CREATING ESTHETIC RESTORATIONS PRESENTED BY : DR. Supratim tripathi TOOTH CARE DENTAL CLINIC ,LUCKNOW, UTTAR PRADESH. INDIA. 7800302984
IntroductionCreating illusions is one of the most important objectives of esthetic dentistry
Esthetics in dentistry requires the artistic skill ofbalancing illusion with reality. This balance iscalled perception – the aspect concerned withvisualization of the appearance.The nature of the substance of the substance ofenamel and dentin and the color of gingivainfluence the ultimate color of the teeth.
Illusion is the art of changing the perception ofan object to appear different from what it is.Illusion about size, shape and color can becreated to solve or hide an esthetically difficultsituation.For this purpose one should understand factorssuch as lighting perspective, rendering of textureand use of colors that make the illusion possible.
PRINCIPLES OF ILLUSION Light has the ability to change theappearance of a surface by its relation to thatform.The relationship of lines plays an importantrole in creating illusion.
COLORProperly used color creates atmosphere,defines space and proportion and establishesorder.
To understand color and the nature of colors following definitions are helpful : Hue : it is the name of the color. Chroma : it is the concentration of color. It represents the saturation of a color Value : it is the degree of whiteness and blackness of the color. Value is measured in variations of grey. Primary colors : these are red, yellow and blue. secondary colors : these are the blend of any two primary colors
• Tints : these are intense colors that are typicallyused to impart character.• Shades : these are colors with quantam of blackadded to a base color.• Temperature : it refers to how warm or cool acolor appears to the eye.Colors used interdentally can make the tooth looknarrow or wide and colors used incisally or at thegingival inclines can make the tooth look elongatedor short.
Illusion cannot be created unless lightingperspective has been mastered .To achieve a successful estheticrestoration one should have a workingknowledge of the properties of light andits characteristics.
Light : is a form of radiant energy consisting of electromagnetic waves including UV light , visible light and IR light.Reflection : it refers to two types – Diffused reflection : in which light waves bounce off objects so that the observer perceives the object rather than the light. Regular Reflection : as in a mirror in which the reflection of the object can be seen.
Refraction : it is the bending of light rays as they pass through one medium to another.Deflection : it is the reflection of light from a surface in a direction different from that of the entry.Absorption : it is the phenomenon in which light is absorbed fully or partly by the object. Metamerism : it is the phenomenon in which the color of an object exposed to two different light sources appears different under each condition. Opacity : it is the quality of an object by which it absorbs or completely reflects all the light falling on its surface.
Creating illusion depends on he control of lightreflection and color contrast on the surface ofthe objects Increased contrast increases visibility .Increased light reflection increases visibility.Increased light deflection diminishes visibility.Shadows create depth.Light creates prominence.vertical lines accent length.horizontal lines accent width.
StainingStaining is the final opportunity to enhance the original shade and to correct and improve restorations.Color indications yellow-orange Creates illusion of narrowness; simulates craze lines. yellow-brown masks blue tetracycline stains blue, gray, violet simulates translucency, decreases value or brightness white increases the brightness; simulates craze lines; simulates enamel hypo calcifications; white spots red, pink simulates gingival tones; enhances vitality; masks blue tetracycline stains
ProcedureTooth preparationCleaning of the toothEtching of the tooth
Applying opaquerPlace a thin layer as a base.the opaquer layer masks anystains or discolorations presenton the tooth surface.
Cervical layerThe composite of thecervical shade is placedfrom the gingival marginand reduced in thicknessto a thin layer and mergedwith the opaquer.
Body layerthis layer projects theoverall hue of the toothand so must be chosencarefully. The layer isblended over the cervicallayer placed , more overthe labial surface andthinned down to theincisal margin.
Applying TintsTints are translucent andcover the spectrum withfairly intense Chroma,simulate general dentinalcolorsThey are used to providesubtle hue enhancements.
Incisal enamelA microfilled compositematerial representing theenamel shade is placednext, on to the incisalthird of the tooth.
Placement of proximalenamelto create the transitionalline angles that give thethird dimension to therestoration a translucentenamel shade is placedon the proximal areasfrom the cervical to theincisal.
Finishing and Polishingfinal finish to therestoration is done alongwith the polishing.
white calcification spots running horizontally across the middle third of the tooth further accentuate widthstaining used to create theillusion of cervical erosion tomatch the adjacent teeth
Check lines andInterproximal restorationstaining has produced theillusion of length.
LIGHT MICROCRACKS SIMULATED RESTORATION AND HYPOCALCIFICATION AREAS HELP CREATE A MORE NATURAL AND YOUTHFUL LOOK.ORANGE STAINING ISDONE HERE WHICH IS ANATURALCHARACTERISTIC OF THEOLDER DENTITION
SHAPING AND CONTOURINGThe most frequent illusion is the creation of a different outline by shaping or carving the tooth
BASIC PRINCIPLES OF ILLUSION CONCERNING SHAPE AND OUTLINE FORM Vertical lines accentuate height and de-emphasize width Horizontal lines accentuate width and de-emphasize height Shadows add depth Angles influence the perception of intersecting lines Curved lines and surfaces are softer ,more pleasing, and perceived as more feminine than sharp angles
ARRANGEMENT OF TEETHThe second most frequently used technique for creating illusions involves the arrangement of the teeth being restored
Creating ‘cracks’ and ‘micro-cracks’ A natural looking micro-crack is added by first applying a broad band of the selected shade of the stain. The flat edge‘micro- The white of the brush is used to achieve cracks appear more the desired thinness esthetically pleasing for a younger patient
Problem : when the tooth is very wide and isneeded to appear thinner
Shallow developmental grooves which break up the smooth labial reflecting surface make the tooth appear less wideFinal result
When space available is too wide, adiastema is preferred
Problem : when the tooth is needed to appear wider thanits actually is Horizontal grooves were carved into the right central (1) to give it a wider appearance
Adding the masculine or the feminine appearance
A SMILE LINE THAT REVEALS UNATTRACTIVE SPACESA REMOVAL ARTIFICIAL TISSUEAPPLIANCE WAS MADE FORTHIS WOMAN ARTIFICIAL GUM APPLIANCE IN PLACE.
LOST GUM TISSUE CAUSING UNSIGHTLY SPACES AND LENGHTENING OF THE CROWNSINCE ENOUGH ENAMELREMAINED ON HERTEETH, THE OLDERFILLINGSWERE REMOVEDAND COMPOSITE RESINBONDING WAS PLACEDAROUND THE NECKS OFTHE FRONT SIX TEETH.
SEVERE TISSUE LOSS W.R.T. RIGHT CANINECOSMETIC GUMSURGERY CONSISTINGOF A GRAFT WAS USEDTO ENHANCE BOTHFUNCTION ANDESTHETICS