The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
prosthodontic management of acquired defects of mandible /certified fixed ort...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
prosthodontic management of acquired defects of mandible /certified fixed ort...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
00919248678078
Implant abutment and implant abutment connectionsDR.BHAVESH JHA
this ppt enlightened with different types of implant abutment connection. Detailed classification of abutments. Different types of abutments. Latest trends of abutments. Smart abutments. Platform switching, rationale of platform switching and related articles.
Nutrition in complete denture Patients /certified fixed orthodontic courses b...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Dental implants require regular professional maintenance as well as proper home care. Taking good care of dental implants is the key for long-term success of Dental Implant.
For more information contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
Description of Biomechanics of occlusion, Effect of anatomical determinants, Ideal occlusion, Evolution of occlusion, Concepts of Occlusion in FPD such as Group function occlusion, canine guided occlusion, Occlusal contacts, Occlusal Interferences, Patient"s adaptability, Pathogenic occlusion and Philosophies of full mouth rehabilitation. Added references for further readings.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Nutrition in complete denture Patients /certified fixed orthodontic courses b...Indian dental academy
Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Dental implants require regular professional maintenance as well as proper home care. Taking good care of dental implants is the key for long-term success of Dental Implant.
For more information contact :-
Dr Sachdeva's Dental Aesthetic And Implant Institute,
I 101, Ashok Vihar Phase 1, Delhi- 110052
Contact us at
• Phone : +919818894041,01142464041
• Our Websites:
• www.sachdevadentalcare.com
• www.dentalclinicindelhi.com
• www.dentalimplantindia.co.in
• www.dentalcoursesdelhi.com
• www.facialaestheticsdelhi.com
• Google+ link: https://goo.gl/vqAmvr
• Facebook link: https://goo.gl/tui98A
• Youtube link: https://goo.gl/mk7jfm
• Linkedin link: https://goo.gl/PrPgpB
• Slideshare link : http://goo.gl/0HY6ep
• Twitter Page : https://goo.gl/tohkcI
• Instagram page : https://goo.gl/OOGVig
Journal Club Presentation on Overlay Removable Partial DentureNeerajaMenon4
Overlay removable partial dentures (ORPDs), a subset of overdentures, are often referred to as an RPD that has part of their components covering the occlusal surface of the abutment teeth to restore them into a functional occlusion
Description of Biomechanics of occlusion, Effect of anatomical determinants, Ideal occlusion, Evolution of occlusion, Concepts of Occlusion in FPD such as Group function occlusion, canine guided occlusion, Occlusal contacts, Occlusal Interferences, Patient"s adaptability, Pathogenic occlusion and Philosophies of full mouth rehabilitation. Added references for further readings.
Indian Dental Academy: will be one of the most relevant and exciting training
center with best faculty and flexible training programs for dental
professionals who wish to advance in their dental practice,Offers certified
courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Gingival Curettage / /certified fixed orthodontic courses by Indian dental ac...Indian dental academy
Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients
State of the art comprehensive training-Faculty of world wide repute &Very affordable.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Establishment of occlusal relationship in rpd/endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Eccentric movements of mandibular movements/prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Evaluation and standardization of impressions in complete denturesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Structural durability /prosthodontic courses/prosthodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Denture base considerations (2)/certified fixed orthodontic courses by Indian...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Gingival perspectives of esthetics/ cosmetic dentistry trainingIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
Periodontal considerations in fpd/ orthodontic straight wire techniqueIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
macroscopic/ clinical features of gingiva
With video clips
Short video descriptions
Lecture for 3rd BDS students
Periodontology
Periodontics aspect
Clinical features of the gingiva
Development of occlusion /certified fixed orthodontic courses by Indian denta...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis & treatment plan for periimplant desease/ dental implant coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
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Biological considerations of maxillary impressions/ courses for dentistryIndian dental academy
Indian Dental Academy: will be one of the most relevant and exciting
training center with best faculty and flexible training programs
for dental professionals who wish to advance in their dental
practice,Offers certified courses in Dental
implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic
Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Described here are the clinical features of gingiva, the various stages of gingivitis and the clinical features associated with them. The microscopic features have been described on a different slide presentation.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
• Introduction
• Definitions
• Macroscopic Features
• Microscopic Features
• Blood supply
• Nerve supply
• Lymphatic drainage
• Role of epithelium in defence mechanism
• Oxygen consumption of gingiva
• Correlation of Macroscopic with microscopic features
• Conclusion
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Similar to Gingival perspectives of esthetics/cosmetic dentistry courses (20)
Opportunity for Dentists (BDS/MDS )to relocate to United kingdom -Register as a DENTAL HYGIENIST/ DENTAL THERAPIST without Board exams and after approval you can register in GDC as a DH/DT and start working as a DH/DT Immediately and get paid.
You can complete the whole process in 3-4 months.Salary range for DH/DT is around 2500-3500 Pounds per month.
Eligibility / requirements-
1. An International English Language Testing System (IELTS) certificate
at the appropriate level.(Within 2 yrs of application date )
2: A recent primary dental qualification that has been taught and examined in English..(Within 2 yrs of application date )
3: A recent pass in a language test for registration with a regulatory authority in a country where the first language is English.
If you are interested Please contact us for more details.
1ST, 2ND AND 3RD ORDER BENDS IN STANDARD EDGEWISE APPLIANCE SYSTEM /Fixed ort...Indian dental academy
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals
who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry,
Periodontics and General Dentistry.
Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.
I –Aligners are made with FDA approved transparent thermoplastic materials using 3D scanning, 3D Printing and finally Trays with Pressure vacuum formers.
Dear Doctor,
Indian Dental Academy Now offers comprehensive online Orthodontics course.
Course includes:
1.whiteboard lecture presentations
2.Case Discussions
3.with hundreds of pictures.
4.Demo on Models
5.Demo on Patients
6. subtitles in your own language
12 months unlimited access and support @350 USD only.
For Demo please visit :www.idalectures.com/preview/
For more details visit: www.idalectures.com
Please contact us for any clarifications:
idalectures@gmail.com
indiandentalacademy@gmail.com
Thanks & Regards
Indian Dental Academy
--
Indian Dental Academy
Leader in continuing dental education
www.indiandentalacademy.com
skype:indiandentalacademy
+919248678078
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Cytotoxicity of silicone materials used in maxillofacial prosthesis / dental ...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Diagnosis and treatment planning in completely endntulous arches/dental coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Properties of Denture base materials /rotary endodontic coursesIndian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Use of modified tooth forms in complete denture occlusion / dental implant...Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Biological screening of herbal drugs: Introduction and Need for
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Natural Products, In vitro evaluation techniques for Antioxidants, Antimicrobial and Anticancer drugs. In vivo evaluation techniques
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A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
2. CONTENTSCONTENTS
INTRODUCTION
ANATOMY OF DENTOGINGIVAL COMPLEX
TISSUE HEIRARCHY
OSSEOUS CREST CONSIDERATIONS
PERIODONTAL BIOTYPE & BIOFORM
TOOTH MORPHOLOGY
CONTACT POINTS
TOOTH POSITION (GINGIVAL PROGRESSION)
EXTRA-ORAL SKELETAL AND SOFT TISSUE
LANDMARKS
REVIEW OF LITERATURE
CONCLUSION
www.indiandentalacademy.com
3. INTRODUCTIONINTRODUCTION
Beauty is in the eye of the beholder. Perception of
beauty is in the brain. An organized and systematic
approach is required to evaluate, diagnose, and resolve
esthetic problems predictably
The gingival perspective of esthetics is concerned with
the soft tissue envelope surrounding the teeth.
www.indiandentalacademy.com
4. ANATOMY OF THE DENTOGINGIVALANATOMY OF THE DENTOGINGIVAL
COMPLEXCOMPLEX
The dentogingival complex is composed of three
entities:
1. The supra-crestal connective tissue
attachment,
2. Epithelial (or junctional epithelium)
attachment and
3. The sulcus.
www.indiandentalacademy.com
5. THE GINGIVA IS DIVIDED ANATOMICALLY INTO
MARGINAL,
ATTACHED,
INTERDENTAL
AREAS.
GINGIVA
Muco-gingival junction
Periodontal
ligament
FREE
GINGIVA
TOOTH
Crest of
Alveolar
bone
Muco-gingival junction
ATTACHED
GINGIVA
Alveolar mucosa
lies outsidealveolar bone
www.indiandentalacademy.com
6. Marginal Gingiva
The marginal or unattached gingiva is the
terminal edge or border of the gingiva
surrounding the teeth in collar like fashion.
In about 50% of cases, it is demarcated from
the adjacent, attached gingiva by a shallow
linear depression, the free gingival groove.
www.indiandentalacademy.com
7. Gingival SulcusGingival Sulcus
The gingival sulcus is the shallow crevice or span around the tooth
bounded by the surface of the tooth on one side and the epithelium
lining the free margin of the gingiva on the other. It is V shaped
and barely permits the entrance of a periodontal probe.
In clinically healthy gingiva in humans, a sulcus of some depth can
be found. The depth of this sulcus, determined in histological
sections, has been reported as 1.8 mm, with variations from 0 to 6
mm; other studies have reported 1.5 mm and 0.69 mm, respectively.
www.indiandentalacademy.com
8. Attached Gingiva
The attached gingiva is continuous with the
marginal gingiva. It is firm, resilient, and
tightly bound to the underlying periosteum of
alveolar bone.
The facial aspect of the attached gingiva
extends to the relatively loose and movable
alveolar mucosa, from which it is demarcated by
the mucogingival junction.
www.indiandentalacademy.com
9. The width of the attached gingiva is another
important clinical parameter.
It is the distance between the mucogingival
junction and the projection on the external
surface of the bottom of the gingival sulcus or
the periodontal pocket.
www.indiandentalacademy.com
10. Interdental GingivaInterdental Gingiva
The interdental gingiva occupies the gingival
embrasure, which is the interproximal space beneath
the area of tooth contact.
The interdental gingiva can be pyramidal or have a
“col” shape.
In the former, the tip of one papilla is located
immediately beneath the contact point; the latter
presents a valley like depression that connects a facial
and lingual papilla and conforms to the shape of the
interproximal contact.
www.indiandentalacademy.com
11. Gingival EpitheliumGingival Epithelium
The principal cell type of the gingival epithelium, as
well as of other stratified squamous epithelia, is the
kerotinocyte. Other cells found in the epithelium are
the clear cells or nonkeratinocytes, which include the
Langerhans cells, Merkel cells, and melanocytes.
The main function of the gingival epithelium is to
protect the deep structures while allowing a selective
interchange with the oral environment. This is
achieved by proliferation and differentiation of the
keratinocyte.
www.indiandentalacademy.com
12. OSSEOUS CRESTOSSEOUS CREST
The quoted measurement of 2.04 mm for the biologic
width assumes that the osseous crest is normal,
prevalent in 85% of the population, with a sulcus depth
of 1 mm, yielding 3 mm for the entire dentogingival
complex.
The importance of the latter is that if crowns are
necessary, meticulous care should be taken to ensure
that this equilibrium is maintained (3 mm), and not
violated by any clinical procedure
www.indiandentalacademy.com
13. GINGIVA: RolesGINGIVA: Roles
Connects soft tissue to hard, while it establishes a seal
around the tooth.
Provides sensation for control of biting & chewing
Controls oral microbes
Protects the PDL & alveolar bone
Adapts to changing oral conditions & eruption
Attaches firmly to the bone supporting the tooth
Joins with the adjacent alveolar mucosa
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14. PERIODONTAL BIOTYPE ANDPERIODONTAL BIOTYPE AND
BIOFORMBIOFORM
The human tissue biotype is classified as thin, normal
or thick.
Thin periodontal biotypes are friable, escalating the
risk of recession following crown preparation and
periodontal or implant surgery.
This is particularly significant for full coverage crowns
for the following reasons.
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15. Firstly, the thin gingival margins allow
visibility of’ a metal substructure (either
porcelain fused to a metal crown or implant
abutment), thereby compromising aesthetics in
the anterior regions of the mouth.
Secondly, due to the thin fragility of the thin
tissue, delicate management is essential for
avoiding recession and hence visibility of
subgingivally placed crown margins at the
restoration / tooth interface.
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16. Conversely a thick biotype is fibrotic and resilient,
making it resistant to surgical procedures with a
tendency for pocket formation (as opposed to
recession).
Therefore, a thick biotype is more conducive for
implant placement, resulting in favorable aesthetic
outcomes
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22. PAPILLAE
The papilla between the two central incisors appears
longer than that of adjacent teeth in relation to the
position of the interproximal contact areas.
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23. Emergence profileEmergence profile
Stein and Kuwata: Described the part of the axial
contour that extends from the base of the gingival
sulcus past the free margin of the gingiva as the
emergence profile.
Failure to maintain proper emergence profile may be a
result of relying on the theory of food deflection when
developing crown contours, or it may be a result of
failure to remove adequate tooth structure during
tooth preparation.
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24. In either case, if the restorative margin is extended
subgingivally, the over-bulked contours change the
emergence profile of the tooth.
This will create a protected area that encourages
plaque accumulation and is more difficult to clean.
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25. TOOTH MORPHOLOGYTOOTH MORPHOLOGY
Tooth morphology determines two aspects of gingival
undulations.
Firstly : the basic tooth forms (determine the degree of gingival
scallop)
#circular
Shallow
#square
#triangular Pronounced
( Predisposes to the so called ‘black
triangles’)www.indiandentalacademy.com
26. Secondly, the convex acuity of a tooth
circumference influences the coronal /
apical position of the FGM. Put succinctly,
convex tooth morphology yields a more
apical location of the FGM, while a
concave shape leads to a coronal position of
the FGM.
The biological relationship of tooth
morphology to FGM locations can be
exploited to manipulate the soft tissue
around prostheses that are aesthetically
sensitive.
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27. CONTACT POINTSCONTACT POINTS
The contact points of the maxillary teeth are relevant
for ensuring optimal ‘pink aesthetics’ for patients with
a high smile line (or visible cervical margins).
The i study by Tarnow, which produced the ‘5 mm
rule’. states that when the distance from the contact
point to the interproximal osseous crest is 5 mm or less,
there is complete fill of the gingival embrasures with
an interdental papilla.
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28. For every 1 mm above 5 mm, the chance of complete
fill is progressively reduced by 50%.
For square-shaped teeth with wide contact points, the
chances of ‘black triangles’ is minimal compared with
triangular teeth having narrow, more incisally
positioned contact points.
The existence of the interdental papilla is dependent on
the presence or absence of teeth. No teeth, no papillae;
a scenario, which is evident in edentulous ridges where
papillae are absent
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29. For example, if a lateral incisor is extracted, the
interproximal papilla between the central incisor and
canine will disappear, and the FGM of the lateral
incisor will reestablish itself to 3 mm from the
underlying osseous crest.
This is identical to the unsupported dentogingival
complex on the midfacial aspect of natural teeth. The
latter is also true for diastema, where an interdental
papilla is absent.
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30. Furthermore, the degree of interproximal fill is also
dependant on the periodontal biotype. A thick
periodontal biotype encourages interdental fill, while a
thinner tissue type creates un-aesthetic hollow gingival
embrasures.
This problem is compounded when an implant is placed
next to a natural tooth. It is the interproximal bone of
the adjacent natural tooth that determines the
presence, or absence of a papilla, not the bone
surrounding the implant fixture.
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31. For thick biotypes, the papilla may be
established to normal dimensions of’ 5 mm, but
for thin biotypes, it is difficult to recreate a
papilla longer than 4 mm from the osseous crest.
Finally, the 5 mm rule is only applicable for
adjacent natural teeth or implants bounded by
natural dentition.
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32. Due to the flat fixture platforms, adjacent
implants lack the inter- proximal osseous peak
present between natural teeth.
The recently introduced scalloped plat form
fixtures (Nobel Perfect, Nobel Biocare,
Sweden), may help to redress this issue with an
endeavour to mimic natural root morphology.
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33. TOOTH POSITION ANDTOOTH POSITION AND
GINGIVAL PROGRESSIONGINGIVAL PROGRESSION
The intra-arch tooth position is assessed in three
planes: vertical (apical—coronal), sagittal (facial—
lingual) and horizontal ( mesial - distal).
In the vertical plane, the cervical portion of the tooth
can be apical, coronal or in line with the FGM. An
example of a coronally positioned FGM occurs in cases
of altered passive eruption, where the FGM fails to
migrate apically to assume its relative position to the
CEJ.
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34. In the sagittal plane, a facially placed tooth
will have an apically located FGM with a thin
underlying buccal plate & vice versa.
Horizontal: imbrications in the horizontal
plane result in crowding, due to limited arch
space for wide teeth. These teeth have close root
proximity with thin interproximal bone.
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36. The opposite is the case for diastema with thick
interproximal bone and blunted papillae.
One of the most significant features of gingival
aesthetics is Contour progression from the
incisors to canine.
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37. GINGIVAL AESTHETIC LINEGINGIVAL AESTHETIC LINE
( GAL( GAL )
The gingival aesthetic line (GAL) is a
classification for creating pleasing gingival level
transition between the maxillary anterior teeth.
GAL is defined as a line joining the tangents of
the zeniths of the FGM s of the central incisor
and canine.
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38. The GAL angle is that formed at the intersection of
this line to the maxillary dental midline.
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39. four classes of GAL
Assuming a normal w/l ratio, anatomy,
position and alignment of the anterior dental
segment, four classes of GAL are described:
Class I:Class I:
Class II:Class II:
Class III:Class III:GAL
Class IV:Class IV:
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40. Class I:Class I: The GAL angle is between 450 and
900 and the lateral incisor is touching or below (1- 2
mm) the GAL-
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41. Class II: The GAL angle is between 450 and 900
but the lateral incisor is above(1-2mm) the GAL and
its mesial part overlaps the distal aspect of the central
incisor
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42. Class III: the GAL is 900, and the canine,
lateral and central incisors all lie below the GAL-
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43. Class IV: The gingival contour cannot be
assigned to any of the above 3 classes. The GAL angle
can be acute or obtuse.
In a single mouth, the right and left sides can display
different GAL classes.
The aim of the clinician is to restore the gingival
contour to a GAL Class I, 11 or Ill to achieve aesthetic
appraisal.
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44. EXTRA ORAL ANATOMYEXTRA ORAL ANATOMY
Extra—oral anatomy is genetically determined,
consisting of the skeletal and soft tissue land— marks,
the perio-oral skeletal and soft tissue form of the lower
third of the face should harmonize with the dentition.
During a relaxed ideal smile, the upper lip exposes the
cervical aspects of the maxillary anterior teeth.
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45. The gingival margins of the maxillary central
Incisors should be symmetrical and at the same
height. Up to 3 mm of gingival exposure above
the cervical margins of the maxillary teeth is
aesthetically acceptable.
Beyond 3 mm results in a ‘gummy smile’
requiring correction by orthodontic or surgical
intervention to avoid visual tension.
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46. Treatment modalities depend on the type of pathosis,
1. Hyper plastic gingivae require gingivectomy or crown
lengthening;
2. Recession can be corrected using orthodontics or cosmetic
periodontal plastic surgery using tissue grafts or guided tissue
regeneration membranes;
3. Over eruption by orthodontic intrusion;
4. Deficient pontic sites by ridge augmentation procedures and
5. Skeletal abnormalities by orthognathic surgery.
E.g.
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47. Esthetic periodontal defects and its
correction
May include :
1. Violations of biologic width
2. Gingival asymmetries
3. Excessively gingival display
4. Localized gingival recessions
5. Deficient pontic areas
6. Abnormal frena.
7. Excessive gingival pigmentation
8. Inadequate interproximal papilla
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48. 1.Violations of biologic width1.Violations of biologic width
Restorations which are over extended in the cervical
region should be carefully removed and proper cleaning
of the teeth is recommended with excavation of deep
carious lesions in the cervical region.
Provisional restorations should then be fabricated
with proper contouring in the cervical region. The
pockets should be probed and isolated areas of
excessive bone loss should be marked and regenerative
procedures instituted.
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49. Surgical technique for establishing proper biologic
width involves recontouring the osseous crest so that a
minimum of 3 mm of the flap can be placed coronal to
the position of the recontoured osseous crest. This will
take into consideration the average biologic width of
2mm.
In accidental tooth fractures or any other clinical
situations where the restorative margins may violate
the biologic width, bone removal in the adjacent teeth
might be necessary to get desired esthetic result
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50. 2.Gingival asymmetries2.Gingival asymmetries
Whenever the facial gingiva of the anterior
teeth does not follow a symmetrical pattern,
crown length discrepancies are perceived; some
teeth appear longer while others appear shorter.
Correcting these discrepancies to an esthetic
gingival pattern becomes the main goal of the
esthetic or restorative dentist.
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51. The possible causes of gingival
asymmetries are :
1. Gingival hyperplasia
2. Altered passive eruption
3. Tooth or teeth malpositioning
4. Over zealous tooth brushing
5. Periodontal disease
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52. Esthetic crown lengthening
When a disparity in the clinical crown length
exits between contra lateral teeth resulting in a
left/right side height discrepancy, esthetic
surgical correction can be provided to enhance
the cosmetic result before restorative measures.
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53. Functional crown lengthening
In such cases ‘esthetic crown lengthening’ may
be carried out by performing gingivectomy and
or osseous resection only on the facial aspect,
for better esthetics.
Root exposure is often a common
complications and intentional root canal or post
surgical treatment with veneers or crowns may
be required
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55. Excessive gingival display (gummy
smile)
A gingival display of more than 3mm in active
or moderate smile may be termed “gummy”.
Excessive gingival display or gummy smile can
be caused by any of three factors.
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56. The causes include:
1. Maxillary over growth
2. Tooth malposition
3. Delayed apical migration of the gingival
margin or altered passive eruption.
Crown lengthening procedures can correct the
latter two defects. Usually a surgical and
orthodontic correction may be needed in these
cases
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57. Excessive gingival pigmentation
Skin tone, texture and color differ in races, and
different regions the color of the human gingiva
also differs, usually pink with certain areas
showing a diffuse pigmentation.
Gingival pigmentation is due to the deposition
of melanin pigments in the basal layer of the
mucosa. In mammals it is brown, black or blue
black.
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58. The saturation of these pigments causes an
unesthetic dark or gingival display.
In people with fair skin and high lip lines. The
pigmentation usually occurs in diffuse patches;
some times a continuous area is seen.
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59. The surgery can be performed under local
anesthesia with the following techniques.
1. Gingivo-abrasion technique
2. Split thickness epithelial excision
3. Combination technique which involves
gingivo-abrasion and split thickness epithelial
excision.
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60. Gingivo-abrasion technique
A medium grit foot ball
shaped diamond bur is used at
high speeds on the epithelium
to denude it.
Care should be taken not to
abrade the periosteum.
A periodontal pack is the
placed over the denuded
epithelium.
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61. Split thickness epithelial excision
technique
A split thickness island of epithelium is
removed on the attached part of the mucosa.
A periodontal pack is then placed and left
for a week.
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62. Combination technique
In cases where pigments are present very
close to the marginal gingiva and where the
gingival pattern as areas of depression and
elevations on the facial aspect, a combination
technique is advised.
Gingivo-abrasion is used near the marginal
gingiva and areas where a split excision of
difficult.
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63. Open inter proximal spaces
Open inter-proximal space may be caused due to
diverging roots, abnormal clinical crown shape and
absence of inter proximal papilla.
The first two can be corrected orthodontically and by
the reshaping of the clinical crown respectively. While
the last is the most difficult to manage.
Because currently there are no predictable methods to
regenerate the inter proximal papilla.
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64. Review of literature
David J. Clark, DDS and Jihyon Kim,; Optimizing Gingival
Esthetics A Microscopic Perspective
CONCLUSION
Reasonable restorative outcomes can be achieved with amalgam
and gold with low or no magnification. In contrast, tooth
colored materials require much higher levels magnification for
consistent success. Common clinical magnification simply has
not kept pace with dramatic changes in restorative materials
and patient expectations. In spite of other advances in
dentistry, marginal integrity, emergence profile, and resistance
to micro leakage have all taken a giant step backward.
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65. MICHAEL S. REDDY, D.M.D., D.M.Sc Achieving gingival
esthetics; JADA, Vol. 134, March 2003
The typical gingival esthetic problems of excessive gingival
display, asymmetry in gingival contours, exposed root surfaces
and loss of papillae can limit the success of cosmetic and
prosthodontic treatment.
In many cases, the combination of periodontal esthetic surgery
with other restorative procedures can create a synergistic
esthetic result that could not have been obtained with either
treatment alone
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68. Anterior Esthetic Gingival Depigmentationand Crown
Lengthening: Report of a Case; The Journal of Contemporary Dental Practice,
Volume 6, No. 3, August 15, 2005
Conclusion
Excessive gingival display and gingival hyper pigmentation are
major concerns for a large number of patients. Although several
techniques are currently in use, the scalpel technique is still the
most widely employed.
Lasers and cryosurgery may offer less postoperative pain.
Additionally, a surgical soft tissue grafting for depigmentation
may ensure less chance for recurrence over a five year follow up.
the external bevel gingivectomy combined with the
depigmentation procedure described above offers practical
technique to dramatically improve patient esthetics.
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71. CONCLUSIONCONCLUSION
Tooth color is obviously essential in the final result, but
esthetic treatment planning should never be devised
around shading improvements alone.
Failure to take account of the soft tissue considerations
will negate all the other aspects of treatment, resulting
in ultimate esthetic failure. Rather than an
afterthought, the gingival viewpoint, at the outset,
should be an integral part of any esthetic treatment
planning, ensuring health, approval and longevity of the
final result
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72. REFERENCES
1. GERARD CHICHE & ALAIN PINAULT
– Esthetics of fixed prosthodontics.
2. CLAUDE R. RUFENACHT, fundamentals
of esthetics
3. CHICHE, esthetics of anterior fixed
prosthodotics.
4. GARDIN, Porcelain laminate veneers
5. SOLOMON EGR: Esthetic consideration of
smile; IPS; 1999: 10(3&4); 41-47
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73. 6. GOLDSTEIN, RE: Change your Smile, ed 3
Chicago, Quintessence, 1997
7. British Dental Journal 2005; 199: 195-202.
8. Dental clinics of North America – 1998 – Achieving
optimal gingival esthetics around restored natural
teeth & implants
9. David J. Clark, DDS and Jihyon Kim,; Optimizing
Gingival Esthetics
A Microscopic Perspective
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74. 10. Anterior Esthetic Gingival Depigmentationand
Crown Lengthening: Report of a Case; the Journal
of Contemporary Dental Practice, Volume 6, No. 3,
August 15, 2005
11. 11.Rosa DS, Aranha AC, Eduardo Cde P, Aoki A
Esthetic treatment of gingival melanin hyper
pigmentation with Er:YAG laser: short-term clinical
observations and patient follow-up. . J Periodontol.
2007 Oct; 78(10):2018-25.
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