3 esthetic consideration

ALPINE SKI HOUSE
Dr. Inas Ayoub Elalem
inas.alalem@gmail.com
00970599448344
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Operative Dentistry V

ALPINE SKI HOUSE
Esthetic
Consideration
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Definition of Esthetic
According to Dr. Ronald E. Goldstein: “ Esthetic dentistry is the art of
dentistry in its purest form”
According to the American Academy of Cosmetic Dentistry, the
cosmetic dentistry is dedicated to the art and science of enhancing a
person’s smile and overall appearance.
According to Webster’s New International Dictionary: defines aesthetic
as “ appreciative of and responsive to the sense of beauty or fine
culture”
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Esthetic Dentistry
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Smile Design Definition
The planning and previsualization
of the desired end result of an
esthetic dental treatment targeting
a more harmonious state instead of
the current disharmony, according
to rules of facial, dental and
gingival harmony as well as to the
patient’s demand.
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The sequence of smile design are:
1) Proper analysis including:
Facial analysis
Labial analysis
Gingival analysis
Dental analysis
2) Design of new smile
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Facial Analysis
The facial morphology is important factor for determination of the tooth
morphology.
Frontal View
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Frontal View
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Correlation of face shape and smile design
The oval face design. A full
range of smile designs is
possible with the oval face.
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The long face design.
An ideal smile design would
minimize a long face by
flattening the upper anterior
smile arch and bulking out the
upper posterior teeth to create
a horizontal band of teeth.
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The round face design. An
ideal smile design would
minimize a round face by
deepening the upper smile
arch, perhaps with 2 longer
central teeth, creating a
vertical stripe on the face.
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The heart-shaped face
design.
An ideal smile design would
enhance this face by
minimizing the chin.
Flattening the smile arch will
accentuate the width instead
of the length of the face.
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The square face design.
To accentuate a square
face, use square or
rectangular nonovate-
shaped teeth with long
proximal lines.
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Lateral Profile
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Facial Midline, Interpupillary line, incisal line
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Facial Thirds ( Horizontal proportions)
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Facial thirds ( Vertical proportions)
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Naso-Labial Angle
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85o to 105o

Ricketts’ E-plan
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4 to 2 mm
Esthetic lip position

Labial Analysis/ Lip morphology
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Everted lips
Thin lips
Full lips
Flat lips

Lip Line
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Beautiful teeth go hand in
hand with beautiful faces
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Gummy Smile
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Botox
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• Botox is a trade name for botulinum toxin, which comes in
the form of a purified protein.
• The mechanism of action for Botox “is injected into the
facial muscles but really doesn’t affect the muscle at all”.
• Botulinum toxin affects and blocks the transmitters
between the motor nerves that innervate the muscle. There
is no loss of sensory feeling in the muscles.
• Once the motor nerve endings are interrupted, the muscle
cannot contract. When that muscle does not contract, the
dynamic motion that causes wrinkles in the skin will stop.
• The skin then starts to smooth out, and in approximately
three to ten days after treatment, the skin above those
muscles becomes nice and smooth.
• The effects of Botox last for approximately three to four
months, at which time the patient needs retreatment.
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• Botox is also used to complement
esthetic dentistry cases:
• as a minimally invasive
alternative to surgically treating
high lip line cases
• lip augmentation
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Dermal fillers
as hyaluronic acid and calcium hydroxylapatite fillers are commonly
used to add volume to :
 The face in the nasolabial folds
 oral commissures
 Lips
 marionette lines
As we age, collagen is lost in these facial areas and these lines start to
deepen. These dermal fillers are injected right under the skin into to
plump up these areas so that these lines are much less noticeable.
Dermal fillers are also used for lip augmentation and are used by
dentists for high lip line cases, uneven lips, and to make the peri-oral
area more esthetic. The face looks more youthful and is the perfect
complement to any esthetic dentistry case that you do. 27

Dermal filler
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Gingivectomy & Gingivoplasty
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Crown lengthening
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Gingival Analysis/ Gingival Level and harmony
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Gingival Analysis/ Gingival Zenith
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Gingival Symmetry
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Gingival Hypertrophy
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Gingival Recession
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Dental Analysis: Teeth size, proportions and position
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75-80 % is considered the most acceptable

Dental Proportions/ Golden proportion
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The width of each anterior tooth is 60% of the width of
the adjacent tooth ( mathematical ratio being 1.6:1:0.6)

Golden Proportion
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Golden Proportion
Different arch form, lip
anatomy and facial
proportions
Limitation of creativity
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Recurring esthetic dental proportion “RED”
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Smile Line
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Dental midline
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Dental midline
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Buccal Corridor
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Display Zone and Teeth Visibility
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When the mouth is relaxed and slightly open: 3.5 mm of the incisal
third of the maxillary central incisor should be visible

Axial Inclination
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Incisal Embrasures
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Interproximal contact point ( ICP)
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Incisal Edge positioning
Vermillion border of
the lower lip
Phonetics
Parallel to
interpupillary line
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Surface Texture and Luster
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Sex, age and personality
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Position and Alignment
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M-position
Measured and analyzed commissure height, philtrum height and visibility of the maxillary
incisors
Younger patients may show between 2-4mm of maxillary incisal edge in this position.
As people age, the maxillary incisal edge reveal shrinks and even disappear.
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E-position
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Analyzed smile line, dental midline, smile symmetry, buccal
corridor, display zone and teeth visibility, smile index, and lip
line.

How we see object?
Light, object, observer
”light hit the object then is
reflected to the eye of the
human
Teeth Shade
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How our eyes receive colors?
Cones observe
the hue,
chroma
the number of
cons are less
Rods observe
the value, the
number of rod
is a larger
number
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The rods are more numerous, some 120 million, and are more sensitive
than the cones.
sensitive to value (greys) that’s why when choosing the value of the color
we close half eye so we will depend in all the rods cells in choosing the
value.
 However, they are not sensitive to color. The 6 to 7 million cones
provide the eye's color, sensitivity and they are much more concentrated
in the central yellow spot known as the macula.
In the center of that region is the " fovea centralis ", a 0.3 mm diameter
rod-free area with very thin, densely packed cones.
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Factors affecting optical qualities of an object as seen by an
observer’s eye:
1. Spectral characteristics of the light source
2. The spectral characteristics of the object
3. Sensitivity of the observer eye
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Sources of light
1. Sunlight at noon
2. Incandescent
Lighting
3. Halogen Lighting
4. Dental
Chair/Surgical Light
5. Fluorescent Lighting
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Metamerism
Metamerism, two colors that appear
to match under a given lighting
condition but have different spectral
reflectance are called metamers, and
the phenomenon is known as
metamerism.
The problem of metamerism can be
avoided by selecting a shade and
confirming it under different lighting
conditions, such as natural daylight
and fluorescent light.
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Color Dimensions
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The following limitations can make accurate color
assessment problematic:
• Retinal Fatigue is partially the result of the firing of rod and cone cells
in the retina after we stare at highly contrasted areas for prolonged
periods; we subsequently lose the ability to make fine distinctions and
accurate color selection.
• Before we attempt to match a color, our eyes must be relaxed. Watching
neutral colors, such as gray, blue, and green
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For example staring at this image for at least 2
minutes should help to restore visual acuity
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• Age affects the retina. Over time, the lens of the human eye becomes
more yellowish brown, thereby imparting a yellow-brown bias.
• Color blindness, for example, It can be a monochromatic blindness that
he can’t see one of the primary colors
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Color Blindness Test
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Requirements for correct color determination
The illuminant should be neutral
The background should be neutral or gray to eliminate dominance of
particular colors
The background involves wetness of the tooth, office curtains walls,
and we should remove any lipstick and make-up before color
determination.
Patient position: color selection is preferably made with patient seated
at the same level relative to the observer’s eye.
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The position of the patient need to be
in upright position in order for the light
to be reflected to my eyes. There is
should be a distance between the dentist
and the patient, which the distance of
the forarm. It’s the closest distance that
any person can talk us, and can notice
everything.
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Hue is represented by A, B, C or D on the commonly used Vita Classic
shade guide ( A: orange, red, B: orange, yellow, C: brown-gray , D: brown
Subjective Technique
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The modification is 3D Master shade guide, first we choose the value then
chroma and the last thing is the hue it’s R “red” L: yellow, M: intermedium
between the 2 colors. This 3 D shade is more physiological because it starts
with the value which the eye is more sensitive to it.
Subjective Technique
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Instrumental: Digital color selection
• Spectrophotometer
• Colorimeters
• Software
Type of measurements used in digital shade selection:
• Spot measurement
• Complete tooth measurement
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Digital color selection
Spectrophotometer
It measure the amount of light energy reflected (wavelength) from an object
at 1-25 nm intervals along the visible spectrum.
It contains a source of balanced light, an optical system of measuring, a
detector and means of converting light obtained to a signal that can be
analyzed.
It contains it’s light so there is no problem with the light source
It is a very precise tool to measure the light, because it measure the
wavelength
It’s more accurate than the Colorimeters
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The Easy Shade
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The compact easy shade
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MHT Spectro Shade
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Olympus Crystal Eye
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Colorimeters
Measure the light reflected from the object using three sensors filtered
to the same sensitivity/color as the human eyes.
The colorimeter identifies color the way the human eye does.
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X-rite Shade-X
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Software (clear match)
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Software (clear match)
This software, will balance the picture that is measured and
compare the tooth color with the reference block for example as
A2 with black and white colors
The digital color selection shade will show the translucency,
overcome the problems of communication with the lab, because
you can send a map for the lab.
82

Cross-polarizer filter
Cross-Polarizer filters can be
used to enhance contrast,
saturation and reduce
reflections or glare on shiny
surfaces as enamel
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Cross polarizer filter/ Smile line
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Cross-Polarizer filter
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Cross-Polarizer filter
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3 esthetic consideration

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