Esthetics / orthodontics courses in india

ESTHETICSESTHETICS
INDIAN DENTAL ACADEMYINDIAN DENTAL ACADEMY
Leader in continuing dental educationLeader in continuing dental education
www.indiandentalacademy.comwww.indiandentalacademy.com
www.indiandentalacademy.com

TABLE OF CONTENTSTABLE OF CONTENTS
 INTRODUCTIONINTRODUCTION
 HISTORYHISTORY
 ORIGIN OF ESTHETICS AND PERCEPTIONORIGIN OF ESTHETICS AND PERCEPTION
 THE SEVEN PRINCIPLES OF ESTHETICSTHE SEVEN PRINCIPLES OF ESTHETICS
 FACTORS OF ESTHETIC DENTOFACIAL COMPOSITIONFACTORS OF ESTHETIC DENTOFACIAL COMPOSITION
 FACIAL COMPONENTFACIAL COMPONENT
 DENTAL COMPONENTDENTAL COMPONENT
 GINGIVAL COMPONENTGINGIVAL COMPONENT
 PHYSICAL COMPONENTPHYSICAL COMPONENT
 COLORCOLOR
 SHADE GUIDESSHADE GUIDES
 ESTHETICS IN COMPLETE DENTUREESTHETICS IN COMPLETE DENTURE
 ESTHETICS IN REMOVABLE PARTIAL DENTUREESTHETICS IN REMOVABLE PARTIAL DENTURE
 ESTHETICS IN FIXED PARTIAL DENTUREESTHETICS IN FIXED PARTIAL DENTURE
 ESTHETICS AND IMPLANT PROSTHESISESTHETICS AND IMPLANT PROSTHESIS
 BLEACHINGBLEACHING
 SUMMARY AND CONCLUSIONSUMMARY AND CONCLUSION
 REFERENCESREFERENCES

A Thing Of Beauty Is A Joy ForeverA Thing Of Beauty Is A Joy Forever
 The science of esthetics literally means “the science ofThe science of esthetics literally means “the science of
beauty in nature and arts”beauty in nature and arts”
 Beauty in itself is a combination of reality and personalBeauty in itself is a combination of reality and personal
perception.perception.
 Thus the science of esthetics remains inexact and aThus the science of esthetics remains inexact and a
subjective domain.subjective domain.
 Beauty can be classified broadly as:-Beauty can be classified broadly as:-
Ideal beauty Human beautyIdeal beauty Human beauty
Natural beauty Abstract beautyNatural beauty Abstract beauty
The search for beauty can be traced to earliestThe search for beauty can be traced to earliest
civilization.Before attempting to identify present daycivilization.Before attempting to identify present day
concept of facial esthetics…..concept of facial esthetics…..

Hence a brief view of our esthetic heritage will be presentedHence a brief view of our esthetic heritage will be presented
herehere
 PREHISTORIC:PREHISTORIC:
The early man unfortunately had a very little time to contemplateThe early man unfortunately had a very little time to contemplate
beauty…beauty…
As early as 35,000 years ago Paleolithic man discovered that….As early as 35,000 years ago Paleolithic man discovered that….
Development of Egyptian civilization….Development of Egyptian civilization….
 THE GREEK:THE GREEK:
First culture to have expressed sensitively facial beauty-First culture to have expressed sensitively facial beauty-
philosophy and sculpture.philosophy and sculpture.
Philosophers like Plato and Aristotle-introduced “aesthetics” as thePhilosophers like Plato and Aristotle-introduced “aesthetics” as the
study of beauty and philosophy of art.study of beauty and philosophy of art.
They felt that beautiful creations respected certain geometricThey felt that beautiful creations respected certain geometric
laws..laws..
 AFTER THE GREEKS:AFTER THE GREEKS:
Esthetic heritage owes much to classical Greeks butEsthetic heritage owes much to classical Greeks but
Romans were the ones who profusely documented beauty.Romans were the ones who profusely documented beauty.

 Interest in esthetics faded out in middle age (dark age)Interest in esthetics faded out in middle age (dark age)
 Until renaissance in the 15Until renaissance in the 15thth
century..century..
 The leader of the movement to modernize and promoteThe leader of the movement to modernize and promote
dentistry wasdentistry was PIERRE FAUCHARDPIERRE FAUCHARD (1678-1761) of France(1678-1761) of France
 Introduction of mineral teeth in 1817 was followed byIntroduction of mineral teeth in 1817 was followed by
manufacture of porcelain teeth.manufacture of porcelain teeth.
Picture shows partial denture of about
1830,porcelain teeth of Fonzi’s design
have been Soldered to a gold backing.
One piece porcelain upper denture crafted by
Dr John Scarborough, Lambertville, New
Jersey 1868.

Wooden dentures, 1538,carved by a buddist priest
Carved ivory upper denture retained
in the mouth by springs with natural
human teeth cut off at the Neck and
riveted at the base

 Auroplasty , colored gutta-perchaAuroplasty , colored gutta-percha
 Parkesin , a celluloid like materialParkesin , a celluloid like material
 Cheoplasty an alloy of tin, silver and bismuthCheoplasty an alloy of tin, silver and bismuth
 Rose pearl, collodionRose pearl, collodion
 Pink hecolitePink hecolite
 Even tortoise shells were used for esthetic effect.Even tortoise shells were used for esthetic effect.
 In late 19In late 19thth
century various techniques used in fixedcentury various techniques used in fixed
prosthodontics were introduced.prosthodontics were introduced.
 By 1970’s composite resins replaced acrylic resins andBy 1970’s composite resins replaced acrylic resins and
silicate cements as permanent restorative material.silicate cements as permanent restorative material.
 Acid etching/bonding radically changed cavityAcid etching/bonding radically changed cavity
treatment by emphasizing conservation of toothtreatment by emphasizing conservation of tooth
structurestructure
 1970’s numerous veneering techniques were introduced1970’s numerous veneering techniques were introduced
A set of vulcanite dentures worn by Gen. John
J. (Blackjack) Pershing, commander of the
American Expeditionary Forces in France
during the First World War
Set of complete dentures
having palate of swaged
Gold and porcelain teeth set
in vulcanite.
Dentures made of polymethyl
methacrylate
Celluloid upper denture 1880

The Origin Of Esthetics And Its Perception:-The Origin Of Esthetics And Its Perception:-
 What is esthetics?What is esthetics?
 The Dorland English dictionary describes it as- “The science ofThe Dorland English dictionary describes it as- “The science of
beauty in nature and arts”beauty in nature and arts”
 According to GPTAccording to GPT
Esthetics 1. The branch of philosophy dealing with beautyEsthetics 1. The branch of philosophy dealing with beauty
2. In dentistry , the theory and philosophy that deal with beauty2. In dentistry , the theory and philosophy that deal with beauty
and the beautiful , especially with respect to the appearance of a dentaland the beautiful , especially with respect to the appearance of a dental
restoration , as achieved through its form or color. Those subjective andrestoration , as achieved through its form or color. Those subjective and
objective elements and principles underlying the beauty and attractivenessobjective elements and principles underlying the beauty and attractiveness
of an object , design and principleof an object , design and principle
 Beauty in nature is the mirror of essential beautyBeauty in nature is the mirror of essential beauty
essential beautyessential beauty
(vegetables) natural beauty (minerals)(vegetables) natural beauty (minerals)
human beautyhuman beauty
 This approach will permit us to aim at the development of objectiveThis approach will permit us to aim at the development of objective
criteria of beauty as well as..criteria of beauty as well as..
 This is not to say that beauty is objective…This is not to say that beauty is objective…
 Hence beauty is a combination ofHence beauty is a combination of realityreality andand perceptionperception

Perception ?Perception ?
 Is the organization of sensory dataIs the organization of sensory data
(sight,touch,hearing,taste and smell stimuli) which are(sight,touch,hearing,taste and smell stimuli) which are
brought to the intellect were an answer is developed inbrought to the intellect were an answer is developed in
combination with results of previous experiences and beliefscombination with results of previous experiences and beliefs
that are unconsciously interpreted.that are unconsciously interpreted.
 In visual perception the rods and cones bring stimuli..In visual perception the rods and cones bring stimuli..
 Scientific investigation in physiology and psychology ofScientific investigation in physiology and psychology of
perception has resulted in formulation of certain principlesperception has resulted in formulation of certain principles
or parameter of visual perception that provides basis for anor parameter of visual perception that provides basis for an
introduction to the elements of esthetics that are a part ofintroduction to the elements of esthetics that are a part of
natural and essential beauty.natural and essential beauty.

ESTHETIC PRINCIPLES:-ESTHETIC PRINCIPLES:-
COMPOSITION:COMPOSITION:
The physiologic property of eye isThe physiologic property of eye is
vision.Vision is possible if eye canvision.Vision is possible if eye can
differentiate.Which is possible only if there isdifferentiate.Which is possible only if there is
contrast.Increase in visibility is proportionalcontrast.Increase in visibility is proportional
to increase in contrast.to increase in contrast.
The relationship between object madeThe relationship between object made
visible byvisible by CONTRASTCONTRAST is calledis called Composition.Composition.
Terminologies in our field of interest areTerminologies in our field of interest are
dental,facial and dentofacial composition.dental,facial and dentofacial composition.
Dentofacial composition
Dental composition

UNITY:UNITY:
 The prime requisite of composition is unity.The prime requisite of composition is unity.
 It gives different parts of the composition the effect ofIt gives different parts of the composition the effect of
the whole.the whole.
 STATIC UNITY DYNAMIC UNITYSTATIC UNITY DYNAMIC UNITY
- composed of irregular Plants and animals- composed of irregular Plants and animals
and geometric shapesand geometric shapes
E.g drops of water,snowE.g drops of water,snow
Flake crystalsFlake crystals
- Is passive and inert Active,living and- Is passive and inert Active,living and
(without motion) growing(without motion) growing

COHESIVE FORCES SEGREGATIVE FORCESCOHESIVE FORCES SEGREGATIVE FORCES
 Elements that tend to unify Opposite of cohesive forcesElements that tend to unify Opposite of cohesive forces
a compositiona composition
 A border is a cohesive force They provide variety in unity….A border is a cohesive force They provide variety in unity….
as well as arrangement ofas well as arrangement of
elements in a definiteelements in a definite
form or according to aform or according to a
principle.principle.

 HOGARTHS line Of Beauty:HOGARTHS line Of Beauty:
 Has long been considered an outstandingHas long been considered an outstanding
example of unity with variety.example of unity with variety.
 It is a line inscribed around a cone.It is a line inscribed around a cone.
 The line is never the same at any pointThe line is never the same at any point
along its course yet it never leaves thealong its course yet it never leaves the
surface of the cone.surface of the cone.
 This is absolute unity with absolute variety.This is absolute unity with absolute variety.

SYMMETRY:SYMMETRY:
 It refers to regularity in the arrangement of form and object.It refers to regularity in the arrangement of form and object.
(Furtwangler,1964).(Furtwangler,1964).
 It is and can be totally differentiated from balance in the sense that inIt is and can be totally differentiated from balance in the sense that in
balance things that are farther from the center grow in importance andbalance things that are farther from the center grow in importance and
weight..weight..
 But in case of symmetry all the elements are alike with references toBut in case of symmetry all the elements are alike with references to
there position in relation to a central point.there position in relation to a central point.
 HORIZONTAL SYMMETRY RADIATING SYMMETRYHORIZONTAL SYMMETRY RADIATING SYMMETRY
 Occurs when a design contains is a result of design of an objectOccurs when a design contains is a result of design of an object
similar elements from left to extending from a central point andsimilar elements from left to extending from a central point and
right in a regular sequence the right and left side are mirrorright in a regular sequence the right and left side are mirror
imagesimages
 Is psychologically predictable and Represents segregating forces thatIs psychologically predictable and Represents segregating forces that
comfortable tends to be brings life and dynamism to acomfortable tends to be brings life and dynamism to a
monotonous compositionmonotonous composition
PRINCIPLE- SYMMETRY MUST BE INTRODUCED IN THE DENTOFACIALPRINCIPLE- SYMMETRY MUST BE INTRODUCED IN THE DENTOFACIAL
COMPOSITION TO CREAT A POSITIVE PHYSIOLOGIC RESPONSECOMPOSITION TO CREAT A POSITIVE PHYSIOLOGIC RESPONSE

Horizontal symmetry Radiating symmetryHorizontal symmetry Radiating symmetry

ProportionProportion ::
Dental esthetics and golden proportionDental esthetics and golden proportion (Edwin I. Levin JPD 40;3,(Edwin I. Levin JPD 40;3,
1978)1978)
 The concept of beauty has most oftenThe concept of beauty has most often
corresponded to a harmony in proportioncorresponded to a harmony in proportion
 The true value of proportion in esthetics, isThe true value of proportion in esthetics, is
its usefulness as a key tool in providing theits usefulness as a key tool in providing the
unity-with-variety quotient in dentalunity-with-variety quotient in dental
composition.composition.
 Golden proportion has been used since timeGolden proportion has been used since time
immemorial.immemorial.
 It was extensively used in Greek architectureIt was extensively used in Greek architecture
eg the Parthenon on the Acropolis of Athens.eg the Parthenon on the Acropolis of Athens.
 Kepler called it theKepler called it the “DIVINE PROPORTION”.“DIVINE PROPORTION”.
 The application of golden no. to dentistry wasThe application of golden no. to dentistry was
first mentioned byfirst mentioned by LOMBARDI(1973)LOMBARDI(1973) andand
developed bydeveloped by LEVIN(1978)LEVIN(1978)..
Parthenon
Square of the ancients
Leonardo da Vinci

 Proportion between teethProportion between teeth
 In its simplest form it is the proportion between the larger partIn its simplest form it is the proportion between the larger part
and smaller part.and smaller part.
 When ratio between B and A is in the golden proportion, then B isWhen ratio between B and A is in the golden proportion, then B is
1.618 times larger than A.1.618 times larger than A.
0.618 1
A B
1

The grid has proved very usefulThe grid has proved very useful
in prosthodontics in detectingin prosthodontics in detecting
what is wrong estheticallywhat is wrong esthetically
when the eye cannot.when the eye cannot.
The number in the solid circleThe number in the solid circle
refers to the width of the centralrefers to the width of the central
incisor. There are 7 grids to acceptincisor. There are 7 grids to accept
all widths of central incisor from 7all widths of central incisor from 7
to 10 mms in steps of 1/2 mm. Theto 10 mms in steps of 1/2 mm. The
grid also shows a number in a dotedgrid also shows a number in a doted
circle which refers to thecircle which refers to the width ofwidth of
the smilethe smile
Golden proportion calipers(1954),
they always open to a constant
golden proportion between the
larger and smaller part
Proportion between teeth and smile

BALANCE:-BALANCE:-
 It can be defined as the stabilization resulting fromIt can be defined as the stabilization resulting from
exact adjustment of opposing forces.exact adjustment of opposing forces.
 Our visual sense is used to maintain or induceOur visual sense is used to maintain or induce
equilibrium-if not established leads to visual tension.equilibrium-if not established leads to visual tension.
 To relieve tension or to reestablish balance 2 possibilitiesTo relieve tension or to reestablish balance 2 possibilities
are left to the operator /viewer:-are left to the operator /viewer:-
1)1) move the causative element towards the line of forcemove the causative element towards the line of force
until the magnitude of visual tension is totally relieved.until the magnitude of visual tension is totally relieved.
2)2) introduce an opposite element in the line of force tointroduce an opposite element in the line of force to
promote equilibriumpromote equilibrium

LINES:-LINES:-
It has been stated that many factorsIt has been stated that many factors
that have been a part of structural orthat have been a part of structural or
biologic beauty depends on visualization ofbiologic beauty depends on visualization of
lines.lines.
Parallel lines are most harmonious as they doParallel lines are most harmonious as they do
not exhibit conflictnot exhibit conflict
Perpendicular suggest psychologicalPerpendicular suggest psychological
relationship and strong segregative forcesrelationship and strong segregative forces
Various lines exists in dentalVarious lines exists in dental
composition:composition:
 occlusal planeocclusal plane
 incisal planeincisal plane
 midlinemidline
 tooth directiontooth direction www.indiandentalacademy.com

DOMINANCE:-DOMINANCE:-
 Just as unity is the prime requisite for a good composition,Just as unity is the prime requisite for a good composition,
dominance is prime requisite for providing unitydominance is prime requisite for providing unity
 dominance providesdominance provides
static unity dynamic unitystatic unity dynamic unity
( monotonous) (vigorous)( monotonous) (vigorous)
 Color,shape and lines are characters that create dominance.e.g..theColor,shape and lines are characters that create dominance.e.g..the
central incisor must be the most dominant element in the dentalcentral incisor must be the most dominant element in the dental
composition.Achieved by….composition.Achieved by….
 TheThe mouthmouth is the dominant feature of the face.It dominates byis the dominant feature of the face.It dominates by
virtue of its size,mobility and psychic association.virtue of its size,mobility and psychic association.
 TheThe amount of dominanceamount of dominance to be given to the mouth by the dentalto be given to the mouth by the dental
compositioncomposition depends on patients personality and strength ofdepends on patients personality and strength of
background facial featuresbackground facial features

FACTORS OF ESTHETIC DENTOFACIALFACTORS OF ESTHETIC DENTOFACIAL
COMPOSITION AND THEiR CLINICALCOMPOSITION AND THEiR CLINICAL
SIGNIFICANCESIGNIFICANCE:-:-
 An organized systematic approach is required toAn organized systematic approach is required to
evaluate,diagnose and resolve esthetic problems.evaluate,diagnose and resolve esthetic problems.
 Two main aims of esthetic treatment:-Two main aims of esthetic treatment:-
1) create teeth in harmonious proportion to one another1) create teeth in harmonious proportion to one another
2) to create a pleasing teeth arrangement in harmony2) to create a pleasing teeth arrangement in harmony
with the lips, gingiva and face of the patient.with the lips, gingiva and face of the patient.
 These factors may be applied to or in treating bothThese factors may be applied to or in treating both
edentulous and dentulous patients.edentulous and dentulous patients.
 The various components of dentofacial complex are:The various components of dentofacial complex are:
 FACIAL COMPONENTFACIAL COMPONENT
 DENTAL COMPONENTDENTAL COMPONENT
 GINGIVAL COMPONENTGINGIVAL COMPONENT
 PHYSICAL COMPONENTPHYSICAL COMPONENT

Facial ComponentFacial Component
 The esthetic orientation of dental composition with the entireThe esthetic orientation of dental composition with the entire
facial composition can be achieved by taking into considerationfacial composition can be achieved by taking into consideration
the references.the references.
 References:References:
 An artist in his creation of facial form makes use ofAn artist in his creation of facial form makes use of
established guidelines….established guidelines….
 The dentist as an artist also has to consider a number ofThe dentist as an artist also has to consider a number of
established guidelines and make use of available referencesestablished guidelines and make use of available references
to orient his creation.to orient his creation.
 The references can be classified as:The references can be classified as:
 HorizontalHorizontal
 VerticalVertical
 Sagittal andSagittal and
 PhoneticPhonetic

Horizontal referencesHorizontal references
 Horizontal perspective of face is provided by:Horizontal perspective of face is provided by:
1) Interpupillary line – Helps to evaluate orientation of:1) Interpupillary line – Helps to evaluate orientation of:
 Incisal planeIncisal plane
 Gingival margin andGingival margin and
 MaxillaMaxilla
2)2) Commissural lineCommissural line
3) Occlusal line3) Occlusal line
Vertical ReferencesVertical References
 Facial midline serves to evaluate location and axis of the dental midlineFacial midline serves to evaluate location and axis of the dental midline
and mesiolateral discrepancies in tooth position.and mesiolateral discrepancies in tooth position.
 The interpupillary line and facial midline emphasize ‘T-effect’ in aThe interpupillary line and facial midline emphasize ‘T-effect’ in a
pleasing smile.pleasing smile.
 Axial inclination – Is the direction of the anterior teeth in relation toAxial inclination – Is the direction of the anterior teeth in relation to
the central midline. All anterior teeth have a definite mesial inclination.the central midline. All anterior teeth have a definite mesial inclination.
Deviation beyond the point of equilibrium can cause visual tension.Deviation beyond the point of equilibrium can cause visual tension.

Axial inclination
Horizontal andHorizontal and
vertical referencesvertical references

 Sagittal reference:Sagittal reference:
 Soft tissue analysis at standardized positionSoft tissue analysis at standardized position
helps in studying the profile of an individual.helps in studying the profile of an individual.
 The contour of the upper and the lower lip.The contour of the upper and the lower lip.
 Lip support.Lip support.
 Lip protrusion.Lip protrusion.
 Amount of prominence of chin.Amount of prominence of chin.
 Recession or prominence of nose and its degree.Recession or prominence of nose and its degree.
All help in diagnosis and treatment planning.All help in diagnosis and treatment planning.
 E-line or esthetic line(Ricketts,1957)E-line or esthetic line(Ricketts,1957) – imaginary line– imaginary line
connecting the tip of the nose to the most prominentconnecting the tip of the nose to the most prominent
portion of the chin on the profile.portion of the chin on the profile.
 Ideally upper lip is 1-2mm behind the lower lip andIdeally upper lip is 1-2mm behind the lower lip and
lower lip is 2-3mm behind the E-line.lower lip is 2-3mm behind the E-line.

 Phonetic reference:Phonetic reference:
 Phonetic plays a part in determining maxillary central incisorPhonetic plays a part in determining maxillary central incisor
design and position.design and position.
 ‘‘F’ and ‘V’s sounds.F’ and ‘V’s sounds.
 ‘‘M’ sounds.M’ sounds.
 ‘‘S’ & ‘Z’ sounds.S’ & ‘Z’ sounds.
E-lineE-line

 Facial features:Facial features:
 Presence of grooves perpendicular toPresence of grooves perpendicular to
direction of pull of the muscles is adirection of pull of the muscles is a
constant of facial anatomic features.constant of facial anatomic features.
 Three important Facial grooves-Three important Facial grooves-
 Nasolabial groove.Nasolabial groove.
 Labial groove.Labial groove.
 Mento-labial groove.Mento-labial groove.
 Tooth visibility:Tooth visibility:
 Vij & Brundo in 1972Vij & Brundo in 1972 made an interesting studymade an interesting study
related to tooth exposure according to gender,related to tooth exposure according to gender,
racial factors, age and lip length showsracial factors, age and lip length shows
extreme variability of factors.extreme variability of factors.
1. Tooth exposure according to1. Tooth exposure according to gendergender appears toappears to
be significantly important for females than forbe significantly important for females than for
males.males.
 Exposure in males 1.91mm.Exposure in males 1.91mm.
 Exposure in females 3.40mm (of maxillaryExposure in females 3.40mm (of maxillary
central incisors).central incisors).

2.2. Race-Race-tooth exposure shows an increase fromtooth exposure shows an increase from
Blacks-Asians-Whites in maxillary central incisorsBlacks-Asians-Whites in maxillary central incisors
and from Asians-Blacks-Whites for mandibularand from Asians-Blacks-Whites for mandibular
central incisors.central incisors.
3.3. Liplength-Liplength-people with short upper lip exposepeople with short upper lip expose
maxillary central incisors, whereas people with longmaxillary central incisors, whereas people with long
upper lip expose mandibular central incisors.upper lip expose mandibular central incisors.
4.4. With ageWith age there is significant decrease in maxillarythere is significant decrease in maxillary
tooth length exposure.tooth length exposure.

 Components of smile:Components of smile:
A pleasant smile is an expression of joy.A pleasant smile is an expression of joy.
 The anatomy of smile(Matthews.T.G,JPD1978; 39:128-134)The anatomy of smile(Matthews.T.G,JPD1978; 39:128-134)
smile expresses it self in oral region and eyes.smile expresses it self in oral region and eyes.
Oral region-upper/lower lip -corner of mouth -anterior portion ofOral region-upper/lower lip -corner of mouth -anterior portion of
cheekcheek
-nasolabial groove -pthiltrum -red zone of lips-nasolabial groove -pthiltrum -red zone of lips
 The relationship exists between teeth and lips during smileThe relationship exists between teeth and lips during smile
and its harmonious integration in facial composition.and its harmonious integration in facial composition.
 The smile can be classified as:The smile can be classified as:
PassivePassive ActiveActive LaughLaugh
Slight parting of theSlight parting of the
lips showing incisallips showing incisal
portion of theportion of the
anterior teethanterior teeth
Shows more teeth,Shows more teeth,
some gingiva andsome gingiva and
negative space withnegative space with
lips slightly stretchedlips slightly stretched
at the cornerat the corner
Maximum exposure ofMaximum exposure of
teeth and gums in anteeth and gums in an
enlarged smile windowenlarged smile window

Lip Lines:Lip Lines:
 The amount of tooth exposure during smileThe amount of tooth exposure during smile
depends on variety of factors…depends on variety of factors…
 Upper lip lineUpper lip line helps to evaluatehelps to evaluate
maxillary incisors exposed at rest andmaxillary incisors exposed at rest and
during smile and a vertical position ofduring smile and a vertical position of
the gingival margins during the smile.the gingival margins during the smile.
 Classified as:Classified as:
 Low, moderate and high.Low, moderate and high.
 Smile can be “Toothy” or “gummy”.Smile can be “Toothy” or “gummy”.
 Lower lip linesLower lip lines helps to evaluatehelps to evaluate
buccolingual position of the incisalbuccolingual position of the incisal
edges of the maxillary incisors andedges of the maxillary incisors and
curvature of the incisal plane.curvature of the incisal plane.
Smile line:Smile line: hypothetical curved linehypothetical curved line
drawn along the edges of the fourdrawn along the edges of the four
anterior maxillary teeth.anterior maxillary teeth.
 the degree of curvature of the incisalthe degree of curvature of the incisal
line is more pronounced for women thanline is more pronounced for women than
men.men.
Feminine type of smile lineFeminine type of smile line
Masculine type of smile lineMasculine type of smile line
Gummy smileGummy smile

Moderate lip line
High lip line
Low lip line
Preoperative
Postoperativewww.indiandentalacademy.com

 The incisal plane is said to have “Gull-wing”The incisal plane is said to have “Gull-wing”
appearance.appearance.
 A straight smile line is associated withA straight smile line is associated with
wear and aging.wear and aging.
 Upper lip curvature:Upper lip curvature:
 Is expected to run upward from theIs expected to run upward from the
central position to the corner of thecentral position to the corner of the
mouth depending on the sequence andmouth depending on the sequence and
degree of implication of facial muscles indegree of implication of facial muscles in
the development of a smile.the development of a smile.
 Negative Space:Negative Space:
 Dark spaces that appear between theDark spaces that appear between the
jaws, at the corner of the mouth orjaws, at the corner of the mouth or
around the facial surfaces of thearound the facial surfaces of the
posterior teeth during laughter and mouthposterior teeth during laughter and mouth
opening.opening.
 Lateral negative space.Lateral negative space.
 Buccal negative space.Buccal negative space.
Lateral negative space ( givesLateral negative space ( gives
depth and mystery to the smile)depth and mystery to the smile)
Absence of negative spaceAbsence of negative spacewww.indiandentalacademy.com

 Smile symmetry:Smile symmetry:
 Refers to the relative symmetric placement of theRefers to the relative symmetric placement of the
corner of the mouth in the vertical plane.corner of the mouth in the vertical plane.
 Perception of facial composition shows progressivePerception of facial composition shows progressive
importance of parallelism of lines that must existsimportance of parallelism of lines that must exists
between the commissural and the occlusal line.between the commissural and the occlusal line.
 The esthetic evaluation of the smile symmetryThe esthetic evaluation of the smile symmetry
relies on unconscious perception of involvedrelies on unconscious perception of involved
crossing joints.crossing joints.

 Smile dominance:Smile dominance:
 In certain cases the most predominantlyIn certain cases the most predominantly
striking feature of the face is the smile,striking feature of the face is the smile,
these are “dominant smiles”:these are “dominant smiles”:
 Guidelines for pleasant smile dominanceGuidelines for pleasant smile dominance
are:are:
 Dominance of the central element.Dominance of the central element.
 Complimentary subsequent elements.Complimentary subsequent elements.
 Pleasing relative proportions.Pleasing relative proportions.
 Order in composition.Order in composition.
 Dynamism of smile.Dynamism of smile.
 Centralized element of unity.Centralized element of unity.

Dental components:Dental components:
 Facial midline is located in theFacial midline is located in the
center of the face pependicular tocenter of the face pependicular to
the interpupillary line.the interpupillary line.
 It has been defined as vertical lineIt has been defined as vertical line
drawn through the forehead, nosedrawn through the forehead, nose
columella, dental midline and chin.columella, dental midline and chin.
 Heartwell – defines it as anHeartwell – defines it as an
imaginary vertical lines that doesimaginary vertical lines that does
not necessarily coincide with facialnot necessarily coincide with facial
midline.midline.
 In a research conducted byIn a research conducted by
Bodden,Miller and Jamison (1979) itBodden,Miller and Jamison (1979) it
was statistically demonstratedwas statistically demonstrated
that..that..

 Tooth proportion:Tooth proportion:
 Tooth proportion is computed by:Tooth proportion is computed by:
1) Width of clinical crown1) Width of clinical crown
Length of the clinical crownLength of the clinical crown
Ideally, 75-80% for maxillary central incisors.Ideally, 75-80% for maxillary central incisors.
= 65% too narrow e.g. implant crowns or after= 65% too narrow e.g. implant crowns or after
periosurgery.periosurgery.
= 85% too wide by attrition.= 85% too wide by attrition.
2) Average of width by length ratio –2) Average of width by length ratio –
Wheelers 0.74 to 0.89 = 0.8Wheelers 0.74 to 0.89 = 0.8
3) Proportion determined by face form – various3) Proportion determined by face form – various
theories have been proposed.theories have been proposed.
Leon Williams described tooth form into square,Leon Williams described tooth form into square,
tapering and ovoid depending on the face forms.tapering and ovoid depending on the face forms.

 Berry postulated :Berry postulated :
 mesiodistal width of toothmesiodistal width of tooth = 1/16= 1/16thth
bizygomatic width.bizygomatic width.
= 1/20= 1/20thth
length of facelength of face
 The geometric theory was challenged by Frush and FisherThe geometric theory was challenged by Frush and Fisher
(1956). They introduced(1956). They introduced “Dentogenic theory”“Dentogenic theory” in which thein which the
tooth selection is governed by – Sex, Personality and Age.tooth selection is governed by – Sex, Personality and Age.
4) Golden proportion:4) Golden proportion:
 This implied that maxillary central incisors –This implied that maxillary central incisors –
approximately 60% wider than lateral incisorsapproximately 60% wider than lateral incisors
 Lateral incisors – 60% wider than mesial aspect ofLateral incisors – 60% wider than mesial aspect of
the canine.the canine.
 Lateral negative space also in golden proportion toLateral negative space also in golden proportion to
half the width of the anterior segment.half the width of the anterior segment.

SYMMETRY:SYMMETRY:
 A dental symmetry relates to the right and left of the midline.A dental symmetry relates to the right and left of the midline.
 Goal is to strike a pleasing balance between ideal and the deviation.Goal is to strike a pleasing balance between ideal and the deviation.
Axial inclination:Axial inclination:
 Is the direction of the teeth with respect to the central midline.Is the direction of the teeth with respect to the central midline.
 There is a definite mesial inclination of all anterior teeth as well as theThere is a definite mesial inclination of all anterior teeth as well as the
premolars and the first molars.premolars and the first molars.
Tooth arrangement:Tooth arrangement:
 Anterior teeth helps in achieving lip and associated muscle support, enables theAnterior teeth helps in achieving lip and associated muscle support, enables the
fulfillment of esthetics, phonetics and function requirement.fulfillment of esthetics, phonetics and function requirement.
 Tooth placement is usually obtained by 3 different methods – empirical,Tooth placement is usually obtained by 3 different methods – empirical,
phonetic, and according to anatomic landmarks.phonetic, and according to anatomic landmarks.
 Phonetic method has proved to be important means in determining the verticalPhonetic method has proved to be important means in determining the vertical
dimension.dimension.

 Use of anatomic landmarks:Use of anatomic landmarks:
 Canine papilla canine line (CPC) – lineCanine papilla canine line (CPC) – line
drawn from the tip of the caninedrawn from the tip of the canine
invariably bisects the middle of theinvariably bisects the middle of the
incisive papilla in 92% of the casesincisive papilla in 92% of the cases
(Schiffman, 1984). The distance from(Schiffman, 1984). The distance from
the line to the outer labial surface ofthe line to the outer labial surface of
the central incisor is 10.2mm.the central incisor is 10.2mm.
 Ortman et al,1979 – posterior borderOrtman et al,1979 – posterior border
of incisive papilla is at an averageof incisive papilla is at an average
distance of 12.48mm to the labialdistance of 12.48mm to the labial
surface of the maxillary centralsurface of the maxillary central
incisors.incisors.
 Distance between base of the sulcus toDistance between base of the sulcus to
the tip of maxillary incisors = 22mmthe tip of maxillary incisors = 22mm
(Turbyfill W.F., Dourdakin J 1989).(Turbyfill W.F., Dourdakin J 1989).

 Arch form:Arch form:
 Square, Ovoid andSquare, Ovoid and
Tapering.Tapering.
 The harmoniousThe harmonious
interrelationshipinterrelationship
between the shape ofbetween the shape of
the arch, dental archthe arch, dental arch
form and teethform and teeth
(Nelson triad) has(Nelson triad) has
been used by manybeen used by many
prosthodontists.prosthodontists.

 GRADATION:GRADATION:
 The two similar structures are placed atThe two similar structures are placed at
different distances from the viewer the closestdifferent distances from the viewer the closest
will appear the largest.will appear the largest.
 The front-back phenomenon is determined byThe front-back phenomenon is determined by
the arch form and the key tooth mostthe arch form and the key tooth most
frequently the canine or the first premolar isfrequently the canine or the first premolar is
the prerequisite for insuring the visualization ofthe prerequisite for insuring the visualization of
the gradation.the gradation.
DENTAL MORPHOLOGY –DENTAL MORPHOLOGY –
1.Texture-1.Texture-
The characterization of the tooth surface is aThe characterization of the tooth surface is a
function of two types of convexities and concavities.function of two types of convexities and concavities.
-Anatomy grooves, facets, prominences that exists-Anatomy grooves, facets, prominences that exists
in various degrees.in various degrees.
-The perikymata, stippling and rippling that may-The perikymata, stippling and rippling that may
affect the enamel surface.affect the enamel surface.
2. Shape of the tooth –2. Shape of the tooth –
- average tooth outline – square, ovoid, tapering and- average tooth outline – square, ovoid, tapering and
mixed (Proposed by Leon Williams 1914).mixed (Proposed by Leon Williams 1914).
3. Mesiodistal width –3. Mesiodistal width –
This dimension is much more critical dimension thanThis dimension is much more critical dimension than
inciso-gingival length for anterior tooth placement.inciso-gingival length for anterior tooth placement.

4. Incisogingival height:4. Incisogingival height:
 The incisal edge of the maxillary central incisor is an importantThe incisal edge of the maxillary central incisor is an important
determinant in creation of a smile.determinant in creation of a smile.
 It serves to determine the proper tooth proportion and gingival level.It serves to determine the proper tooth proportion and gingival level.
 Elongation of the incisal edge indicated in –Elongation of the incisal edge indicated in –
 Incisal wear.Incisal wear.
 Inadequate tooth display orInadequate tooth display or
 Displeasing tooth or crown proportion.Displeasing tooth or crown proportion.
 Shortening of the incisal edge may be require:Shortening of the incisal edge may be require:
 To correct excessive tooth display.To correct excessive tooth display.
 Displeasing tooth or crown portion orDispleasing tooth or crown portion or
 To compensate for unesthetic elongation created by periodontalTo compensate for unesthetic elongation created by periodontal
recession.recession.
 Position of the incisal edge acts as the parameter upon which rest of thePosition of the incisal edge acts as the parameter upon which rest of the
treatment is built.treatment is built.
 AGE, GENDER & LENGTH & CURVATURE OF THE UPPER LIP WILLAGE, GENDER & LENGTH & CURVATURE OF THE UPPER LIP WILL
DETERMINE THE INCISO-GINGIVAL LENGTHDETERMINE THE INCISO-GINGIVAL LENGTH
 Average anatomic crown length for maxillary central incisors – 10.4 – 11.2mm.Average anatomic crown length for maxillary central incisors – 10.4 – 11.2mm.

 The clinician should not base theThe clinician should not base the
decision solely on esthetic factors butdecision solely on esthetic factors but
also on the relation of the incisal edgealso on the relation of the incisal edge
to the anterior guidance and phonetics.to the anterior guidance and phonetics.

Zenith Point:Zenith Point:
 Zenith points are the most apical point of the clinical crowns, which are theZenith points are the most apical point of the clinical crowns, which are the
height of contour. There position are dictated by:height of contour. There position are dictated by:
 Root form anatomy.Root form anatomy.
 CEJ.CEJ.
 Osseous crest, where gingiva is scalloped the most.Osseous crest, where gingiva is scalloped the most.
 They are generally located just distal to a line drawn vertically through theThey are generally located just distal to a line drawn vertically through the
middle of each anterior toothmiddle of each anterior tooth
 ..
 The lateral incisors are one exception as their zenith point are placed moreThe lateral incisors are one exception as their zenith point are placed more
centrally or on the midline of the tooth.centrally or on the midline of the tooth.
 Importance of zenith point –Importance of zenith point – when closing diastemas or changing the mesialwhen closing diastemas or changing the mesial
or distal tilt position of the tooth.or distal tilt position of the tooth.
(These are e.g. of moving zenith points horizontally)(These are e.g. of moving zenith points horizontally)
 In cases where teeth needs to be shown longer or more taper at theIn cases where teeth needs to be shown longer or more taper at the
gingival 1/3gingival 1/3rdrd
Zenith point can be moved apicallyZenith point can be moved apically
 Therefore, zenith point can enhance:Therefore, zenith point can enhance:
1.1. Perception of tooth axis.Perception of tooth axis.
2.2. Length.Length. By horizontal & verticalBy horizontal & vertical
3.3. Gingival shapes.Gingival shapes. AlterationsAlterationswww.indiandentalacademy.com

Diastema closure
Zenith point moved
more horizontally
Short teeth made
to appear longer by
Moving the zenith
point apically

 Contact Points (ICP) & InterdentalContact Points (ICP) & Interdental
contact areas (ICA):contact areas (ICA):
 A broad zone in which two adjacent teethA broad zone in which two adjacent teeth
appear to touch –appear to touch – Interdental contactInterdental contact
area.area.
 TheThe 50-40-30 rule (Morley JA, 2000)50-40-30 rule (Morley JA, 2000)
indicating relationship between anteriorindicating relationship between anterior
teeth applies to 50% of the length ofteeth applies to 50% of the length of
maxillary central incisors and is definedmaxillary central incisors and is defined
asas ideal connector zoneideal connector zone. This needs that. This needs that
40% of the length of central incisors is40% of the length of central incisors is
the ideal connector zone betweenthe ideal connector zone between
maxillary lateral and central incisors andmaxillary lateral and central incisors and
is 30% between laterals and canines.is 30% between laterals and canines.
 The most incisal aspect of the contactThe most incisal aspect of the contact
area is called asarea is called as Contact point.Contact point. After thisAfter this
point, the two adjacent tooth divergespoint, the two adjacent tooth diverges
and mesiodistal contact turns to incisaland mesiodistal contact turns to incisal
edge.edge.
 Line drawn to the anterior contact pointsLine drawn to the anterior contact points
reinforces the curve of the incisal linereinforces the curve of the incisal line
and the lower lip line (provides cohesiveand the lower lip line (provides cohesive
forces to the dentofacial composition andforces to the dentofacial composition and
the degree of curvature introducesthe degree of curvature introduces
segregative forces in the composition).segregative forces in the composition).
50-40-30 rule Contact points
Interdental contact areas

Embrasures /Embrasures /
Interdental spaces:Interdental spaces:
 The conical portion of theThe conical portion of the
contact area, thecontact area, the
interproximal wall of theinterproximal wall of the
adjacent teeth and theadjacent teeth and the
interdental papilla formedinterdental papilla formed
the interdental embrasure.the interdental embrasure.
 As the dentition progressesAs the dentition progresses
away from the midline, theaway from the midline, the
size and volume of incisalsize and volume of incisal
embrasure increases.embrasure increases.
 Incisal embrasure betweenIncisal embrasure between
CI is smallest in area andCI is smallest in area and
shortest in angle.shortest in angle.

GINGIVAL COMPONENTGINGIVAL COMPONENT
 The gingiva begins at theThe gingiva begins at the
mucogingival junction and finishes atmucogingival junction and finishes at
the tooth collar. It is divided intothe tooth collar. It is divided into
free and attached gingiva.free and attached gingiva.
 Free gingiva is divided into –Free gingiva is divided into –
marginal & interdental gingiva.marginal & interdental gingiva.
 Gingival contour:Gingival contour:
 The normality of the gingival contourThe normality of the gingival contour
is judged according to 4 subsidiaryis judged according to 4 subsidiary
factors.factors.
1.1. Embrasures.Embrasures.
2.2. Gingival zenith.Gingival zenith.
3.3. Gingival height – Class I & Class II.Gingival height – Class I & Class II.
4.4. Gingival symmetryGingival symmetry
A gingival symmetry of CI requiresA gingival symmetry of CI requires
special attention. Gingival symmetryspecial attention. Gingival symmetry
between LI and canine is notbetween LI and canine is not
mandatory.mandatory.

Dento-gingival unit & Biologic widthDento-gingival unit & Biologic width
 Unique anatomic feature concerned with attachment of gingiva to theUnique anatomic feature concerned with attachment of gingiva to the
tooth.tooth.
EpithelialEpithelial
compartmentcompartment
Gingival epitheliumGingival epithelium
Sulcular epithelium –Sulcular epithelium –
sulcus depth (avg.sulcus depth (avg.
0.69mm)0.69mm)
Junctional epitheliumJunctional epithelium
– 0.97mm– 0.97mm
Connective tissueConnective tissue
compartmentcompartment
Represents fibrousRepresents fibrous
attachment of the gingivaattachment of the gingiva
to the hard tissue wall andto the hard tissue wall and
support to the epitheliumsupport to the epithelium
of the dentogingivalof the dentogingival
junction.junction.
DeterminedDetermined
in a study byin a study by
Garginlo et alGarginlo et al
(1961)(1961)

 InIn 1962 Cohen1962 Cohen defineddefined BiologicBiologic
WidthWidth of supracrestal gingivalof supracrestal gingival
tissue as those junctionaltissue as those junctional
epithelium and connective tissueepithelium and connective tissue
elements of dentogingival unit thatelements of dentogingival unit that
occupy the space between the baseoccupy the space between the base
of the gingival crevice and theof the gingival crevice and the
alveolar crest. The total dimensionalveolar crest. The total dimension
would be 2.04mm.would be 2.04mm.
 By Nevin & Skurov –By Nevin & Skurov –
Biologic width = supracrestal fibersBiologic width = supracrestal fibers
+ junctional epithelium + gingival+ junctional epithelium + gingival
sulcus.sulcus.
 It was better termed asIt was better termed as biologicbiologic
zonezone by Kois = 3mm in health normalby Kois = 3mm in health normal
gingivalgingival

Physical ComponentsPhysical Components
 The art of creating illusion consists of changingThe art of creating illusion consists of changing
perception to cause an object to appear differentperception to cause an object to appear different
from what it actually is. The use of optical conceptsfrom what it actually is. The use of optical concepts
to create optical illusion may be best way to solve orto create optical illusion may be best way to solve or
hide an esthetically difficult situation.hide an esthetically difficult situation.
 The tooth may be made to appear smaller, larger,The tooth may be made to appear smaller, larger,
wider, narrower, shorter, longer, younger, older,wider, narrower, shorter, longer, younger, older,
masculine or feminine.masculine or feminine.

 PRINCIPLES OF ILLUSION:PRINCIPLES OF ILLUSION:
1.1. Principle of illumination –Principle of illumination –
shadows create depth and light createsshadows create depth and light creates
prominence.prominence.
 Unidirectional artificial light throws noUnidirectional artificial light throws no
shadow therefore displays only length andshadow therefore displays only length and
width.width.
 Multidirectional light throws shadowsMultidirectional light throws shadows
promoting a feeling of depth.promoting a feeling of depth.
2. Principle of line –2. Principle of line –
Vertical lines accentuates length andVertical lines accentuates length and
horizontal lines accentuates width.horizontal lines accentuates width.
 This can be brought about by –This can be brought about by –
Tooth ContouringTooth Contouring andand Color ManipulationColor Manipulation..
Limited to angles,
natural grooves and
prominences, incisal
and gingival lines and
incisal edges.
Is best applied in there
natural location-gingival
inclines, interdental
areas and selected
tooth surfaceswww.indiandentalacademy.com

ColourColour
“An age is called dark, not because light fails to shine, but because“An age is called dark, not because light fails to shine, but because
people refuse to see it”people refuse to see it”
- James Michener- James Michener
 THE PHYSICAL SPECIFICATIONS OF OBJECT COLORTHE PHYSICAL SPECIFICATIONS OF OBJECT COLOR
 Light is a form of radiant energy consisting of electromagneticsLight is a form of radiant energy consisting of electromagnetics
waves including UV, visible & IR lightwaves including UV, visible & IR light
 When the light strikes an object, a range of possible interactions areWhen the light strikes an object, a range of possible interactions are
seen.seen.
1.1. Reflection –Reflection – 2 types – diffused reflection and regular reflection.2 types – diffused reflection and regular reflection.
2.2. Refraction –Refraction – is bending of light waves as they pass from oneis bending of light waves as they pass from one
medium to another.medium to another.
3.3. Deflection –Deflection – is the reflection of light from a surface in directionis the reflection of light from a surface in direction
different from the entry of light.different from the entry of light.
4.4. Absorption –Absorption – is phenomenon in which light is absorbed fully oris phenomenon in which light is absorbed fully or
partially by the object.partially by the object.
5.5. Scattering –Scattering – is the random deflection of light rays by fineis the random deflection of light rays by fine
particles.particles.
6.6. Translucency –Translucency – is transmission and diffusion of light through anis transmission and diffusion of light through an
object so that definite image beyond the object cannot be seen.object so that definite image beyond the object cannot be seen.
Enamel more translucent than dentin.Enamel more translucent than dentin.

7.7. Transparent –Transparent – is the qualityis the quality
of an object by which lightof an object by which light
passes entirely through it.passes entirely through it.
8.8. Opacity –Opacity – quality of anquality of an
object by which it absorbsobject by which it absorbs
or completely reflects allor completely reflects all
the light on its surface.the light on its surface.
9.9. Fluorescence –Fluorescence – is theis the
capacity of an object to emitcapacity of an object to emit
light waves after absorptionlight waves after absorption
of light.of light.
10.10. Gloss –Gloss – is an optical propertyis an optical property
associated with smoothassociated with smooth
surface that producessurface that produces
lustrous surface appearancelustrous surface appearance
and thus increases theand thus increases the
effects of color difference.effects of color difference.
11.11. MetamerismMetamerism – is phenomena– is phenomena
in which the color of anin which the color of an
object exposed to twoobject exposed to two
different light sourcesdifferent light sources
appears different underappears different under
each conditions.each conditions.
Shade viewed under
different lighting
conditions
Under fluorescent
light
Under incandescent
light

Dimensions of color:Dimensions of color:

HUE, CHROMA, VALUE & TRANSLUCENCYHUE, CHROMA, VALUE & TRANSLUCENCY
1) HUE1) HUE ––
Is simply the colour tone i.e.Is simply the colour tone i.e. RED, BLUERED, BLUE, YELLOW etc., YELLOW etc.
The term is synonymous with the term colour but is notThe term is synonymous with the term colour but is not
colour itself.colour itself.
 In Munsells words “it is that quality by which weIn Munsells words “it is that quality by which we
distinguish one color family by another”.distinguish one color family by another”.
 Six Hue families V, B, G, Y, O, R e.g.Six Hue families V, B, G, Y, O, R e.g.
 Vita shape guide has a 4 hues.Vita shape guide has a 4 hues.
 A – Reddish brown.A – Reddish brown.
 B- Red yellow.B- Red yellow.
 C- Grey.C- Grey.
 D – Reddish grey.D – Reddish grey.
2) CHROMA2) CHROMA ––
Is intensity or saturation of color tone (Hue) i.e.Is intensity or saturation of color tone (Hue) i.e.
light blue or dark blue.light blue or dark blue.
 In Munsells words- “it is the quality by which weIn Munsells words- “it is the quality by which we
distinguish a strong color from a weak one”.distinguish a strong color from a weak one”.
 Human teeth fall into yellow to yellow-red area ofHuman teeth fall into yellow to yellow-red area of
Munsell colour order system.Munsell colour order system.
 E.g. In HUE A of Vita shaped guide A1- lowestE.g. In HUE A of Vita shaped guide A1- lowest
chroma, A4 – Highest chroma.chroma, A4 – Highest chroma.

33) VALUE (BRILLIANCE)) VALUE (BRILLIANCE)::
Is the relative lightness (brightness) or darkness of theIs the relative lightness (brightness) or darkness of the
hue.hue.
 On a scale of black-whiteOn a scale of black-white
 High value = white &High value = white &
 Low value = darkLow value = dark
 Midway between white & black is medium grey.Midway between white & black is medium grey.
 Value is the only dimension of color that can exist byValue is the only dimension of color that can exist by
itself.itself.
 E.g. Hue A of Vita shadeE.g. Hue A of Vita shade
A1-brightest; A4- darkestA1-brightest; A4- darkest
4) TRANSLUCENCY:4) TRANSLUCENCY:
Is a 3-D representation of value.Is a 3-D representation of value.
 It is best represented by value differences. HighlyIt is best represented by value differences. Highly
translucent teeth tend to be lower in value…..translucent teeth tend to be lower in value…..
 Translucency and value are most important parameters inTranslucency and value are most important parameters in
shade selection.shade selection.
 Value differences are easy to identify since they areValue differences are easy to identify since they are
more rods than cones in the anatomy of human eye.more rods than cones in the anatomy of human eye.
 Chroma = 1 / valueChroma = 1 / value ChromaChroma ↑↑ - value- value ↓↓
 E.g. A4 has high chroma and low value shade.E.g. A4 has high chroma and low value shade.
 A1 has low chroma and high value shade.A1 has low chroma and high value shade.

 SPECTAL COLOURS:SPECTAL COLOURS:
 Light passing through a prism is refractedLight passing through a prism is refracted
(Sir. Issac Newton 1676) and light energy is(Sir. Issac Newton 1676) and light energy is
dispersed into various wavelength of whitedispersed into various wavelength of white
light.light.
 Acronym – VIBGYOR (cones of the eyeAcronym – VIBGYOR (cones of the eye
perceive only these wavelength of light –perceive only these wavelength of light –
visible light spectrum).visible light spectrum).
 390 – 800µ.390 – 800µ.
 COMPLIMENTARY COLOURS:COMPLIMENTARY COLOURS:
 Primary colorsPrimary colors::
 Red, Yellow, BlueRed, Yellow, Blue
 These colors cannot be formed by mixingThese colors cannot be formed by mixing
other colors. They occur naturally byother colors. They occur naturally by
themselves.themselves.
 Secondary colorsSecondary colors::
 Are formed by mixing primary colors.Are formed by mixing primary colors.
 RED + Yellow = OrangeRED + Yellow = Orange
 Yellow + Blue = GreenYellow + Blue = Green
 Blue + Red = Violet.Blue + Red = Violet.
 Complimentary colors:Complimentary colors:
They look good together they enhanceThey look good together they enhance
appearance of one and another.appearance of one and another.
Red – Green; Yellow-Violet; & Blue-Orange.Red – Green; Yellow-Violet; & Blue-Orange.
 E.g. A3 shade contains orange hue + blueE.g. A3 shade contains orange hue + blue
stain.stain.

Color perception:Color perception:
 Perception of color involves many:Perception of color involves many:
 Physical – wavelength of light.Physical – wavelength of light.
 physiological – Reception of wavelength of light by the eye.physiological – Reception of wavelength of light by the eye.
 Psychological - Interpretation of wavelength of light by brain.Psychological - Interpretation of wavelength of light by brain.
 It is an immediate and unconscious sense influenced by light source, objectIt is an immediate and unconscious sense influenced by light source, object
and observer.and observer.
1.1. Light source:Light source: has the colour of emitted light and is described in colourhas the colour of emitted light and is described in colour
temperature (°Kelvin).temperature (°Kelvin).
2.2. The observer:The observer: The stimulus of light travels through cornea, lens, aqueousThe stimulus of light travels through cornea, lens, aqueous
and vitreous humors and reaches cones and rods of the eyes.and vitreous humors and reaches cones and rods of the eyes.
Cones – functions for day light vision and colour perception.Cones – functions for day light vision and colour perception.
Rods – are sensitive to quantity of light received.Rods – are sensitive to quantity of light received.
Binocular difference in colour perception:Binocular difference in colour perception:
Colour perception differs between individuals.Colour perception differs between individuals.
It also differs even in the same individual. This phenomena is called asIt also differs even in the same individual. This phenomena is called as
binocular colour perception, it is perception variance between right eye andbinocular colour perception, it is perception variance between right eye and
left eye.left eye.
3.3. The Object -The Object -

 CONTRAST EFFECT:CONTRAST EFFECT:
 The phenomenon of contrast effect canThe phenomenon of contrast effect can
alter the perception of colour as well asalter the perception of colour as well as
ability to evaluate colour in a clear,ability to evaluate colour in a clear,
concise and objective way.concise and objective way.
 There are 4 categories of contrastThere are 4 categories of contrast
effect:effect:
 Simultaneous contrast.Simultaneous contrast.
 Areal contrast.Areal contrast.
 Spatial andSpatial and
 Successive.Successive.

Simultaneous contrastSimultaneous contrast
 Light & dark contrastLight & dark contrast
 If surrounding background isIf surrounding background is
dark, object appears bright anddark, object appears bright and
vice versa.vice versa.
 Clinical application –brightClinical application –bright
shades for light toned patients,shades for light toned patients,
dark shades for pigment toneddark shades for pigment toned
patients.patients.
 Hue & Chroma contrastHue & Chroma contrast
 When two chromatic colours areWhen two chromatic colours are
combined the perceived hue variescombined the perceived hue varies
closer to the complimentary colour thancloser to the complimentary colour than
to that of the background.to that of the background.
 Clinical application – tooth shades fallClinical application – tooth shades fall
predominantly into orange hue family.predominantly into orange hue family.
So to see orange tones moreSo to see orange tones more
discriminately we can precondition onediscriminately we can precondition one
eye by first looking at a light blueeye by first looking at a light blue
background prior to shade selectionbackground prior to shade selection
procedure.procedure.

2) Areal contrast:2) Areal contrast:
 Visual color perception is alsoVisual color perception is also
influenced by size of objectinfluenced by size of object
 Bright object will appear larger, andBright object will appear larger, and
dark object will appear smaller.dark object will appear smaller.
3) Spatial contrast-3) Spatial contrast-
 when same colors are observed inwhen same colors are observed in
different positional relationships. Itdifferent positional relationships. It
can be equated to brightness and sizecan be equated to brightness and size
as well.as well.
 An object i.e. more receded appears toAn object i.e. more receded appears to
be smaller in size and not as bright.be smaller in size and not as bright.
4) Successive contrast4) Successive contrast –– when one colorwhen one color
is observed after seeing another the afteris observed after seeing another the after
effect of original color affects the coloreffect of original color affects the color
perception of the second object.perception of the second object.

Color specifications:Color specifications:
 Color can be specified by using numbers and lettersColor can be specified by using numbers and letters
so that they can be communicate and reproduced.so that they can be communicate and reproduced.
There are two main methods:There are two main methods:
1.1. Colour order system.Colour order system.
2.2. Calorimetry.Calorimetry.
• Color order system – a systematic way to arrange colour inColor order system – a systematic way to arrange colour in
3-D space.3-D space.
• Chronicles of main colour order systemsChronicles of main colour order systems::
YearYear System nameSystem name FounderFounder
19051905 Munsell systemMunsell system MunsellMunsell
19161916 Oswald systemOswald system OstwaldOstwald
19471947 OSA-UCS systemOSA-UCS system Members in optical Society ofMembers in optical Society of
AmericaAmerica
19551955 DIN systemDIN system RichterRichter
19681968 Natural colour system (NCS)Natural colour system (NCS) Haid and SinikHaid and Sinik
19621962 Caloroid Color systemCaloroid Color system MemisicsMemisicswww.indiandentalacademy.com

Shade GuidesShade Guides
 Shade matching tools are called as color standards or shade guides.Shade matching tools are called as color standards or shade guides.
 Tooth color standards – dental shade guides.Tooth color standards – dental shade guides.
 Color standards for oral soft tissues – gingival shade guides.Color standards for oral soft tissues – gingival shade guides.
 facial prosthesis – facial shade guides.facial prosthesis – facial shade guides.
 History:History:
 Hall designed and made porcelain shade guide using the principles whichHall designed and made porcelain shade guide using the principles which
were later used to develop Vita pan shade guide.were later used to develop Vita pan shade guide.
 Miller L.L. demonstrated that Vita classic shade guide was too low in chromaMiller L.L. demonstrated that Vita classic shade guide was too low in chroma
and too high in value compared to the natural tooth samples.and too high in value compared to the natural tooth samples.
CERAMIC MADE COLOR STANDARDSCERAMIC MADE COLOR STANDARDS
1.1. Vita pan classicVita pan classic
2.2. Chromascop andChromascop and
3.3. Vitapan 3D shade masterVitapan 3D shade master
4.4. Vintage Halo shade guide (Shofu dental)Vintage Halo shade guide (Shofu dental)
Vita pan ClassicVita pan Classic – in this hue is categorized according to group or families:– in this hue is categorized according to group or families:
A – Orange (A1,A2,A3,A3.5,A4)A – Orange (A1,A2,A3,A3.5,A4)
B – Yellow. (B1,B2,B3,B4)B – Yellow. (B1,B2,B3,B4)
C – Yellow/Grey (C1,C2,C3,C4)C – Yellow/Grey (C1,C2,C3,C4)
D – Orange / Grey (D2,D3,D4)D – Orange / Grey (D2,D3,D4)

Vita pan classic
Vita pan 3D shade master
Chromoscop system

 Chromoscope system:
 Instead of letters to identify shade numbers were used:Instead of letters to identify shade numbers were used:
 100 – White.100 – White.
 200 – Yellow.200 – Yellow.
 300 – Orange.300 – Orange.
 400 – Grey400 – Grey
 500 – Dark.500 – Dark.
 Vitapan 3D shade masterVitapan 3D shade master – is a unique departure from conventional lettering and– is a unique departure from conventional lettering and
numbering categorization, it is based upon pioneer work of Miller and furthernumbering categorization, it is based upon pioneer work of Miller and further
developed by McLaren.developed by McLaren.
 L – Tendency towards yellow hue.L – Tendency towards yellow hue.
 R – Tendency towards red hue.R – Tendency towards red hue.
 Within the group the tabs are arranged according to chorma (vertically) andWithin the group the tabs are arranged according to chorma (vertically) and
hue (horizontally)hue (horizontally)
 Vitapan classic and the chromoscop system communicates chroma by a system ofVitapan classic and the chromoscop system communicates chroma by a system of
increasing numbers.increasing numbers.
 Vitapan Classic –Vitapan Classic – 1 to 41 to 4 11↓↓ 44↑↑ In ChromaIn Chroma
 Chromoscop system 10 to 40Chromoscop system 10 to 40 1010↓↓ 4040↑↑
 3D master3D master 1 to 31 to 3 11↓↓ 33↑↑
 Vita pan classic and chromoscop system addresses value through chroma. 1 to 4 andVita pan classic and chromoscop system addresses value through chroma. 1 to 4 and
10 to 40 -10 to 40 - ↑↑ in chroma andin chroma and ↓↓ in value.in value.
 Vitapan 3D shade master addresses –VALUE first.Vitapan 3D shade master addresses –VALUE first.
1 to 5 – 1 is brightest – High value.1 to 5 – 1 is brightest – High value.
5 is darkest – Low value.5 is darkest – Low value.

 Value based versus hueValue based versus hue
based shade guides:based shade guides:
 Value based shade guidesValue based shade guides
more accurate as are eyesmore accurate as are eyes
are more sensitive toare more sensitive to
changes inchanges in
lightness/darkness andlightness/darkness and
chroma than subtle changeschroma than subtle changes
in hue.in hue.
 Thus VALUE becomes aThus VALUE becomes a
dominant parameter.dominant parameter.
Resin made color standards.Resin made color standards.
E.g.E.g.
 Esthet-X – DentsplyEsthet-X – Dentsply
 Miris – Coltene / WhaltdentMiris – Coltene / Whaltdent
 Tetric Ceram – IvoclarTetric Ceram – Ivoclar
VivadentVivadent
 Venus – Hereaus KulzerVenus – Hereaus Kulzer
 Vit-I –Escence – UltradentVit-I –Escence – Ultradent

 Technology based shade guideTechnology based shade guide
systems:systems:
11.Shofu shade eye.Shofu shade eye – Ex – 1998 1– Ex – 1998 1stst
introduced in literature by Goldsteinintroduced in literature by Goldstein
and later by Yamamoto.and later by Yamamoto.
Single point source spectrophotometer.Single point source spectrophotometer.
2.2. ShadescanShadescan – 2000– 2000 Robert reported the application of thisRobert reported the application of this
technology.technology.
It is a computer aided digital and video camera vision technologyIt is a computer aided digital and video camera vision technology
to analyze dental images and infer color and translucency.to analyze dental images and infer color and translucency.
Uses – RGB, Digi Camera V/s Spectrophotometer used by otherUses – RGB, Digi Camera V/s Spectrophotometer used by other
systems.systems.
3.3. Spectroshade systemSpectroshade system – 2001 described by Cherkar– 2001 described by Cherkar
(MHT International, Newton, PA)(MHT International, Newton, PA)
Uses – spectrophotometer data for analysis of shade with 3 lakhUses – spectrophotometer data for analysis of shade with 3 lakh
points of reference which is then formatted using computerpoints of reference which is then formatted using computer
imaging (Shofu Shade Eye measures only single point source ofimaging (Shofu Shade Eye measures only single point source of
reference).reference).
Chroma meter (Shofu, MentoChroma meter (Shofu, Mento
Park, CA)Park, CA)
Cynovad (Cortex machine,Cynovad (Cortex machine,
Monreal, CanadaMonreal, Canada))

 Shofu shade eye-EXShofu shade eye-EX
 Shade scanShade scan
 Spectro shade systemSpectro shade system

 Shade guides for oral soft tissues:Shade guides for oral soft tissues:
1)1) Lucitone 199 (Dentsply trubyte)Lucitone 199 (Dentsply trubyte)
4 glossy shade types4 glossy shade types
 Original (OR)Original (OR)
 Light (LT)Light (LT)
 Light reddish pink (LRP)Light reddish pink (LRP)
 Dark (DARK)Dark (DARK)
2) Ivoclar Plus Gingiva indicator (Ivoclar V)2) Ivoclar Plus Gingiva indicator (Ivoclar V)
4 shades –4 shades –
 Pink (P)Pink (P)
 Fibred light pink (US-L)Fibred light pink (US-L)
 Fibred pink (US-P)Fibred pink (US-P)
 Preferred shade (Pref)Preferred shade (Pref)
3) IPS gingival (Ivoclar)3) IPS gingival (Ivoclar)
5 regular shades – G1 – G55 regular shades – G1 – G5
4 gingival modifiers – GM1 – GM44 gingival modifiers – GM1 – GM4
1 Gingival opaque shade – GO1 Gingival opaque shade – GO
4) Gummy gingiva indicator set (Shofu Dental)4) Gummy gingiva indicator set (Shofu Dental)
3 reddish shades – light, medium, dark3 reddish shades – light, medium, darkwww.indiandentalacademy.com

Esthetics in Complete denture
 Dental esthetics and beauty of smile are of
prime importance in today's society. The
edentulous patient is no exception.
 Prior to 1909,tooth form was based on…
 Origin of dentogenic concept took place in
Swiss dent foundation in 1952.
 Dentogenics means art, practice and
techniques used to achieve the esthetic goal
in dentistry.
 Thus introduction to Dentogenic restoration
was the introduction to SPA factor.

From her finger tips to her smile…
A women is feminine
Before dentogenics conventional and
False gender
After, dentogenics and feminine
Before dentogenics conventional and
Neuter gender
From his hands to his mouth…..
A man is masculine
After, dentogenic and masculine

 SEX FACTORSEX FACTOR ((John P FrushJohn P Frush , Roland D Fischer JPD, Roland D Fischer JPD
6:161-172, 1956)6:161-172, 1956)
 Roundness, smoothness, and softness is typical of women.Roundness, smoothness, and softness is typical of women.
 Cuboidal, vigorous appearance is typical of men.Cuboidal, vigorous appearance is typical of men.
 Incisal edges of maxillary anterior teeth of females followedIncisal edges of maxillary anterior teeth of females followed
by the curve of lower lip.by the curve of lower lip.
 Sex interpretation by tooth position:Sex interpretation by tooth position:
 Central incisors.Central incisors.
 Lateral incisors andLateral incisors and
 Canine.Canine.

Softer type interpretation of feminity Vigorous feminine interpretation of tooth form
The depth of evaluation requires a study well
Beyond face form alone
Denture constructed according to dentogenic concept
Reflect the sex, personality and age of the patient

 A basic tooth form which expresses masculine charactersticsA basic tooth form which expresses masculine characterstics
shows vigor, boldness, and hardness.shows vigor, boldness, and hardness.
 The central incisorsThe central incisors
-we can move one of the central incisor from the starting position-we can move one of the central incisor from the starting position
out at the cervical endout at the cervical end
-second most vigorous position is to move one central incisor bodily-second most vigorous position is to move one central incisor bodily
anterior to otheranterior to other
-third position is combined rotation of two CI with distal surface-third position is combined rotation of two CI with distal surface
forward, one incisor depressed at the cervical end and the otherforward, one incisor depressed at the cervical end and the other
depressed incisallydepressed incisally
Tooth form helps in determining the
Degree of masculinity, less vigorous mold
Vigor and strong masculinity can be projected by a
Brawny harshness in surface design

Depth grindingDepth grinding
 We always need the feeling of
depth, the third dimension for
realism.
 Used for women – spheroidal
shape.
 For men cuboidal shape.
 Done only on mesial surface of
central incisors.
 For delicate look – less depth
grinding.
 Vigorous look – severe depth
grinding.
 Average look – between delicate
and vigorous appearance.
Positioning of lateral incisor imparts
A quality of feminine softness
A hardened smile for the vigorous male can
Be achieved by rotating the lateral incisor mesially
Depth grinding accentuates the third dimensional
depth necessary For true dentogenic restorationwww.indiandentalacademy.com

PersonalityPersonality Factor
(John P Frush , Roland D Fischer JPD 6:441-449 1956)
 The comprehensive use of personality depends onThe comprehensive use of personality depends on
our manipulation of tooth shape, colour, position andour manipulation of tooth shape, colour, position and
matrix (visible denture base) of these teeth.matrix (visible denture base) of these teeth.
 3 divisions of personality spectrum:3 divisions of personality spectrum:
1.1. DelicateDelicate – meaning fragile, frail, opposite to– meaning fragile, frail, opposite to
robust.robust.
2.2. Medium pleasingMedium pleasing – normal, moderately robust,– normal, moderately robust,
healthy and of intelligent appearance.healthy and of intelligent appearance.
3. Vigorous - opposite of delicate, hard and
aggressive in appearance, the extreme male
animal, muscular type almost primitive, ugly
Most men are found to be towards vigorous end
Of spectrum most women are found to be towards
Delicate end of spectrum, both may still be
Within the broad medium personality band

The type of central and lateral incisor and cuspid which wouldThe type of central and lateral incisor and cuspid which would
Be used for the youthful, good-looking model type of patientBe used for the youthful, good-looking model type of patient
CI considerably more coarse and are for ample bodied,obese
women
Robust form of sculpturing make them universally acceptable
For men and women by further shaping
Teeth on left have been shaped to appear soft on right
They have been shaped to appear hard, outline form
can be changed by grinding
The effect of age is added by abrasion of incisal
Edges, use of diastemas,,gingival erosion ,
Manipulation of interdental papillae.

Delicate contours of the sculpted giraffe are the same
Delicate contours of the teeth
Medium character in the personality in the sculpture IIama
Same medium pleasing character of these teeth
Vigorous type of sculpting as represented by the bull and
The teeth of the same vigorous quality

AGE FACTOR (John P Frush , Roland D
Fischer JPD 7:5-13 1956)
 Dignity of advancing age should beDignity of advancing age should be
appropriately portrayed in the denture byappropriately portrayed in the denture by
careful – tooth colour selection and moldcareful – tooth colour selection and mold
refinement.refinement.
 With age:With age:
 Increase in the interincisal distance andIncrease in the interincisal distance and
increased visibility of mandibular teeth.increased visibility of mandibular teeth.
 Wearing off of incisal edges.Wearing off of incisal edges.
 Wearing away off of contact points andWearing away off of contact points and
migration creates spaces between teeth.migration creates spaces between teeth.
 Smile line looses its sharpness in older age.Smile line looses its sharpness in older age.

Changing cuspid tip with ageChanging cuspid tip with age Variable long axis becomes accentua
With age
Interdental papillae
youth
Middle age
Advanced age
Youth middle age advanced age

Dynesthetic interpretation of the DentogenicDynesthetic interpretation of the Dentogenic
concept (concept (John P FrushJohn P Frush , Roland D Fischer JPD 7:5-, Roland D Fischer JPD 7:5-
13 1956)13 1956)
 Dynesthetic is a compound word. TheDynesthetic is a compound word. The
prefix dyn is the combining form, from theprefix dyn is the combining form, from the
Greek wordGreek word dynamicsdynamics meaning powermeaning power
 Dynesthetic techniques are rules whichDynesthetic techniques are rules which
concerns the three important divisions ofconcerns the three important divisions of
denture fabricationdenture fabrication
 1) Tooth1) Tooth
 2) Its position2) Its position
 3) Its matrix (visible denture base)3) Its matrix (visible denture base)

Considerations in DynestheticsConsiderations in Dynesthetics
 MOLD: selection of an acceptable personality mold involves itsMOLD: selection of an acceptable personality mold involves its
subsequent treatment for abrasion, erosion, depth grinding,subsequent treatment for abrasion, erosion, depth grinding,
masculinity, or feminity, shaping and polishingmasculinity, or feminity, shaping and polishing
Progressive abrasion of artificial tooth as
Age progresses, cut made for normal abrasion
Tooth modified to simulate erosion
Depth perception increased by depth grinding , cut made
On the labial mesial line angle of the artificial teeth
Masculine femininewww.indiandentalacademy.com

 Lip supportLip support
 Labio versionLabio version
 MidlineMidline  Smile lineSmile line
Lip support is mainly by
central incisor Position A
is for maximum
mechanical Stability.
Position B, C, D represent
the Progressive
dynesthetic positioning of
the Central incisors for
pleasing lip support
An acceptable midline
(solid line)
The broader curve of this
smiling line indicates
An older dental composition
Speaking line is correct because a portion of the
Lateral incisor show when the patien speaks
seriously
The sharp curve of this
smiling line is youthful

 Impression stageImpression stage
 Registration stageRegistration stage
 Teeth selection and arrangementTeeth selection and arrangement
 Characterization ofCharacterization of
denture basedenture base

Classification of errors in dental estheticsClassification of errors in dental esthetics
(Lombardi R.E,JPD;32:501-513,1974)(Lombardi R.E,JPD;32:501-513,1974)
 Inharmonious dentofacial ratioInharmonious dentofacial ratio
A)A) Shade disharmonyShade disharmony
B)B) Compositional incompatibilityCompositional incompatibility
1. static denture in dynamic mouth1. static denture in dynamic mouth
2.Inharmonious strength or weakness2.Inharmonious strength or weakness
of dental composition compared toof dental composition compared to
background featuresbackground features
a. Weak mouth with strong facea. Weak mouth with strong face
b. strong mouth with weak faceb. strong mouth with weak face
 Intrinsic dental disharmonyIntrinsic dental disharmony
1. Space allocation error1. Space allocation error
1 Inadequate vertical space1 Inadequate vertical space
allocationallocation
2 excessive vertical space allocation2 excessive vertical space allocation
3 excessive horizontal space3 excessive horizontal space
allocationallocation
2. Structural line errors2. Structural line errors
1 elevated occlusal plane1 elevated occlusal plane
2 occlusal plane drops down2 occlusal plane drops down
posteriorlyposteriorly
3 asymmetrical occlusal plane3 asymmetrical occlusal plane
3. Unnatural lines3. Unnatural lines
1 Reverse smiling line1 Reverse smiling line
2 unnatural axial inclination2 unnatural axial inclination
3 cuspless posterior teeth3 cuspless posterior teeth
4 gradation errors4 gradation errors
5 Age-Sex-Personality disharmony5 Age-Sex-Personality disharmony
4. Single –line errors4. Single –line errors
1. Vertical deviation1. Vertical deviation
2. Horizontal deviation2. Horizontal deviation
3. Line conflict3. Line conflict
5. Imbalance5. Imbalance
1. Midline errors1. Midline errors
2.Imbalance of direction2.Imbalance of direction
3. Artifact error3. Artifact error
4. Diastema error4. Diastema error

Esthetics in removal partial dentureEsthetics in removal partial denture
 Unaesthetic RPD can be avoided with appropriateUnaesthetic RPD can be avoided with appropriate
diagnosis and design using conventional clasping ordiagnosis and design using conventional clasping or
attachment aided prostheses.attachment aided prostheses.
 Classification overviewClassification overview

Principles of DesignPrinciples of Design
 A prudent treatment plan involves analysis of patients dentition andA prudent treatment plan involves analysis of patients dentition and
supportive tissue that will influence the partial denture componentsupportive tissue that will influence the partial denture component
selection and anticipate estheticsselection and anticipate esthetics
 Kennedy Class I, II, large Class IV are considered tooth tissueKennedy Class I, II, large Class IV are considered tooth tissue
supported indicatingsupported indicating
 Flexible direct retainer assembliesFlexible direct retainer assemblies
 Mesioocclusal rest on posterior distal extension abutmentMesioocclusal rest on posterior distal extension abutment
 Indirect retainers to limit rotationIndirect retainers to limit rotation
 Kennedy Class III, and Small class IV are considered toothKennedy Class III, and Small class IV are considered tooth
supported.supported.
 No additional support from tissue is generally neededNo additional support from tissue is generally needed
 Clasp assemblies are more rigidClasp assemblies are more rigid
 Indirect retainers usually not indicated.Indirect retainers usually not indicated.
 Examination of patientExamination of patient
 ClinicalClinical
 Radiographic diagnosisRadiographic diagnosiswww.indiandentalacademy.com

Use of surveyorUse of surveyor
 Surveyor may be used for diagnostic cast analysis. SurveySurveyor may be used for diagnostic cast analysis. Survey
objectives includeobjectives include
 Determination of acceptable path of insertion to eliminate interferenceDetermination of acceptable path of insertion to eliminate interference
with placement and removal…..with placement and removal…..
 Identification of proximal tooth surface to be made parallel to act asIdentification of proximal tooth surface to be made parallel to act as
guide planes.guide planes.
 Location and measurements for undercut and suitable esthetic claspLocation and measurements for undercut and suitable esthetic clasp
placement.placement.
 Delineation of height of contourDelineation of height of contour
 Recording cast positionRecording cast position
 An esthetic determination of survey is establishing one path ofAn esthetic determination of survey is establishing one path of
placement to minimize the retentive element and acrylic resin orplacement to minimize the retentive element and acrylic resin or
denture base display.denture base display.
 Area of retention should be selected to enhance esthetic values ofArea of retention should be selected to enhance esthetic values of
RPD.RPD.
 Anterior modification space – path of placement should be selectedAnterior modification space – path of placement should be selected
to minimize excessive modification of adjacent abutment teeth.to minimize excessive modification of adjacent abutment teeth.
 Anterior tissue undercut may dictate a posteriorly directed path ofAnterior tissue undercut may dictate a posteriorly directed path of
placement….placement….
 Rest of highly esthetic anterior region should be………..Rest of highly esthetic anterior region should be………..www.indiandentalacademy.com

Specific clasp types and estheticSpecific clasp types and esthetic
considerationsconsiderations
 The use of conventional clasping in esthetic region of theThe use of conventional clasping in esthetic region of the
mouth can present difficulties with patient acceptance.mouth can present difficulties with patient acceptance.
Proper surveying and mouth preparation may circumventProper surveying and mouth preparation may circumvent
complications.complications.
 Clasp may approach undercut fromClasp may approach undercut from
Suprabulge region
↓
Placing it in this matter will
improve esthetic results and
diminish torquing forces applied
to the tooth by the clasp
Infrabulge region
↓
Provides better esthetics
but may have limitations
owing to anatomic
considerations
-Height of vestibule
-Position of frena
-Bony prominences

Circumferential claspCircumferential clasp
 Suprabulge claspSuprabulge clasp
 Used for tooth supported abutments in posteriorUsed for tooth supported abutments in posterior
region of mouth.region of mouth.
 Retention arm and reciprocal armRetention arm and reciprocal arm
 Due to relative size of this clasp use of clasp aboveDue to relative size of this clasp use of clasp above
height of contour for reciprocal clasp should beheight of contour for reciprocal clasp should be
limited in esthetic region of the mouth.limited in esthetic region of the mouth.
I, Y, T / modified T-bar claspI, Y, T / modified T-bar clasp
 I Clasp – infrabulge approach optimizes estheticsI Clasp – infrabulge approach optimizes esthetics
(especially in patients with high lipline).(especially in patients with high lipline).
 Is placed approximately one tooth distal to theIs placed approximately one tooth distal to the
abutment teeth.abutment teeth.

T/Y bar claspT/Y bar clasp
 Achieves undercut engagement of 0.25mm on eitherAchieves undercut engagement of 0.25mm on either
M/D surfaces of the teeth.M/D surfaces of the teeth.
 Only one tip of Y or T clasp is placed in the retentiveOnly one tip of Y or T clasp is placed in the retentive
undercut, other provides support only.undercut, other provides support only.
 Removal of anterior arm of T bar clasp produces aRemoval of anterior arm of T bar clasp produces a
MODIFIED T BAR CLASPMODIFIED T BAR CLASP - provides better esthetic- provides better esthetic
results while using in the distal undercut.results while using in the distal undercut.
 Functional advantage – reduces the torque andFunctional advantage – reduces the torque and
distal tipping of the tooth.distal tipping of the tooth.
RPI bar clasp (by Kratochvil modifiedRPI bar clasp (by Kratochvil modified
by KROL)by KROL)
 Consist ofConsist of
 Mesioocclusal restMesioocclusal rest
 Proximal plateProximal plate
 I barI bar
 RPI clasp fulfills all requirements of a conventionalRPI clasp fulfills all requirements of a conventional
clasp yet demonstratesclasp yet demonstrates
 Minimum tooth coverageMinimum tooth coverage
 Limited metal displayLimited metal display
 An infrabulge approachAn infrabulge approach
 Disadvantage – In adequate vestibular depth,Disadvantage – In adequate vestibular depth,
anatomic structures like frenum.anatomic structures like frenum.

Mesial groove reciprocal clasp (MGR) by McCartneyMesial groove reciprocal clasp (MGR) by McCartney
(JPD, 1982)(JPD, 1982)
 Is indicated for maxillary distalIs indicated for maxillary distal
extension RPDs when canine serves asextension RPDs when canine serves as
abutment teeth. Facial bracing isabutment teeth. Facial bracing is
important because unlike premolars theimportant because unlike premolars the
mesiolingual contour of the canine doesmesiolingual contour of the canine does
not usually permit enough surface tonot usually permit enough surface to
resist distal movement.resist distal movement.
Camouflaging of RPD clasps:Camouflaging of RPD clasps:
 Includes addition of acrylic resin orIncludes addition of acrylic resin or
resin composites veneers to RPD claspsresin composites veneers to RPD clasps
 Difficulty is in the difference betweenDifficulty is in the difference between
their ability to flex and theirtheir ability to flex and their
coefficient of thermal expansioncoefficient of thermal expansion
 Other concerns-Other concerns-
 Effect of intra oral forces ofEffect of intra oral forces of
masticationmastication
 Adjustibility of veneered claspsAdjustibility of veneered clasps
 Additional bulk of claspAdditional bulk of clasp

Retention enhancementRetention enhancement
 Composite resinsComposite resins
 ConservativeConservative
 Cost effectiveCost effective
 Minimally invasive methodMinimally invasive method
 Enhancing retentionEnhancing retention
 In-vitro studies by Tietge JD et al (1992, IJP)In-vitro studies by Tietge JD et al (1992, IJP)
 I-bar produced wear in the resin but stainless steel round claspI-bar produced wear in the resin but stainless steel round clasp
did not.did not.
 Donna L. Dixon et al (1990, JPD) showed the use of partialDonna L. Dixon et al (1990, JPD) showed the use of partial
coverage porcelain laminate bonded to a tooth enhancecoverage porcelain laminate bonded to a tooth enhance
retention which solved the problems associated withretention which solved the problems associated with
composite resin and full surface laminate.composite resin and full surface laminate.
Rest seatRest seat
 Traditionally incisal rest advocated on mandibular anteriorTraditionally incisal rest advocated on mandibular anterior
teeth. They are unaesthetic , may interfere with occlusionteeth. They are unaesthetic , may interfere with occlusion
and may increase torquing forces on the teeth.and may increase torquing forces on the teeth.
 Bonded resin composite or metal rest seats have shown toBonded resin composite or metal rest seats have shown to
provide satisfactory esthetics alternative to incisal rests.provide satisfactory esthetics alternative to incisal rests.
Flange designFlange design
Artificial teethArtificial teeth

Attachments for removable partial denture:Attachments for removable partial denture:
 The demands for highly esthetic dentures providesThe demands for highly esthetic dentures provides
the catalyst for attachment RPD. The estheticthe catalyst for attachment RPD. The esthetic
expectation of a patient should be the primaryexpectation of a patient should be the primary
directive for attachment use.directive for attachment use.
 TypesTypes
 PrecessionPrecession
 SemiprecessionSemiprecession
 IntracoronalIntracoronal
 ExtracoronalExtracoronal
Extra coronal
- Dolbo, Act system
- SA Swiss anchor
- Stern ERA, Stern RV
- Hader vertical
- ASC-52 ball attachment
- ORS (DE) attachment
Intra coronal
- Stern G/A, G/L type 7
- Swiss McCollum & Crismani
attachment
- Schatzmann, Biloc, Plasta and
Score attachment

Esthetics in Fixed Partial DentureEsthetics in Fixed Partial Denture
 To the patients the cosmetics of anterior fixedTo the patients the cosmetics of anterior fixed
prosthodontics are usually more important than theprosthodontics are usually more important than the
functional and technical aspects of the restoration.functional and technical aspects of the restoration.
 A logical sequence of diagnosis and treatmentA logical sequence of diagnosis and treatment
planning is required.planning is required.
Diagnostic wax-upDiagnostic wax-up
 Of proposed FPD can be invaluable in determining theOf proposed FPD can be invaluable in determining the
esthetic criteria for a treatment plan.esthetic criteria for a treatment plan.
 It allows for opportunity to observeIt allows for opportunity to observe
 Abutment tooth pontic relationshipAbutment tooth pontic relationship
 Pontic ridge relationshipPontic ridge relationship
 Evaluate exact edentulous space.Evaluate exact edentulous space.
 Edentulous area badly resorbed ……Edentulous area badly resorbed ……
 Frequent orthodontic treatment best solution for …….Frequent orthodontic treatment best solution for …….
 May indicate endodontic treatment…….May indicate endodontic treatment…….

 Once diagnostic process has beenOnce diagnostic process has been
completed treatment option may becompleted treatment option may be
selected from following choices.selected from following choices.
 Retainers:Retainers:
 Partial coveragePartial coverage
 CementedCemented
 Resin bondedResin bonded
 Porcelain veneersPorcelain veneers
 Complete coverageComplete coverage
 All metalAll metal
 All ceramicAll ceramic
 Metal ceramicMetal ceramic
– MarginsMargins

LocationLocation

MaterialMaterial

Metal collar marginMetal collar margin

Disappearing metal marginDisappearing metal margin

Porcelain marginPorcelain margin
– Porcelain metal junctionPorcelain metal junction
 Other considerationsOther considerations
 Cantilever FPDCantilever FPD
 ImplantsImplants
 SplintingSplinting
 Use of telescopic crown as abutmentUse of telescopic crown as abutment
•PonticPontic
-Design-Design
-Edentulous ridge form-Edentulous ridge form
-Material-Material

RetainersRetainers
 When selecting a retainers esthetics is one theWhen selecting a retainers esthetics is one the
three important factors to be considered, othersthree important factors to be considered, others
being biologic and functional factors.being biologic and functional factors.
 These are also important to consider as it does littleThese are also important to consider as it does little
good to have a beautifully esthetic restoration thatgood to have a beautifully esthetic restoration that
fails because the biologic and functional issues arefails because the biologic and functional issues are
not taken care off.not taken care off.
Partial coverage retainersPartial coverage retainers
1.1. Cemented – Metal onlay, inlays, ¾ crownCemented – Metal onlay, inlays, ¾ crown

2. Resin bonded retainers2. Resin bonded retainers
- Is currently the most widely usedIs currently the most widely used
partial coverage retainerpartial coverage retainer

3. Porcelain veneer3. Porcelain veneer
- It is no doubt one of the mostIt is no doubt one of the most
esthetic of all the partialesthetic of all the partial
coverage retainer.coverage retainer.
- The porcelain veneers thatThe porcelain veneers that
fits and is bonded to thefits and is bonded to the
tooth correctly has adequatetooth correctly has adequate
strength to survive moststrength to survive most
clinical conditions as singleclinical conditions as single
tooth restoration.tooth restoration.
- This problem is magnifiedThis problem is magnified
when porcelain pontics arewhen porcelain pontics are
attached to porcelain veneersattached to porcelain veneers
with porcelain connectors.with porcelain connectors.
- This type can be used only ifThis type can be used only if
- Minimum or no occlusal forcesMinimum or no occlusal forces
- Patient compliance in avoidingPatient compliance in avoiding
biting of hard food andbiting of hard food and
- Wearing occlusal splintsWearing occlusal splints

Esthetics / orthodontics courses in india

Esthetics / orthodontics courses in india

Recommended

Recommended

More Related Content

What's hot

What's hot (20)

Viewers also liked

Viewers also liked (20)

Similar to Esthetics / orthodontics courses in india

Similar to Esthetics / orthodontics courses in india (20)

More from Indian dental academy

More from Indian dental academy (20)

Recently uploaded

Recently uploaded (20)

Esthetics / orthodontics courses in india