Dentofacial esthetics/ orthodontic teeth


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Dentofacial esthetics/ orthodontic teeth

  1. 1. DENTOFACIAL ESTHETICS INDIAN DENTAL ACADEMY Leader in continuing dental education
  4. 4. Webster’s Third New International Dictionary defines “esthetic” as appreciative of responsive to, or zealous about the beautiful: having a sense of beauty or fine culture.”
  5. 5. GPT: 1. The branch of philosophy dealing with beauty 2. “The theory and philosophy that deal with beauty and beautiful, especially with respect to the appearance of a dental restoration, achieved through its form and /or color
  6. 6. HISTORY In the EL Gigel cemetery located in the vicinity of the great Egyptian pyramids, two molars encircled with gold wire were found. This was apparently a prosthetic device. In the Talmudic law of the Hebrews, tooth replacement permitted for women.
  7. 7. The Etrascans were well versed in the use of human teeth or tooth carried from animals to restore missing dentition.
  8. 8. The dentolabial smile, where the teeth are seen behind the lips, starts to emerge In the first decades of 20th century
  9. 9. The ancient Japanese proudly displayed black teeth The Mayans flashed a jadeite studded smile testify to an apparently deep seated urge decorate the body. Today, dental esthetic is founded on a more esthetically sound basis the general improvement of dental health.
  10. 10. The esthetic principles and various scientific guidelines that is elementary for the study of dentofacial esthetic. Physical attributes of the elements of the dentofacial composition. Factors of esthetic dentofacial composition and their significance.
  11. 11. Physical attributes of the elements of the dento-facial composition CONTRAST UNITY OF ONENESS SYMMETRY PROPORTION GOLDEN PROPORTION
  13. 13. Factors of esthetic dento-facial composition and their clinical significance 1 REFERENCES 2 SMILE ELEMENTS 3 DYNESTHETICS 4 BUCCAL CORRIDOR 5 BIOLOGY OF ESTHETICS
  15. 15. CONTRAST It is that factor which makes the various elements of a composition visible. The eye can differentiate the part of an object due to contrast of color, lines, patterns, textures etc
  16. 16. UNITY OR ONENESS “It gives different parts of the composition the effect of a whole.”Unity can either be static, when repeated shapes or designs are seen as in inanimate things, like the composition of crystals or dynamic and changing as in living beings.
  17. 17. COHESIVE AND SEGREGATIVE FORCES Any element which tends to unity a composition is a cohesive force. Segregative forces are those elements which break the monotony of the composition
  18. 18. SYMMETRY It is the regularity of arrangement of forms either from left to right as in horizontal symmetry or from a central point to either side like a mirror image as in radiating symmetry. The horizontal symmetry looks dynamic respective and uninteresting which the radiating symmetry looks dynamic and interesting.
  19. 19. PROPORTION To be able to give a certain mathematical representations of beauty for numerically expressing the relationship of the various units that combine to make a composition, the term proportion is used.
  20. 20. In a dento-facial composition a golden proportion exists between the maxillary teeth antero-posteriorly.
  21. 21. Given its name by Pacioli a mentor of Leonardo Da Vinci, this phenomenon has unique properties and it battles the imagination and eludes understanding. The proportion is 1.0 to 1.618. This relationship links geometry to mathematics, hence it has also been called the “sacred geometry,” the magic numbers,” and “the golden cut”.
  22. 22. In the case of teeth, the lower central incisor may be used as a starting reference. Interesting the upper central incisor has a golden phi or 1.618 proportion to the lower incisor and the total width of both lower controls are golden that of the upper incisors.
  23. 23. GOLDEN PROPORTION: A central incisor is considered perfectly proportionate when the maximum width is approximately 75% of the maximum length (of clinical crown) this is the ideal width to length ratio
  24. 24. DOMINANCE It exists when a strong centralized structure is surrounded by well documented, characterized structures
  25. 25. BALANCE It is achieved when there is an exact equilibrium between the forces presents an either side of the fulcrum in a composition. In dentistry this implies the balance of the elements in relation to the midline.
  26. 26. REFERENCES HORIZONTAL inter pupillary line The comissural line
  27. 27. The interpupillary line helps to evaluate the orientation of the mesial plane the gingival margins and the maxilla. An imaginary horizontal line through the incisal plane and the gingival margins should be visibly parallel to the interpupillary line.
  28. 28. VERTICAL LINE REFERENCES The facial midline serves to evaluate the location and axis of the dental midline and the mediolateral discrepancies in the tooth position
  29. 29. SAGITTAL REFERENCES Soft tissues analysis at a standardized position left in studying the profile of an individual.The contours of the upper and lower lips and lip support is determined by the position of the anterior teeth.
  30. 30. PHONETICS REFERENCES Phonetics play a part in determing maxillary central incisor design and position ‘F’ and ‘V’ are used to determine the tilt of the incisal third of the maxillary central incisors and their length. The ‘M’ sound is used to achieve a relaxed rest position and if repeated at slow intervals can help evaluate and the incisal display at rest position.
  31. 31. ‘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
  32. 32. Smile can be classified as Passive, active and laugh. Passive Smile: In passive smile the lips are parted slightly away from the rest position expressing content passion, desire, surprise etc.
  33. 33. Active Smile: In active smile the lips move to a significant extent away from the rest position displaying more tooth and even gums, expressing joy, welcome, happiness etc. Laugh: Laugh is an instant fluctuation from an active smile position where the facial muscles instantly act leading to a maximum exposure of the teeth and gums. Humorous and funny situations usually lead to such an expression
  34. 34. LIP AND LIP LINE: The length the curvature and the shapes of the lips significantly influence the amount of tooth exposure during rest and in function.
  35. 35. UPPER LIP LINE: Upper lip line helps evaluate the length of the maxillary incisor exposed at rest and during smile and the vertical position of the gingival margins during smile
  36. 36. LOWER LIP LINE Lower lip line helps to evaluate the buccolingual position of the mesial edge of maxillary incisors and the curvature of the incisal plane.
  37. 37. SMILE LINE: It is an imaginary line passing through the incisal edge of the upper anterior teeth. The smile line usually coincides or runs parallel to the inner vermilion border of the lower lip.
  38. 38. NEGATIVE SPACE Negative Space is a dark space appearing between the Jaws and the mouth opening either at the corner of the mouth or around the buccal aspect of the posterior teeth during active smile
  39. 39. SMILE DOMINANCE Different facial features stand out differently in the eyes of every be holder. In certain cases the most predominantly striking features of a face is the smile these are the ‘Dominant Smile’
  40. 40. DYNESTHETICS The dentogenic concept and dynesthetics must be given favorable consideration. This concept is a very useful guideline in the selection of artificial teeth. Fisher states, “We utilize the approach of the artist when we analyze the patient first as to sex, that is male or female; then as to age young middle aged or old.
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  42. 42. Buccal corridor The shape and position of the dental arch determines the size of the buccal corridor. The buccal corridor is the space between the buccal surface of the upper teeth and the corners of the mouth visible when the patient smiles
  43. 43. DISRUPTION OF THE DENTAL –ALVEOLAR ELEMENTS The structural and spatial elements are significant in diagnosis, treatment planning and reconstruction of esthetics are multiple. They are : The height and inclination of the plane of occlusion The arch from contours of the maxilla and mandible and their relationship in the static and dynamic state.
  44. 44. The overjet and overbite in the static and dynamic states. The individual tooth position in the arch with respect to the coronal and root inclination relative to the vertical plane The inter cuspal relationship with respect to centric relation, centric occlusion protrusive and other excursive positions.
  45. 45. THE IMPORTANT ELEMENT EFFECTING ESTHETICS. The biology of lip and face contours and profile. The dental arch form. The inclination of the labial surface of tooth contours. The vertical dimension of facial height. The esthetic of adult development and aging.
  46. 46. ILLUSION Creating esthetic restoration through special effects. Creating illusions one of the most important objectives of esthetic dentistry. The ability to make a tooth wider or thinner, smaller or larger is a invaluable aid when solving difficult esthetic problems.
  47. 47. Principles of Illusions Principles of illusion such as those used to describe form light, and line may be applied specifically to dentistry. In the presence of excess light or in the absence of light, form cannot be distinguished since shadows are necessary to help make perceptible the contour or curvature of surface and depth
  48. 48. Illusion in dentistry are created using three techniques Shaping and contouring Arrangement of teeth Staining
  49. 49. Color can also be used to increase the illusion of width. For instance when a body color is selected that is slightly lighter than that of the adjacent teeth the narrow tooth will more prominent and therefore wider
  50. 50. Techniques for various problems. The most commonly encountered problems that can be corrected through illusion are discussed below. Space available is wider than the ideal Replacement tooth Shaping The width of the replacement tooth or teeth will have to wider then ideal, therefore various illusions achieved through shaping and contouring should be used. The Width needed to close the space is gained in the areas of contact.
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  52. 52. The too short tooth If a tooth appears too short, as is likely if it is wider than normal, several techniques can be used to create the illusion of length. If the gingival third is narrowed mesiodistally the tooth will appear more taped and longer
  53. 53. The too long tooth When alveolar or gingival recession has been severe, the length of pontics or crowns must be made to appear shorter. Basically vertical groves or lines should be diminished and horizontal lines emphasized
  54. 54. Incorporating the personality of the patient A delicate personality can be differentiated from the vigorous one by the degree of characterization, coloring and arrangement of teeth.
  55. 55. INCORPORATING SEX CHARACTERISTIC When teeth are contoured crowns or carved, we may need to incorporate either feminine or masculine characteristic To interpret a female mouth as one where the contours and lines are more rounded and curved than those in the male, which are usually flatter, sharper , and more angular.
  56. 56. By rounding angels and edges, a more feminine appearance can be achieved. By squaring angles and edges, a more masculine feeling is created. The idea of masculity can be further enhanced by slightly abrading the incisal surface
  57. 57. Aging wears down the incisors Increasing the internicisal distance by making the centrals again longer than the laterals can help make the individual appear younger.
  58. 58. REDUCING AGE EFFECTS ON THE SMILE Many patients are motivated to seek esthetic dental treatment to make them look younger. This is usually possible by the use of various restorative techniques.
  59. 59. Incorporating Age characteristics Once the correct form and function have been achieved in a crown The wear and stains that normally accumulate with age should be incorporated into the new restorations to blend with the appearance of the remaining natural teeth
  60. 60. ARRANGEMENT The most direct solution for inadequate space is to rotate and overlap the replacement crowns or teeth without reducing their ideal widths. If rotation and overlap is unacceptable or impossible, and if the encroachment upon the space has been severe, it may be possible to eliminate one tooth entirely with good results
  61. 61. COLOR The three dimensions of color Evaluating color differences Dental shade guide lines Shade selection Shade modification A look to the future
  62. 62. The three dimensions of color: E Brace Clark an early leader in color matching in dentist stated the need for learning the three dimensional nature of color.
  63. 63. Hue: The dimension of hue is most easily understood. It is in Munsell’s words, that quality by which we distinguish one color family from another, as red from blue to purple.
  64. 64. VALUE Value relates color brightness to the specific area on the black-while scale. The value of a color is determined by that quality of gray with which its brightness can be matched
  65. 65. CHROMA Chroma, third dimension, was described by Munsell as that quality which distinguishes a strong color from a weak one
  66. 66. Perception of color The eye: Under low lighting conditions, only rods are used . These receptors allow an interpretation of the brightness of objects to be made. They are most sensitive to blue-green objects. Color vision is dependent on the cones, which are active under higher lighting conditions.
  67. 67. Color adaptation: Color vision decreases rapidly as an object is observed. The original color appears to becomes less and less saturated until it appears to less almost gray.
  68. 68. Deceptive color perception: The brain can be tricked in how it perceives color. The color of teeth can also look different if the patient is wearing brightly colored clothing or lipstick. . Fluorescence: Fluorescent materials, such as tooth enamel, re-emit radiant energy at a lower frequency than it is absorbed.
  69. 69. Metamerism: Two colors that appear to be a 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
  70. 70. Opalescence: Natural teeth, particularly at their incisal edge, exhibit a light-scattering effect that creates the appearance of bluish-white colors as the teeth are seen at different angles. Color blindness: Defect in color vision effect about 8% of the male population and less of the female population. Different types exist, such as achromatism, dischromatism, and anomalous trichromatism.
  71. 71. Vitapan 3D Master Shade guide The manufacturer of this recently introduced shade system claims that it covers the entire tooth color space. The shade samples are grouped in six lightness levels, each of which has chroma and hue variations in evenly spaced steps.
  72. 72. Currently available devices Shade eye: Manufactured by Shofu Dental Corporation. It is a colorimeter. Easy Shade: Manufactured by Vident. It is a spectrometer. Shade Scan: Manufactured Cynorad. It is a digital color imaging/colorimeter.
  73. 73. Shade vision: Manufactured by X-Rite Inc. It is a Digital color imaging/colorimeter. Spectro shade: Manufactured by MHT, Niedederhasli. It is a digital color imaging/spectrometer. Clear Match: Manufactured by smart technology. Software to be used with digital camera
  74. 74. ESTHETIC IN COMPLETE DENTURES Tooth selection Tooth selection involves choices of shade, size and shape of the artificial teeth. Tooth shade Historically shade selection was based on the patients’ hair and eye color, complexion and age. Fursh and Fisher introduced the dentogenic concept for establishing esthetics.
  75. 75. Tooth Size Generally men have larger teeth than women. There are two popular methods to select the appropriately size of the maxillary teeth. The first is to base the selection on the space available for the placement of teeth. The second is based as the facial and tooth size proportion
  76. 76. Tooth form Berry probably was first to demonstrate the correlation between the outlined of maxillary incisor and the inverted outline form of the face. J Leon William’s classified facial form as square, tapering, square-tapering and ovoid. House and Loop proposed 3 typical forms Square Tapering Ovoid
  77. 77. And six other combination forms Square tapering Reverse tapering Ovoid square Ovoid tapering Ovoid reverse tapering Square tapering
  78. 78. GUIDELINES FOR TOOTH PLACEMENT AND ARRANGEMENT FRONTAL VIEW: (ANTERIOR TEETH) Anterior teeth parallel to interpupillary line. Incisal edge of maxillary incisors 1-2mm below maxillary lip at rest. No bulging should be evident under the nostrils Philtrum should be restored. Full vermillion border of lip should seen. Smile line should follow the line of the lower lip in smiling.,
  79. 79. Saggital view Upper lip should be averted and not fallen Tooth support of the lip is by 2/3 of the incisal labial surface of the anteriors.
  80. 80. Horizontal view: Central incisor should be 8-10mm anterior to the midpoint of the incisive papillae. Canines are on a line drawn perpendicular to the middle of the palate, through the center of the incisive papilla.
  81. 81. Characterization Lombardi felt that the central incisors make the best statement of the patient’s ages whereas lateral incisors note patient’s sex and canines reflect patients’ vigor.
  82. 82. ESTHETICS OF FIXED PROSTHODONTICS Diagnosis and treatment planning of esthetic problems . Orthodontic considerations: Because alignment of anterior teeth is an important aspect of dental aesthetics, orthodontics has traditionally been intimately involved in esthetic dentistry
  83. 83. VERTICAL TOOTH POSITION: We must assess the position of the maxillary incisors relative to other facial landmarks. From an orthodontic perspective, two major landmarks are critical to the analysis. The first is the level of the lip when the patient is smiling, and the second is the interpupillary line.
  84. 84. INTERPUPILLARY LINE: If the incisal plane of the maxillary anterior teeth does not coincide with the interpupillary line orthodontic planning depends on the inter relationship of four factors: incisal plane posterior occlusal plane, inter pupillary line and crown length.
  85. 85. Upper lip line: When patients smiles, the upper lip should expose the entire crown of the central incisors. some patients show excessive amounts of gingiva when they smile which may be unaesthetic. The orthodontic movement can be accomplished intracoronally with an intrusive force to the incisors, or extra orally using a head gear to place the maxillary incisor superiorly.
  86. 86. MEDIOLATERAL POSITION: The mediolateral position of the maxillary central incisors is important aspect of esthetics. In some situations the maxillary dental midline will deviate to one side. When correcting these situations it is important to distinguish between the true midline deviation and improperly inclined incisors.
  87. 87. CROWN LENGTH: Assessment of crown length discrepancies is important in order to determine proper treatment become several options exist for correcting crown length discrepancies. CROWN WIDTH: An important but often overlooked aspect of maxillary anterior aesthetes is crown width, orthodontist often treat patients with disproportionate width of anterior teeth.
  88. 88. RESTORATIVE DENTISTRY CONSIDERATION Bleaching, composite resin bonding cosmetic contouring and porcelain laminate veneers used singly or various combinations provide conservative solutions or economic alternatives for numerous esthetic problems that would conventionally have required extensive crown preparation. .
  89. 89. DIRECT COMPOSITE RESIN BONDING: The main advantages of direct composite resin bonding are to obtain an immediate esthetic result and patient satisfaction in one of two office visits, conservatively and relatively low cost.
  90. 90. PORCELAIN LAMINATE VENEERS: This minimally invasive procedure results in limited pulp and periodontal involvement because tooth preparation is mostly contained to the enamel and relies on supraginigval margins.
  91. 91. Full coverage crowns Metal ceramic crows: Mechanical strength durability, simplicity and excellent esthetic potential are traditionally associated with metal ceramic restorations. To achieve a proper shade, tooth reduction may have to be invasive and result in pulp trauma or dictate elective endodontic therapy.
  92. 92. ALL CERAMIC CROWNS. For maximum predictability, all ceramic crowns are presently best suited for maxillary incisors with proper indication, in addition their mechanical properties may be enhanced with resin luting cements. E.g.: Aluminous porcelain jacket crown. Hi-ceram, Dicor, Optec H.S.P. In-ceram, Allceram Dicor, Foil crowns
  93. 93. ESTHETIC IN IMPLANT DENTISTRY . The requirements for optimizing good esthetics: . Bone quantity: This is the defining factor for deal positioning of the implant. Bone augmentation procedures: Especially on the anterior of maxilla to give adequate support for implants. Soft tissue management for esthetics: One of the most satisfactory and simple procedures performed to optimize esthetics is to guide the gingival tissue to form the interdental or interimplantar gingival papilla
  94. 94. ADVANCED MATERIAL IN DENTOFACIAL ESTHETICS: Polymer ceramic: The products in this new category of restorative materials have improved properties of previous Bis GMA, urethane, or polycarbonate based resin composite due to advances in matrix chemical bonding The other terms used to describe these products include are (1) Polymer glass ceramic (2) Ceramic optimized polymer (3) Ceromer
  95. 95. commercial products: Art glass (Heraeus Kulzer) Belle Glass HP (kerr/Sybron) Hercuilite XRVT (Kerr VSA)
  96. 96. ADVANTAGES wear is very close to that of natural teeth. Improved color stability over conventional composites is due to reduced water sorption. The moduli of elasticity are quite similar to that of dentin these materials can be bonded to enamel and dentin for excellent retention and seal. They are easily repaired intra orally than porcelain. From a laboratory perspective fabrications can be done directly an working dies shrinkage is minimal compared to porcelain
  97. 97. LASERS IN AESTHETIC DENTISTRY Two separate issues appear vital for success when performing aesthetic general dentistry, the first is achieving adequate isolation of the operative site and leaving the healthy tissue intact. The other procedures by laser gingivectomy including crown lengthening, ovate site creation, uncovering implant and taking impressions gingival sculpting and tissue management during bonding procedures. The second point for cosmetic success is the preservation of as much natural tooth structure as possible and hard tissue laser offers this conservation and structural integrity.
  98. 98. CONCLUSIONS: With changing “concepts” the perception of beauty there is an emergence of new definitions to the parameters of judging aesthetics. The changing trends in this field will reorient the art element involved in esthetic dental creations but its established scientific guidelines will always provide the sound basis for this change.
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