chief complaint and concerns and whether he
or she can achieve or succeed the patient’s desired
final result.
• After a thorough review of the patient’s medical and
dental history, a comprehensive dental examination is
completed, including proper radiographs, evaluation of
the muscles and temporomandibular joint (TMJ).
9

10. • When it comes to restorative dentistry that involves
significant dental treatment, including the patients
smile, it is essential to have proper documentation to a
achieve proper diagnosis.
• This will include proper photos that are taken with a
digital SLR camera with a macro lens that include: full
face photos; 1:2 lip at rest or repose photos; anterior
and lateral photos and/or video of the patient smiling
naturally, dynamically as well as an exaggerated smile.
10

11. • 1:2 retracted anterior and lateral views ; retracted views
occlusally ; 1:1 retracted views of the anterior dentition.
• The clinician should also obtain impressions (whether
digital or analog) as well as a facebow and a bite
registration in CR (centric relation), so that the case can be
properly mounted and articulated on a semiadjustable
articulator.
• All of this critical information for the clinician to properly
evaluate, review, treatment plan and thus, treat the patient
appropriately and effectively.
11

12. CLASSIFICATION OF SMILE:(SOLOMON)
 Depending on the nature of labial
mucous
membrane
 papilla smile
 Gingival smile
 Mucosa smile
 Dependant on the lip component
 Straight smile
 Convex smile
 Concave smile
12

13. ESTHETIC DIAGNOSIS & TREATMENT
PLANNING:
 A meticulous esthetic diagnosis followed by a
well- defined treatment plan is the
foundation of successful esthetic dental
treatment. The definitive treatment plan
should address the treatment periods,
expenses, treatment sequencing and all
aspects related to the function and
maintenance of the anticipated results.
13

14. TOTAL SMILE ANALYSIS:
 Total smile analysis is a cumulative interference
analysis, drawn by interpreting and integrating
various analysis like a visual, space profile and
computer analysis after performing the preliminary
analysis.
14

15. SPACE ANALYSIS:
 Help to gauge the amount of space available during the
treatment planning stage(measure the widths of all teeth and
to compare it with the space present in the arch).
 Disproportionate space may be due to discrepancies in jaw
and tooth size, malformed teeth, missing teeth, malaligned
teeth, etc
 Corrections of labiolingual inclinations and rotations of teeth
by restorative procedures will result in a change in the width
space ratio due to the change of angulation involved.
15

16. PROFILE ANALYSIS:-
 Straight orthognathic – normal profile.
 Any deviation from this should be recorded and
considered in treatment planning.
 Examination of the profile could be in the antero-posterior
plane or in the vertical plane.
COMPUTER ANALYSIS:-
 Radiographic and photographic assessments can be used.
Computer aided technology has broadened the utility of
radiographs and photographs in the dental field.
 They give enlarged images of the photographic and radiographic
outputs on the screen without the involvement of any hard copies of
photographs or radiographs with multiple magnifications & at
various angles.
 Esthetic enhancement with a change of arrangement , form , shape or
color can be demonstrated quickly.
16

17. COMPONENTS OF AN
ESTHETIC SMILE
Facial component
Hard tissues
Soft tissues
Dental component
Teeth
Gingiva
17

18. • Interpupillary line
• lips
Facial features that
play a vital role
18

19.  During a relaxed 'ideal smile', the upper lip exposes the cervical
aspects of the maxillary anterior teeth.
 The gingival margins of the maxillary central incisors should be
symmetrical and at the same height. Up to 3 mm of gingival
exposure above the cervical margins of the maxillary teeth is
aesthetically acceptable .
 Beyond 3 mm results in a 'gummy' smile, requiring
correction by orthodontic or surgical intervention to avoid visual
tension .
19

20. TREATMENT MODALITIES
DEPENDING UPON THE TYPE
OF PATHOSIS
20

21. • Hyperplastic gingivae  gingivectomy or crown
lengthening
• Recession  orthodontics or cosmetic periodontal
plastic surgery using tissue grafts or guided tissue
regeneration membranes
• Over eruption  orthodontic intrusion
• Deficient pontic sites  ridge augmentation
procedures
• Skeletal abnormalities  orthognathic surgery.21

22. Teeth that are small, have incisal
edge wear, small spaces,
collapsed buccal corridors, and
are slightly deflective
GREAT RESTORATIVE
CANDIDATES FOR
MINIMAL OR NO
PREPARATION
VEENERS
22

23. Teeth that are buccally displaced or in a
severely lingualized position, are flared
out incisally creating open gingival
embrasures, or have obvious rotations or
canted axial inclinations
POOR
CANDIDATES FOR
MINIMAL OR NO
PREPARATION
VEENERS
23

24. To lengthen teeth, mask dark or
discolored teeth,repair fractured
pontics, closing a diastema
DIRECT
COMPOSITE
RESTORATIONS
24

25. Enamel fractures, enamel and dentin
fractures, and enamel and dentin
fractures with pulp exposure
DIRECT COMPOSITE
LAYERING
TECHNIQUE,
LAMINATE VEENERS,
CERAMIC CROWNS
25

26.  E-line or esthetic line is an imaginary line connecting the tip
of the nose to the most prominent portion of the chin on the
profile, ideally the upper lip is 1-2 mm behind and the lower
lip 2-3mm behind the E-line. Any change in the position of
the E-line indicates the abnormality in the upper or lower lip
position.
26

27. VITAL ELEMENTS OF SMILE DESIGN- DENTAL
COMPONENTS
Tooth components Soft tissue components
Dental midline Gingival health
Incisal lengths Gingival levels and harmony
Tooth dimensions Interdental embrasure
Zenith point Smile line
Axial inclinations
Interdental contact
Embrasures
Symmetry and balance
27

28. MIDLINE :
 Dental midline should be collinear with facial midline.
 Vertical contact interface between the 2 centrals
 Perpendicular to the interpupillary line and parallel to facial
midline
 As long as the midline is parallel with the long axis of the face
, midline discrepancies up to 4mm is not considered
unaesthetic.
 But canted midlines aren’t considered esthetic.
Image of smile where the
facial and dental midline do
not line up. 28

29. A slanted mid line, or a
dental mid line that is
placed obliquely in relation
to the facial mid line, will
always distort the
symmetry, even placed in
exactly the correct position.
It looks even more
unpleasant when it is
slanted and shifted to the
side at the same time.
29

30. INCIAL LENGTHS( EDGE POSITION) :
 Most important determinant in smile creation as once set, it
serves as a reference point for establishing the proper tooth
contours and gingival levels.
 IMPORTANT PARAMETERS 
 Degree of tooth display
 Phonetics
 Patient input
30

31. • The normal tooth display at rest is about 2.5 to 3mm.
• If the overall display of teeth is less than 2.5 mm then
orthodontic extrusion or orthognathic surgery has to be
considered.
• In teeth with both angles fractured, this can serve as a guide
in deciding placement of incisal edge.
• But this is only true for young individuals.
DEGREE OF TOOTH
DISPLAY
31

32. PHONETIC
REFERENCES:
 ‘E’  incisal edge should
be halfway between
upper and lower lip
 Phonetics play a part in determining maxillary central
incisor design and position.
 ‘F’ and ‘V’ sounds are used
to determine the tilt of the
incisal third of the
maxillary central incisors
and their length.
32

33.  The ‘M’ sound is used to achieve relaxed rest position and
repeated at slow intervals can help evaluate the incisal display
at rest position .
 ‘S’ or ‘Z’ sounds determine the vertical dimension of speech.
Its pronunciation makes the maxillary and the mandibular
anterior teeth come in near contact and determine the
anterior speaking space.
33

34. TOOTH
DIMENSIONS
 Correct dental proportion is related to facial morphology and is
essential in creating an esthetically pleasing smile.
 CENTRAL DOMINANCE dictates that the centrals must be the
dominant teeth in the arch and they must display pleasing proportions.
 The proportions of the centrals must be esthetically and
mathematically correct  the width to length ratio  4:5
 The shape and appearance of the centrals influences the placement of
laterals and canines. 34

35. GUIDELINES FOR CORRECT PROPORTIONS…
GOLDEN PROPORTION (lombardi)
RECURRING ESTHETIC DENTAL PROPORTION
(ward)
M PROPORTION (methot)
CHU’S ESTHETIC GAUGE
35

36. GOLDEN
PROPORTION
 is expressed in numerical form and
applied by classical mathematicians
such as Euclid and Pythagoras in pursuit
of universal divine harmony and
balance.
 It has been applied to a lot of ancient Greek and Egyptian architecture and
may be expressed as the ratio 1.618:1.
 If the ratio is applied to the smile made up of the central, lateral incisor and
the mesial half of the canine, it shows that the central incisor is 62% wider
than the lateral incisor which in turn is 62% wider than the visible portion
of the canine which is the mesial half, when viewed from the front.
36

37. • Snow considered a bilateral analysis of apparent individual tooth
width as a percentage of the total apparent width of the six anterior
teeth. He proposed the golden percentage, wherein the proportional
width of each tooth should be: canine 10%, lateral 15%, central 25%,
of the total distance across the anterior segment, in order to achieve
an esthetically pleasing smile
37

38. RECURRING ESTHETIC DENTAL PROPORTION
(WARD)
• The successive width proportions when viewed from the facial aspect should
remain constant as we move posteriorly from midline.
• This offers greater flexibility to match the tooth proportions to the facial
dimensions.
Image showing close to an 80% width to-
length ratio and optical width of the central relative
to the lateral and the lateral relative to the
canine. Note that esthetic percentages do not follow
the golden proportion, especially the canine.
38

39. M PROPORTIONS
• A modified symmetrical Ruler has been proposed
referring to a mathematical formula related to the inter-
molar distance of each patient, representing the width
of the arch, and the width of the upper centrals to
determine the correct balance for the teeth displayed
within that arch to create a pleasing smile.
• The new mathematical formula determines a variable
ratio in function of Phi called the “M Proportions”, (“M”
for Methot the inventor).
39

40. • The central line (1) is placed on the dental midline and the
outermost line (7) is positioned by the user, advantageously on the
buccal face of the first molar, (representing the arch width) the
remaining lines (2, 3, 4, 5, 6) are positioned symmetrically by the
computer software using the “M” formula: these new proportions
are called “M” Proportions. Software allows sliding the lines “en
masse” symmetrically maintaining their proportion as they slide.
40

41. CHU’S ESTHETIC PROPORTION GAUGE
• Chu’s esthetic proportion gauge is a set of one handle and
four colour coded tips, the T bar tip, the inline tip, the
papilla gauge and the bone sounding gauge
41

42. • T bar tip is ‘T’ shaped and has color coded bands with
preset height/ width ratio (Table I and Figure 2) viz red,
blue and yellow on its vertical bar (height measurements)
and the horizontal bar (width measurements) which
correspond to each other . Height and width dimensions
are measured simultaneously.
• These bands are at a distance of 1 mm from each other.
42

43. INDIVIDUAL TOOTH DIMENSIONS…
 MAXILLARY LATERAL INCISOR-
 Playful part of smile
 Provide individuality
 Never symmetrical
 Influence gender characterization
 MAXILLARY CENTRAL INCISOR-
 Length 10-11 mm
 Width 75-80% of length
43

44.  MAXILLARY CANINES-
 Critical point in creating a pleasing smile
 Junction between the anterior and posterior teeth
 Supports frontal muscles
 Size and shape of buccal corridor depends on the canine
Note :-
Centrals wider than laterals by 2-3mm
canines by 1-1.5mm
Canine wider than lateral by 1- 1.5mm
Canine and central are longer than lateral by 1-1.5mm
 MAXILLARY BICUSPIDS-
 Important role in arch design
 Fill the buccal corridor
44

45. BUCCAL CORRIDOR
 In an esthetic smile there is what has been termed negative
space, which is a small space between the maxillary posterior
teeth and the inside of the cheek.
 In an esthetic smile the percentage visibility decreases as we go
more posteriorly . If there is any malocclusion or discrepancy
in arch form leads to loss of esthetics.
45

46.  If the space appears excessive when the patient is smiling, a
small amount of the space can be filled by increasing the buccal
contours of the maxillary posterior restorations.
 If conservative additive or subtractive (i.e., esthetic contouring)
techniques will not work esthetically, then orthodontics should
be considered.
Gives depth & mystery to the
smile
Indicates occlusal
disturbance or inadequate
restorative dentistry
46

47. INTERDENTAL CONTACT AREAS &
POINTS
Longest contact – between
central incisors
Shortest contact- between
lateral & canine
Interdental contact
points
– where the interdental
contact area ends
47

48.  The contact points of the maxillary teeth are relevant for
ensuring optimal 'pink aesthetics' for patients with a high smile
line (or visible cervical margins).
 The '5 mm rule', states that when the distance from the contact
point to the interproximal osseous crest is 5 mm or less, there is
complete fill of the gingival embrasures with an interdental
papilla.
 For every 1 mm above 5 mm, the chance of complete fill is
progressively reduced by 50%.
Black
triangle
48

49. Interdental contact area can be moved apically to
close the gap
49

50. GINGIVAL ZENITH OR HEIGHT OF
CONTOUR:
 The apex of the gingival
height of contour on the
anterior teeth is called
zenith point.
 Central : distal third
 Lateral: central
 Cuspid : distal third
 Bicuspids : central
50

51.  Nicely scalloped gingival contours – the pleasing
relationship of the zenith points should create a
shallow reverse triangle at zenith point of lateral
incisor – 0.5 – 1mm incisally.
51

52. INCISAL
EMBRASURES
 In an esthetic smile, the edges of the maxillary anterior teeth
follow a convex or gull-wing course matching the curvature of
the lower lip.
 Reduced incisal embrasures and leveling of the gull-wing
effect as in a straight smile line is associated with aging.
52

53. Smallest & sharpest between the
central incisors
90º BETWEEN PREMOLARS
IN YOUNG UNWORN
DENTITIONS
In aged / worn dentition – embrasures are smaller or disappear –
teeth need to be lengthened & embrasures need to be recreated
53

54. SOFT TISSUE
COMPONENT OF SMILE
 The lips frame the teeth and gingiva. The gingiva frames the teeth. The ratio of
tooth structure to the amount of gingival and labial tissue should be
harmonized to prevent an over-dominance of any one element.
Gingival Line :
 GAL- gingival aesthetic line – the ideal gingival line from the cuspid to the
central incisors intersects the dental midline at an angle >45° but <90°.
 The key esthetic issue is that the gingival line for the anterior teeth should be
relatively horizontal to the horizon and relatively symmetric on both sides of
the midline.
 In an esthetic smile, the volume of the gingiva from the apical aspect of the free
gingival margin to the tip of the papilla is about 40% to 50% of the length of
the maxillary anterior tooth and fully fills the gingival embrasure. 54

55. 55

56. Image demonstrating the
measurements of the ideal
gingival scallop, with the
percentages showing the papilla
length relative to tooth length.
Image showing the gingival line
on the same patient. Note the
lateral and central apical
position of the gingival margin
is on a straight line that is
completely horizontal.
56

57. PERIODONTAL BIOTYPE
AND BIOFORM
 The human tissue biotype is classified as thin, normal or thick.
 The thin periodontal biotypes are friable, escalating the risk of
recession following crown preparation and periodontal or
implant surgery.
 This is particularly significant for full coverage crowns for the
following reasons.
1. Firstly, the thin gingival margins allow visibility of a metal
substructure (either porcelain fused to a metal crown or
implant abutment), thereby compromising aesthetics in the
anterior regions of the mouth. In these circumstances, all-
ceramic crowns, or ceramic implant abutments are a
prerequisite to avoid aesthetic reproval.
57

58. Secondly, due to the fragility of the thin tissue,
delicate management is essential for avoiding
recession and hence visibility of subgingivally
placed crown margins at the restoration/tooth
interface.
58

59. ESTHETIC TREATMENT PLANNING AND
SEQUENCING
 integral part of treatment planning
 Treatment procedure which will be programmed or charted
 FINAL CASE PRESENTATION:- three basicmethods
1. Mock up - with soft tooth colored wax or composite resin- Direct
composite resin placement along with the use of intraoral
markers ( provide a visual three dimensional means for the
patient to see the final result prior to committing to treatment).
The functional movements in the mouth can also be checked at
this time to determine any occlusal obstruction or difficulties.
59

60. 2. Diagnostic wax-up or study casts- This wax
up can be evaluated by the patient directly on
the diagnostic casts of the articulator and also
intraorally with the use of acrylic overlays and
acetate matrices.
3. Computer imaging- Digital imaging takes
advantage of contemporary technology. In a
particular case, esthetic enhancement with a
change of arrangement, form, shape and color
can be demonstrated quickly.
60

61. PRINCIPLES OF SHADE
SELECTION
Teeth to be matched must be clean .
Remove bright colors from field of view
-makeup / tinted eye glasses
-bright gloves
- non neutral operatory walls
- View patient at eye level.
Evaluate shade under multiple light sources
Make shade comparisons at beginning of appointment
Shade comparisons should be made quickly to avoid eye fatigue
61

62. COMMERCIAL SHADE
GUIDES
 Vita Classic
 Vitapan 3D –Master
 Extended Range Shade
Guides
 Most convenient and common method of making
shade selections
 Guides consist of shade tabs
 Metal backing
 Opaque porcelain
 Neck, body, and incisal color
 Select tab with the most natural intraoral
appearance
62

63. VITA CLASSIC
SHADE GUIDE
63

64. RECENT ADVANCEMENT IN SHADE
GUIDES
• Advances in electronic technology have provided solutions for many of the current
problems in shade selection and color matching in dentistry:
• Advantage of Digital shade analysis
• a) Eliminates the subjectivity of color analysis and provides exact information for
laboratory fabrication of the prosthesis.
• b) Influence is more objective, can be repeatedly verified.
• c) Not influenced by external factors like surrounding environment
• d) Involves less chair-side time.
• e) The quality control aspect is a real advantage. The technician can verify that the
color replication process was accurate for the shade requested, and. with the more
sophisticated systems, a ―virtual try-in‖ can be accomplished.
• f) The reading can be translated to materials that can reproduce those
characteristics in the fabricated restorations.
64

65. CURRENTLY AVAILABLE DEVICES
• a. Shofu’s Shade Chroma Meter
• b. The Vita Easyshade
• c. The ShadeScan
• d. ShadeRite Dental Vision System
• e. The Spectro Shade
• f. Clear Match System
65

66. SHOFU’S SHADE CHROMA METER
66

67. THE VITA EASYSHADE
67

68. THE SHADE SCAN
68

69. SHADE RITE DENTAL VISION SYSTEM
69

70. THE SPECTRO SHADE
70

71. CLEAR MATCH SYSTEM
71

72. OPACITY & TRANSLUCENCY:
 As light strikes a surface, it is either totally reflected, totally
absorbed or a combination of both.
 Opaque objects reflect all or most of the light that is incident
on them whereas transparent objects transmit all of the light
that is incident on them.
72

73.  Translucency, in effect is the three dimensional facial
relationship or representation of value.
Highly translucent teeth tend to be lower in value, since
they allow light to be transmitted through the teeth,
while opaque teeth have higher values.
 To mimic natural teeth the effective use of restorative materials
should largely depend upon mimicking the translucent or
opaque effect.
73

74. METAMERISM:
 The change in color perception of two objects under different
light sources is called metamerism.
 This can be attributed to the difference in the radiant energy of
two different wavelengths of light. The standardization of
lighting condition during shade matching diminishes the effect
of metamerism.
74

75. FLUORESCENCE
• The emission of light by an object at a different wavelength
from that of an incident light is called fluorescence.
• The emission stops immediately on removal of incident light.
Teeth fluoresce with a stimulus in range of 340nm-410nm.
This spectrum is the blue range.
• Thus, according to the principle of additive color, the emitted
blue light acts with the yellowness of the tooth to produce a
white tooth.
• Fluorescing pigments incorporated in the ceramic restorations by the
ceramist and in the composite restorations by the manufacturer may
thus be advantageously used in altering the perception of final result.
GLOSS-
Gloss is an optical property associated with a smooth surface
that produces lustrous surface appearance and reduces the
effect of color differences.
75

76.  Illusion is a figament of imagination where a perception of
an object is created.
 FUNDAMENTALS AND PRINCIPLES-
 The art of creating illusion consists of changing perception, to
cause an object to appear different from what it actually is.
 Teeth can be made to appear smaller, larger, wider,
narrower, shorter, longer, younger, older, masculine or
feminine.
PERCEPTUAL ASPECTS - THE ART OF
ILLUSION
76

77. • Illusion works on two basic principles, which are the illusion of
principles of illumination and the principle of line.
• The most important of these is the perception that light approaches
and dark recedes. This is termed as “principle of illumination”.
• The second artistic prediction of great importance in dentistry is
the use of horizontal and vertical lines and ridges.
Horizontal lines make the objects appear wider and vertical lines make
the object appear longer. This is termed as the principle of line.
The artistic predilection exhibited in the principle of illumination can
be maintained to change the size, shape and the overall form of the
tooth through illusions.
77

78. Narrowing illusion
Widening illusion
78

79. Lengthening illusion
Shortening illusion
79

80. ESTHETIC CONTOURING
INDICATIONS
 Alteration of tooth structure
 Correction of developmental
anomalies
 Minor orthodontic problems
 Removal of stains & discolorations
 Periodontal problems – trauma
from occlusion
 Bruxism
 Reshaping & rounding of the
corners of CI & LI to give more
youthful look.
CONTRAINDICATIONS
 Hypersensitivity of teeth.
 Large pulp canals
 Thin enamel
 Deeply pigmented stains
 Occlusal interferences
 Susceptibility to caries
 Extensive anterior
crowding & occlusal
disharmony
80

81. TECHNIQUES OF ESTHETIC RECONTOURING:
Achievement of illusions
 The purpose of planning is to determine how to achieve an
illusion of straightness. This process must include different
views and perceptive. An optical illusion must work most
effectively in the position from which most people would be
viewing the patient
 Developmental grooves play important role in creating illusion.
 If the grooves are placed more apart illusion of more wide
teeth can be created & vice versa.
 If there is dark pigmentation in the periphery and light in
central portion
of the facial aspect of tooth an illusion of narrow teeth can be
created.
81

82. ANGLE OF CORRECTION
 A lower incisor that actually or apparently, extends above the lower incisal plane is quite
noticeable.
 The angle of view is important specially in shaping lower teeth. Because of the angle of
view, an anterior teeth which is in linguoversion appears to be much more prominent
than the one in labioversion.
 To contour the tooth in linguoversion, its incisal edge should be beveled lingually.
Reduction
 reshaping of the natural dentition must always be in relationship to the lip position in
both speaking and smiling.
 In rare cases it may be necessary to desensitize the tooth - sodium fluoride or a dentin
sealer.
 with the use of water, it is often possible to see a slight color shift before the enamel is
completely penetrated. The last few layers of enamel are more translucent so that the
yellow dentin becomes more visible. Enamel removal should be stopped as soon as color
shift is observed and hopefully before
 Anterior teeth in the lower arch should be shortened only to the level where they still
occlude in protrusive movements.
82

83.  Reduction is accomplished by
carefully shaping the marked
areas with the bulk reduction
diamonds except for the lower
anterior teeth. Bulk reduction
in these teeth should be done
with fine finishing diamonds at
high speed.
 Final shaping on the mesial,
distal, incisal and embrasure is
done with the thin and the extra
thin diamond points, because
their shape allows for better
access to these areas. This is
followed by the white or green
finishing stone.
83

84. ALTERATION OF
TOOTH FORM:
 A canine that has drifted or been repositioned into the space of
an extracted or a congenitally missing lateral incisors can
sometimes congenitally be reshaped to resemble the missing
tooth.
 Another example is to remove the part of the lingual cusp and
reshaping of the labial surface of a first bicuspid so that it
resembles a cuspid.
84

85. PEG SHAPED LATERALS: TREATMENT
OPTIONS
1.No treatment, patient not concerned
2.Orthodontic treatment first to align the
teeth in the arch
3.Direct composite bonding onto peg laterals
4.Indirect composite placement
5.Bonded crowns
6.Porcelain bonded to metal crowns (Bello
1997)
7.Crown lengthening surgery to get better
gingival heights.
8.Extractions and implant placement
9.Combinations of treatment in
different sequences
85

86. GOALS FOR ACHIEVING MAXIMUM
ESTHETICS…
Tooth
preparation
• Adequate tooth prep to avoid
unaesthetic contours.
• Allows sufficient bulk of the material
Gingival
retraction
• Harmony with the adjacent
periodontium
• Emergence profile highly esthetic
impression
• Correctly reproducing the finish lines
• Accurate for better results
86

87. ACHIEVING AN ESTHETIC SMILE WITH TISSUE MANAGEMENT
• Gingival Enhancement with Laser Treatment-
For more than 20 years, bonded porcelain veneers have been placed
to meet the esthetic desires of patients. But, in this time of
heightened cosmetic awareness and greater desire for more
acceptable long-term solutions, gingival enhancement with laser
treatment has become an important adjunct.Creating a highly
esthetic smile can only be accomplished with a sound union of proper
restorative material selection, adequate tooth preparation, and
biologically acceptable soft-tissue treatment.The result will be
achieving a maximum level of stable esthetics.
87

88. 88

89. VENEERS
 It is a layer of tooth colored material that is applied to a
tooth to restore localized or generalized defects and intrinsic
discoloration.
 INDICATIONS:
 Discolorations
 Enamel defects
 Diastema
 Malpositioned teeth
 Faulty / poor restorations
 Aging
 Wear patterns
 Malformed lateral incisors 89

90. CONTRAINDICATIONS:
 Ability to etch enamel – deciduous
& fluoridated teeth
 Bruxism
 Available enamel is thin
 Teeth with severe crowding
101
90

91. CONCLUSION
 The crafting of an ideal smile requires analyses and evaluations of the face, lips,
gingival tissues, and teeth and an appreciation of how they appear collectively .
 Such an ideal smile depends on the symmetry and balance of facial and dental
features. The color, shape, and position of the teeth are all part of the equation.
Recognizing that form allows function and that the anterior teeth serve a vital
role in the overall health and well being of the patient is paramount.
 Using a comprehensive approach to diagnosing and treatment planning of
esthetics can help achieve the smile that best enhances the overall facial
appearance of the patient and provides the additional benefit of enhanced oral
health. All these equations and proportions do not still adequately hold good
toward restoring an ideal smile. 91

92. REFERENCES
 Evaluation of maxillary anterior teeth proportion with
Chu’s Gauge in a population of Central India: an in vivo
study .Sukhada Arun Wagh, Sneha S. Mantri, Abhilasha
Bhasin. MEDICINE AND PHARMACY REPORTS Vol. 93 /
No. 1 / 2020: 75 – 80
 Smile projection‐a new concept in smile design.Article in
Journal of Esthetic and Restorative Dentistry · February
2021
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93. 106
93