This presentation is mainly assigned to academic dental students , dentists and professional restorative dentist .

1. Aesthetic problems solving
part I
By : Hana Ibrahim Blgasem
(BDS, clinical demonstrator and 2nd postgrad. Student )
Faculty of dentistry , Benghazi university
November 14 , 2019
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2. 2

3. 3

4. 4

5. 5
6.evaluation
1.identification 2.analysis 3. brainstorming 4.Selection
5.Implemention

6. 6

7. Aesthetic dentistry
Vs
Cosmetic dentistry
Vs
theatrical dentistry
7

8. Aesthetic dentistry
replicate natural beauty
• “aesthetic” derives from a Greek word meaning the feeling and
perception of nature and organic formations
• aims to give the patient the best natural-looking result
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9. Cosmetic dentistry
• The Greek origins of the word “cosmetic” means jewel, jewellery or
adornment (decoration )and therefore implies something that is fake
or man-made
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DENTAL TATTOOS

10. )beyond what can occur in nature(
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“bleach shade” porcelain veneers

11. theatrical dentistry
• Teeth can be modified to
create special smiles and
customize as per
character of a role in
theatres / movies /
media, etc..
• It can be artificially made
with the help of a special
prosthesis which is usually
removable (temporary).
• Teeth play a significant
role to match with the
facial expressions and
facial makeovers
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12. 12

13. 13

14. 14
Snaggleteeth and London Gaps:
the imperfect teeth trend

15. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
15

16. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
16

17. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
17

18. 1-Tooth related problems:
1. Size and shape problems
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19. 1-Tooth related problems:
1. Size and shape problems
1.Abrasion
2.Erosion
3.Attrition
4.Aged teeth-worn
5.Extruded tooth
6.Chipped tooth
7.Feminine teeth- excessive
8.Masculine teeth- excessive
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9.Large tooth
10.Small tooth
11.Long tooth
12.Short tooth
13.Malformed (mild – severe)
14.Narrow tooth
15.Wide tooth
16.Pig lateral incisor
17.Fractured tooth

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21. 21
Aged teeth-worn Extruded tooth Chipped tooth
Small teeth Large teeth

22. 22
Long teeth Short teeth
Malformed teeth Pig lateral incisor Fractured tooth

23. 1-Tooth related problems:
1. Size and shape problems
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24. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
24

25. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
25

26. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
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1. Anterior flared teeth (major- minor)
2. Crowding
3. Diastema
4. Excessive spacing
5. Extruded tooth
6. Generalized spacing
7. High smile line
8. Long tooth
9.Midline disharmony
10.Migrated teeth
11.Multiple diastema
12.Open bite (mild-severe)
13.Overbite / overjet
14.Traumatic injury –luxation
15.Overlapped teeth

27. 27
Anterior flared teeth Crowding
Diastema Generalized spacing

28. 28
High smile line Midline disharmony
Migrated teeth Open bite

29. 29
Traumatic injury -luxation Overlapped teeth

30. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
30

31. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
31

32. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
32

33. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
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1) Aged-dark- teeth
2) Discoloration
3) Congenital discoloration
4) Endodontic discoloration
5) Tetracycline discoloration
6) Traumatic discoloration
7) Fluorosis
8) Endemic fluorosis
9) Staining
10) Tooth color(too light/too dark)
11) White spots

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Aged-dark- teeth Congenital discoloration
Endodontic discoloration
Tetracycline discoloration

35. 35
Traumatic discoloration
Fluorosis
Staining White spots

36. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
36

37. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
37

38. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
38

39. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
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1) Multiple missing teeth
2) Single missing tooth
3) Migrated tooth –single
4) Migrated teeth –multiple
5) traumatic injury – avulsion

40. 40
Multiple missing teethSingle missing tooth
traumatic injury – avulsion

41. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
41

42. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
42

43. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
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1) Carious restorative margins
2) Carious tooth

44. 44
Carious restorative margins Carious tooth

45. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
45

46. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
46

47. 1-Tooth related problems:
1. Size and shape problems
2. Position problems
3. Color problems
4. Missing teeth problems
5. Caries
6. Repairs
47
1) Acrylic veneer facing- dislodgment
2) Carious restoration margins
3) Porcelain fracture –ceramometal restoration

48. 48
Porcelain fracture Acrylic veneer
facing dislodgment

49. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
49

50. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
50

51. 2. Non-Tooth related problems
• Gingival asymmetry
• Gingival hypertrophy
• Gingival inflammation
• Gingival recession
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52. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
52

53. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
53

54. 3. Dermatologic problems
1) Aging
2) Scars
3) Wrinkles
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55. 55
Aging
Scars
Wrinkles

56. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
56

57. Aesthetic problems classified into:
1) Tooth related problems
2) Non-Tooth related problems
3) Dermatologic problems
4) Facial contours and skeletal problems
57

58. 4. Facial contours and skeletal problems
1) Facial asymmetry
2) Bimaxillary prognathism
3) Excessive lip support
4) Hypogenia
5) Insufficient lip support
6) Macrogenia problems
7) Maxillary prognathism
8) Maxillary retrognathism
9) Mandibular prognathism
10) Mandibular retrognathism
11) Open bite (mild-severe)
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Facial asymmetry Bimaxillary prognathism Excessive lip support

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Hypogenia
Insufficient lip support
Macrogenia
Hypogenia
Open bite

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Mandibular
prognathism
Mandibular
retrognathism
Maxillary
prognathism
Maxillary retrognathism

62. 62

63. Aesthetic treatment
• Non-invasive options : (Tooth-whitening, Orthodontics – the use of
aligners, adhesive restorations, Removable prostheses….etc )
• Invasive options: ( veneers , PFM , surgery …….etc )
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64. minimally invasive cosmetic dentistry
(MICD/MIED)
• “a holistic approach that explores the smile defects and aesthetic
desires of a patient at an early stage and treats them using the least
intervention options in diagnosis and treatment technology by
considering the psychology, health, function and aesthetics of the
patient.
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65. 65

66. Abrasion , Erosion, Attrition , Aged teeth-worn
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1.Direct composite resin restoration
2.Indirect composite resin restoration
3.Ceramometal restoration
4.All-porcelain restoration
5. Porcelain laminate veneer

67. Extruded tooth
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1. Cosmetic recontouring
2. Ceramometal restoration (possibly combined with endodontic and periodontal
therapy )
3. Indirect composite resin restoration

68. Chipped tooth
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1. Cosmetic recontouring
2. Direct composite resin restoration
3. Indirect composite resin restoration
4. Ceramometal restoration
5. All-porcelain restoration
6. Porcelain laminate veneer

69. Macrodontia (Large tooth)
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Types
• True generalized – (all the teeth are larger than normal)
• Related generalized – (normal teeth, smaller jaw)
• Localized – (one or more large teeth, normal dentition
and body size)
Clinical features
• Teeth size –(larger than normal)
• Malocclusion –crowding (may result in malocclusion)
• Impaction – as space is less, there is impaction of teeth
Radiographic features
• The increased size will be demonstrated on the radiograph
Management
• If necessary orthodontic treatment is done • If impacted extraction is indicated

70. Microdontia( Abnormally small teeth)
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Clinical features
• True generalized
• Related generalized
• Localized focal microdontia (maxillary lateral
incisors (peg lateral) and maxillary third molars)
• Supernumerary teeth are often microdonts

71. Long tooth
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(gum recession)

72. 12.Short tooth
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73. 13.Malformed (mild – severe)
Enamel Hypoplasia
• Having thin tooth enamel can lead to:
• pits, tiny groves, depressions, and fissures
• white spots
• yellowish-brown stains (where the underlying layer
• of dentin is exposed)
• sensitivity to heat and cold
• lack of tooth contact, irregular wearing of teeth
• susceptibility to acids in food and drink
• retention of harmful bacteria
• increased vulnerability to tooth decay and cavities
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74. In the case of sensitivity, cavities, or tooth structure showing
wear, treatment options include:
• Resin-bonded sealant.
• Resin-based composite fillings.
• Dental amalgam fillings.
• Crowns.
• Enamel microabrasion.
• Professional dental whitening.
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75. Pig lateral incisor
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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 PFM
7. Crown lengthening surgery to get better
gingival heights then direct bonding.
8. Extractions and implant placement
9. Combinations of treatment in different
sequences

76. Fractured tooth
Treatments for cracked teeth include:
• gluing on the chipped or broken part of a tooth
• repairing the crack with resin
• using a filling
• using a crown
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77. conclusion
• First , It is said “ Beauty is in the eye of the beholder “, i.e. beauty is
a subjective experience( flavoured by ethnicity , culture and an
endless list of other factors ) .
• Secondly , Imperfection (less than the perfect) is the key of beauty .
• Finally , If it is necessary to treat those aesthetic problems-in some
circumstances , it has to be in the range of minimal invasive aesthetic
dentistry MIAD/MICD .
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78. References
• Kenneth w Aschheim, Esthetic Dentistry: A Clinical Approach to
Techniques and Materials,third edition
• Nehal Vithlani Jan2015, macrodontia, Dentist and oral health
professional, https://www.slideshare.net/nehal288/2macrodontia
• SHORT TEETH, https://smiletogo.com.au/smile-gallery/short-teeth/
• Peg Lateral Incisors, https://www.gotoapro.org/symptoms/peg-lateral-
incisors/
• Linda Greenwall, Treatment options for peg-shaped laterals using direct
composite bonding,
http://www.moderndentistrymedia.com/jan_feb2010/greenwall.pdf
• How do you know if you have a cracked tooth?,
https://www.medicalnewstoday.com/articles/322015.php
78
Nehal Vithlani
,

79. • Cosmetic Dentistry vs Aesthetic Dentistry,
https://coastaldentalcare.com.au/blog/cosmetic-dentistry-vs-
aesthetic-dentistry/
• TOOTH JEWELLERY / THEATRICAL / DENTAL TATTOS,
http://www.drbhimanidentistry.com/tooth-jewellerytheatricaldental-
tattos/
• Cosmetic Dentistry Vs. Aesthetic
Dentistryhttps://russoddsraleigh.com/2017/03/28/cosmetic-
dentistry-aesthetic/
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80. •To be continued …….
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