Dental Esthetics Overview

Dental esthetic procedures enhance the appearance and smile of a patient.
The smile has an important role in a person's appearance.
Subjective factors influence a person's perception of dental esthetics.
The role of teeth in esthetic formula is divided into Micro esthetic and Macro esthetic.

Micro Esthetics refer to features that make an individual tooth appear natural.
- Color: The shade of a tooth
- Translucency: The amount of light that passes through a tooth
- Size: The size of a tooth
- Shape or Form: The shape of a tooth
- Surface Texture: The texture of a tooth
- Alignment and Position: The position of a tooth in the mouth
Macro Esthetics refer to the relationship between the face, lips, gingiva, and teeth.
- Dental & Facial Midline: The alignment of the teeth and facial features
- Smile Line: The shape of the gum line when smiling
- Incisal Position & Length: The position and length of the incisal edges of the teeth
- Gingival Level and Zenith: The height and position of the gum line
- Anterior teeth proportion (Golden proportion) The ideal proportion of the anterior teeth

Smile design involves facial, labial, gingival, and dental analysis.
Facial analysis includes:
- The shape of the face
- The lateral profile
- The facial midline
- The interpupillary line
Labial analysis includes:
- Lip morphology (shape and size)
- Lip line (the line where the lip meets the teeth)
Gingival analysis includes:
- Gingival Level & Symmetry: The evenness and height of the gum line
- Gingival Zenith: The highest point of the gum line
- Gingival Size: The width of the gum line
Dental analysis includes:
- Dental Midline
- Incisal edge length, position, and display: The length, position, and visibility of the incisal edges
- Smile Line
- Teeth Color
- Translucency & Surface Texture
- Teeth Size & Proportion
- Teeth Shape
- Teeth Alignment and Position
- Interproximal Contact Point: Where teeth touch each other
- Incisal Embrasures: The spaces between teeth near the incisal edge

Exact color matching: Difficulty in matching the color of restorations to existing teeth
Gingival & periodontal health: Gingivitis and periodontal disease can affect esthetic outcomes
Establishment of adequate retention: Restorations can be challenging to place if the tooth structure is compromised
Abnormal occlusion or biting habits: Problems with biting can cause esthetic issues and restoration failure

Conservative Esthetic Procedures: Minimally invasive procedures that enhance the appearance of teeth.
Non-Conservative Esthetic Procedures: More invasive procedures to improve the appearance of teeth
Advanced Esthetic Procedures: Advanced procedures that address specific esthetic challenges

Dental Caries:
- Can cause discoloration of the remaining tooth substance.
- Can cause change in tooth translucency if the pulp is involved.
- Can cause loss of tooth structure and form.
- Can create tooth movement such as over-eruption of opposing teeth and drifting of adjacent teeth.
Faulty Restoration:
- Improper size or shape of the restoration.
- Restoration with inaccurate color match.
- Marginal discoloration and recession.
- Restoration with recurrent caries.
Loss of Tooth Substance:
- Traumatic fracture
- Erosion
- Abrasion
- Attrition
- Abfraction

Extrinsic Stains:
- Located on outer surfaces of teeth.
- Caused by poor oral hygiene, existing restorations, plaque accumulation, or eating/drinking habits.
- Most can be removed by prophylactic procedures.
Intrinsic Stains:
- Caused by deeper internal stains or enamel defects.
- Caused by hereditary disorders, medications, excess fluoride, high fevers, or trauma.
- More difficult to treat.

Exact Color Matching:
- Difficult to match the color of two optically different tissues (enamel and dentin).
- The surrounding background and the observer’s eye can affect color determination.
- The type of illumination can affect shade selection.
- Metamerism can cause a color mismatch under different light sources.
- Restorations may be subjected to discoloring influences.
- Lab technicians may not reproduce the exact color blending.
Gingival & Periodontal Health:
- Gingival inflammation and periodontal disease can affect esthetic outcomes.
- Restorations in the presence of periodontal problems accelerate the rate of periodontal destruction.
- Elimination of gingival inflammation is necessary before restorative treatment.
- Restoration margins must be placed subgingivally to maintain gingival health.
Establishment of Adequate Retention:
- Retention can be a problem if the tooth is extensively damaged.