Esthetic Presentation 1 (RDS531) 2023 PDF

Osama Bagabas BDS, MS Restorative Dental Science Department College of Dentistry Taibah University Conservative Esthetic Procedures O. Bagabas References ž Sturdevant’s Art and Science of Operative Dentistry, Harald O. Heymann. Sixth Edition. Chapter 12. ž The Scien...

Osama Bagabas BDS, MS Restorative Dental Science Department College of Dentistry Taibah University Conservative Esthetic Procedures O. Bagabas References ž Sturdevant’s Art and Science of Operative Dentistry, Harald O. Heymann. Sixth Edition. Chapter 12. ž The Science and Art of Porcelain Laminate Veneers. Galip Gurel. Chapter 1 & 2 ž Bhuvaneswaran M. Principles of smile design. Journal of conservative dentistry 2012; 13(4): 225. Conservative Esthetic Procedures O. Bagabas Contents ž Introduction ž Components of Dental Esthetic ž Smile Design & Analysis ž Causes of Esthetic Defects ž Limiting Problems in Restoring Esthetics ž Esthetic Treatment Modalities Conservative Esthetic Procedures O. Bagabas Contents ž Introduction ž Components of Dental Esthetic ž Smile Design & Analysis ž Causes of Esthetic Defects ž Limiting Problems in Restoring Esthetics ž Esthetic Treatment Modalities Conservative Esthetic Procedures O. Bagabas Conservative Esthetic Procedures O. Bagabas Definition ž Esthetics is defined as the appreciation to the sense of beauty. ž Dental esthetic procedure is any dental work that conservatively enhance and strengthen the health and function of a patient's overall appearance and smile. ž The esthetic dentist's should provide treatment that is esthetically pleasing, functional, as well as biocompatible. Conservative Esthetic Procedures O. Bagabas Significance of Dental Esthetics ž The lower one-third of the face has a major impact on the perception of facial esthetics, and the role of a beautiful smile, therefore is important for self- image and confidence. Conservative Esthetic Procedures O. Bagabas Significance of Dental Esthetics ž The size and the mobility of the mouth make it the most dominant feature of the face. ž For that reason the teeth and smile play a major role in individual’s face attractiveness. Conservative Esthetic Procedures O. Bagabas Significance of Dental Esthetics Conservative Esthetic Procedures O. Bagabas Perception of Dental Esthetics ž Patient’s perception to dental esthetics can be influenced by several factors such as age, gender socioeconomic status or life style. ž Smile concepts are subjective and opinion varies depending on personal experience and degree of professionalism. Conservative Esthetic Procedures O. Bagabas Perception of Dental Esthetics ž Patient’s perception to dental esthetics can be influenced by several factors such as age, gender socioeconomic status or life style. ž Smile concepts are subjective and opinion varies depending on personal experience and degree of professionalism. Conservative Esthetic Procedures O. Bagabas Conservative Esthetic Procedures O. Bagabas Esthetic Formula ž The natural harmony between teeth, supporting bones of the jaws and soft tissue of the face, this provides the esthetic formula. ž Components of esthetic formula of the face: 1- Basal Bones 2- Musculature 3- Teeth Conservative Esthetic Procedures O. Bagabas 1- Basal Bones ž The mandible and maxilla provides: - Form and contour of lower face - Foundation for lips, cheeks and associated musculature Conservative Esthetic Procedures O. Bagabas 1- Basal Bones ž Disharmony in size or functional relationships of jaw bones may cause noticeable face deformity Conservative Esthetic Procedures O. Bagabas 1- Basal Bones ž The disharmony may be due to: - Over or underdevelopment of mandible or maxilla - Loss of alveolar bones following tooth extraction Conservative Esthetic Procedures O. Bagabas 1- Basal Bones “Straight” Class I “Convex” Class II “Concave” Class III Conservative Esthetic Procedures O. Bagabas 2- Musculature ž The size and attachment of lips have special importance in the overall esthetic appearance, specially the upper lip. Conservative Esthetic Procedures O. Bagabas  2- Musculature Lip size and shape differ from person to another affecting the appearance of the smile Conservative Esthetic Procedures O. Bagabas 2- Musculature A patient with an incisal line asymmetry, the lips are sagging towards the right due to loss of muscle tone Conservative Esthetic Procedures O. Bagabas 2- Musculature ž Muscles of upper lip determine: 1- The level of lip line. 2- The extent of the area showing from anterior teeth and gingiva during smiling or talking. Conservative Esthetic Procedures O. Bagabas 2- Musculature High, medium and low lip lines. Gingival margins of upper teeth and the inferior border of the upper lip are the important landmarks in determining the level of the lip line. Conservative Esthetic Procedures O. Bagabas 3- Teeth ž Teeth play important role in the esthetic formula, also on the personality and psychological health of the individual. ž Their appearance may be drastically damaged by esthetic defects that may involve their color, size, form, translucency, surface texture, position and alignment. Conservative Esthetic Procedures O. Bagabas 3- Teeth ž The role of teeth in esthetic formula is divided into: a. Micro esthetic b. Macro esthetic Conservative Esthetic Procedures O. Bagabas A) Micro Esthetic ž All features that make an individual tooth looks natural are considered micro esthetic. ž These features include: 1- Color 2- Translucency 3- Size 4- Shape or Form 5- Surface texture 6- Alignment and Position Conservative Esthetic Procedures O. Bagabas B) Macro Esthetic ž Macro esthetic includes the inter-relationship between the face, lips, gingiva and teeth. ž This relationship includes: 1- Dental & Facial Midline 2- Smile line 3- Incisal Position & Length 4- Gingival Level and Zenith 5- Anterior teeth proportion (Golden proportion) Conservative Esthetic Procedures O. Bagabas Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile Design is defined as the planning and pre-visualization of the desired end result of an esthetic dental treatment targeting a more pleasant state according to rules of facial, dental and gingival harmony as well as to the patient’s demands. Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis 3. Gingival analysis Lips 4. Dental analysis Gingiva Teeth Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis 3. Gingival analysis Lips 4. Dental analysis Gingiva Teeth Conservative Esthetic Procedures O. Bagabas Smile Design 1. Facial analysis a. Face Shape Face morphology is important factor for determination of the tooth morphology. The basic shape of the face when viewed from the frontal aspect can be square, tapering, square tapering or ovoid. Conservative Esthetic Procedures O. Bagabas Smile Design 1. Facial analysis b. Lateral Profile Convex, concave or straight Conservative Esthetic Procedures O. Bagabas Smile Design 1. Facial analysis c. Facial Midline An imaginary line located in the center of the face drawn between the nasion, base of the philtrum and chin. Whenever possible the midline between the maxillary central incisors should be coincided with the facial midline. Conservative Esthetic Procedures O. Bagabas Smile Design 1. Facial analysis d. Interpupillary line It passes through the center of the pupil of each eye. The interpupillary line should be perpendicular to the midline of the face and parallel to the incisal plane. Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis 3. Gingival analysis Lips 4. Dental analysis Gingiva Teeth Conservative Esthetic Procedures O. Bagabas Smile Design 2. Labial analysis a. Lip morphology Conservative Esthetic Procedures O. Bagabas Smile Design 2. Labial analysis b. Lip Line - Refers to the position of the inferior border of the upper lip during smiling. - Determines the display of tooth or gingiva at this hard and soft tissue interface. Conservative Esthetic Procedures O. Bagabas Smile Design 2. Labial analysis b. Lip Line - “High lip line” 3-4 mm of gingiva exposed on smiling - “Medium lip line” 1-2 mm of gingiva exposed on smiling - “Low lip line” showing only the edges of upper front teeth on smiling Conservative Esthetic Procedures O. Bagabas Smile Design 2. Labial analysis b. Lip Line - “Reversed lip line” showing the lower teeth Conservative Esthetic Procedures O. Bagabas Smile Design 2. Labial analysis b. Lip Line ”Gummy smile” exposure of excessive amounts (5 mm or more) of gingiva on smiling or during conversation. It often requires surgical and cosmetic periodontal recontouring to achieve good results. Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis 3. Gingival analysis Lips 4. Dental analysis Gingiva Teeth Conservative Esthetic Procedures O. Bagabas Smile Design 3. Gingival Analysis a. Gingival level and symmetry - The cervical gingival height (position or level) of the centrals should be symmetrical. It can also match that of the canines. - For a pleasing esthetics, the gingival margin of the lateral incisor is 0.5–1 mm below that of the central incisors and canines. Conservative Esthetic Procedures O. Bagabas Smile Design 3. Gingival Analysis a. Gingival level and symmetry The pleasing relationship of the gingival levels should create a shallow reverse triangle. The apex of the triangle (gingival level of the lateral incisor) is 0.5 to 1 mm positioned incisally Conservative Esthetic Procedures O. Bagabas Smile Design 3. Gingival Analysis b. Gingival Zenith - Zenith points are the most apical points of the clinical crowns. - The zenith points are generally located just distal to the vertical midline of anterior teeth except lateral incisors. The laterals’ zenith points are located more central or on the midline. Conservative Esthetic Procedures O. Bagabas Smile Design 3. Gingival Analysis c. Gingival Size - Gingival hypertrophy or gingival recession should be treated with periodontal surgery before any esthetic treatment. Gingival hypertrophy: (a) before treatment, (b) after treatment Conservative Esthetic Procedures O. Bagabas Smile Design 3. Gingival Analysis c. Gingival Size - Gingival hypertrophy or gingival recession should be treated with periodontal surgery before any esthetic treatment. Gingival recession (before and after treatment) Conservative Esthetic Procedures O. Bagabas Smile Design ž Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis 3. Gingival analysis Lips 4. Dental analysis Gingiva Teeth Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis a. Dental Midline Dental midline is an imaginary vertical line between central incisors, ideally should coincides and parallel with the facial midline. Also perpendicular to the incisal plane. Minor discrepancies between facial and dental midlines are acceptable and not noticeable (1-2mm) Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis a. Dental Midline Dental midline is an imaginary vertical line between central incisors, ideally should coincides and parallel with the facial midline. Also perpendicular to the incisal plane. Minor discrepancies between facial and dental midlines are acceptable and not noticeable (1-2mm) Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis a. Dental Midline A slanted midline, or a dental midline that is placed obliquely in relation to the facial midline will always distort the symmetry and esthetics. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis b. Incisal edge length, position and display Incisal edge positioning is determined by the vermillion border of the lower lip, parallel to interpupillary line, phonetics and lower anterior teeth. The incisal edge of the maxillary central incisors is very imperative in the creation of a smile. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis b. Incisal edge length, position and display Mandibular Incisors establish occlusal contact with the maxillary incisors owing to their position, which is 1 mm behind and 1 mm below the edges of the maxillary teeth. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis b. Incisal edge length, position and display Phonetic including the ”F” sound is one of the most useful guides for precisely positioning the upper incisal plane because to make an F sound, air is compressed into a broad, flat band between the lower lip and the upper incisal edges. The incisal plane should contacts inner vermillion border during gentle speech. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis b. Incisal edge length, position and display The “S” sound is used to evaluate the upper teeth slightly overlapping the lower teeth so that lower teeth edges can evenly approximate the concavity of the lingual upper teeth. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis b. Incisal edge length, position and display When the mouth is relaxed and slightly open, approximately 3.5 mm of the incisal third of the maxillary central teeth should be visible in young individuals. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis c. Smile Line Smile line is identified as an imaginary line along incisal edges of the maxillary anterior teeth that mimic the curvature of the superior border of the lower lip while smiling. In a pleasing smile, smile line follows the incisal edges of the maxillary anterior teeth that follow the convex curvature of the lower lip. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis c. Smile Line Convex Smile Line Flat Convex Smile Line Reverse Smile Line Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color The most noticeable element in smile creation. ž Color Parameters : a) HUE: Color tone or color name. b) CHROMA: The intensity or saturation of hue. c) VALUE: Relative darkness and lightness of color Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color Hue: Color tone or color name Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color Chroma: The intensity or saturation of color Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color Value: Relative darkness and lightness of color Conservative Esthetic Procedures O. Bagabas Smile Design Gingival 1/3 Middle 1/3 4. Dental Analysis d. Teeth Color Incisal 1/3 Teeth typically are composed of a multitude of colors. A gradation of color usually occurs from the gingival region to the incisal region, with the gingival region being typically darker because of thinner enamel. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: I. Shade Taps (Visual technique) Classical shade guide, hue is categorized according to groups with letter notations: A- Orange B- Yellow C- Yellow/Gray D- Orange/Gray (Brown) Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: I. Shade Taps (Visual technique) Chroma is categorized 1 to 4 1 is the least chromatic, 4 is the most chromatic. 1 to 4 not only increasing in chroma but also decreasing in value (1 high value, 4 low value) Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: I. Shade Taps (Visual technique) The order for shade selection is selecting value first, chroma and hue lastly Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: II. Digital shade selection (Instrumental technique) a) Spectrophotometer b) Colorimeter c) Digital cameras and imaging systems Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: II. Digital shade selection (Instrumental technique) a) Spectrophotometer Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: II. Digital shade selection (Instrumental technique) b) Colorimeter Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis d. Teeth Color ž Shade selection methods: II. Digital shade selection (Instrumental technique) c) Digital cameras and imaging systems Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis e. Translucency and Surface Texture The degree of translucency is related to how deeply light penetrates into the tooth or restoration before it is reflected outward. Translucency is greatly affected by surface texture which refers to the degree of smoothness or roughness on the tooth surface. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis e. Translucency and Surface Texture The maxillary right central incisor exhibits intrinsic yellow staining as a result of calcification. Opaque composite veneer used to mask the stain. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis e. Translucency and Surface Texture Anatomic features of natural teeth surfaces (e.g, developmental depressions, prominences) make the light breaks up and reflects it in many directions. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis f. Teeth size & proportion ž Centrals dominance The centrals are the key to the smile. They must be the dominant teeth in the smile and they must display pleasing proportions. The width to length ratio of the centrals should be approximately of 75–80%, which is considered the most acceptable Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis f. Teeth size & proportion ž Centrals dominance In most cases, the width of the central incisors ranges from 8.37 mm to 9.3 mm, whereas the length differs from 10.4 mm to 11.2 mm. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis f. Teeth size & proportion ž Golden proportions Is considered a mathematical tool for determining dominance and proportion in the arrangement of the maxillary anterior teeth when viewed facially. It follows that if the width of the lateral incisor is 1, the central should be 1.6 times wider and the canine 0.6 times narrower. Golden proportion calculation not always used and sometimes difficult to be applied because it doesn't use the actual teeth width. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis g. Teeth Shape The shape of teeth largely determines their esthetic appearance. The personality, age and gender of the person can reflect in the shape and form of that individual's teeth. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis g. Teeth Shape Examples: -Youthful teeth have unworn incisal edges, aged teeth are worn and shorter. -Female teeth are round and soft, male teeth are more cuboidal and sharp. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis h. Teeth Alignment and Position Teeth should be aligned in harmony. Malposed or rotated teeth disrupt the arch form and may interfere with the appearance of the dental esthetics. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis h. Teeth Alignment and Position There should be natural, progressive increase in the mesial axial inclination toward the mesial of each following anterior tooth (from the central to the canine) Axial inclination Least noticeable with the centrals and more pronounced with the laterals and more so with the canines Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis h. Teeth Alignment and Position Teeth alignment before and after orthodontic treatment Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis i. Interproximal Contact Point As a general rule, the interproximal contact point moves more apically as it goes posteriorly from the midline. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis j. Incisal Embrasures Embrasures are V shaped spaces present interproximally around the proximal contact existing between the adjacent teeth. The incisal embrasures should display a natural, progressive increase in size or depth from the central to the canine. Conservative Esthetic Procedures O. Bagabas Smile Design 4. Dental Analysis Conservative Esthetic Procedures O. Bagabas Smile Design Digital Smile Design The Digital Smile Design is a multiuse conceptual tool that can strengthen diagnostic vision, improve communication, and enhance predictability throughout treatment. Digital Smile Design sketches can be performed in presentation software such as Keynote or Microsoft PowerPoint. Conservative Esthetic Procedures O. Bagabas Conservative Esthetic Procedures O. Bagabas Practice Quiz ž One of the following is not considered a micro esthetic feature of the teeth: a) Teeth shade b) Alignment and position of teeth c) Teeth form and characteristics d) Gingival level of teeth Conservative Esthetic Procedures O. Bagabas Practice Quiz ž One of the following is not considered a micro esthetic feature of the teeth: a) Teeth shade b) Alignment and position of teeth c) Teeth form and characteristics d) Gingival level of teeth Conservative Esthetic Procedures O. Bagabas Practice Quiz ž Inthe classical shade guide system (shade taps), shade A4 consist of: a) Low chroma & low value b) High chroma & high value c) High chroma & low value d) Low chroma & high value Conservative Esthetic Procedures O. Bagabas Practice Quiz ž Inthe classical shade guide system (shade taps), shade A4 consist of: a) Low chroma & low value b) High chroma & high value c) High chroma & low value d) Low chroma & high value Conservative Esthetic Procedures O. Bagabas Conservative Esthetic Procedures O. Bagabas