Conservative Esthetic Procedures PDF

Osama Bagabas BDS, MS Restorative Dental Science Department College of Dentistry Taibah University Contents Introduction Components of Dental Esthetic Smile Design & Analysis Causes of Esthetic Defects Limiting Problems in Restoring Esthetics Esthetic Treatment Modalities Conservative Esthetic Procedures O. Bagabas Contents Introduction Components of Dental Esthetic Smile Design & Analysis Causes of Esthetic Defects Limiting Problems in Restoring Esthetics Esthetic Treatment Modalities Previous lecture Definition of Dental esthetic procedure: is any dental work that conservatively enhance and strengthen the health and function of a patient's appearance and smile. Previous lecture Importance of the smile and its appearance to the face and to the person. Subjective factors affecting the person’s perception to dental esthetics. Previous lecture The role of teeth in esthetic formula is divided into: a. Micro esthetic b. Macro esthetic Previous lecture A. Micro Esthetic All features that make an individual tooth looks natural are considered micro esthetic. These features include: 1- Color 2- Translucency 3- Size 4- Shape or Form 5- Surface texture 6- Alignment and Position Previous lecture B. Macro Esthetic includes the inter-relationship between the face, lips, gingiva and teeth. 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) Previous lecture Smile Design & Analysis Smile design should follow proper analysis that includes: 1. Facial analysis Face 2. Labial analysis Lips 3. Gingival analysis Gingiva 4. Dental analysis Teeth Previous lecture Smile Design & Analysis 1. Facial analysis ü Face Shape ü Lateral Profile ü Facial Midline ü Interpupillary line Previous lecture Smile Design & Analysis 2. Labial analysis ü Lip Morphology ü Lip Line Previous lecture Smile Design & Analysis 3. Gingival analysis ü Gingival Level & Symmetry ü Gingival Zenith ü Gingival Size Previous lecture Smile Design & Analysis 4. Dental analysis ü Dental Midline ü Incisal edge length, position and display ü Smile Line ü Teeth Color ü Translucency & Surface Texture ü Teeth Size & Proportion ü Teeth Shape ü Teeth Alignment and Position ü Interproximal Contact Point ü Incisal Embrasures Contents Introduction Components of Dental Esthetic Smile Design & Analysis Causes of Esthetic Defects Limiting Problems in Restoring Esthetics Esthetic Treatment Modalities Etiology of Esthetic Defects 1. Dental caries 2. Faulty restoration 3. Loss of tooth substance 4. Tooth discoloration 5. Anatomical abnormalities 6. Missing teeth 1. Dental Caries Cause discoloration of remaining tooth substance. Can cause change in tooth translucency if the pulp involved. Cause loss of tooth structure and form. Can create tooth movement such as over eruption of opposing and drifting of adjacent teeth. 1. Dental Caries Dark discoloration caused by dental caries 1. Dental Caries Loss of tooth structure as a result of dental caries 2. Faulty Restoration including direct, indirect or implant supported restorations: Improper size or shape of the restoration Restoration with inaccurate color match Marginal discoloration and recession. Restoration with recurrent caries 2. Faulty Restoration Inaccurate crown shade, shape and margin can cause esthetic failure 2. Faulty Restoration Discoloration from anterior composite restoration 2. Faulty Restoration Crowns with marginal recession and root caries 2. Faulty Restoration Metal showing on a dental implant crown 3. Loss of Tooth Substance Traumatic fracture Erosion Abrasion Attrition Abfraction 3. Loss of Tooth Substance Traumatic fracture Loss of tooth structure due to trauma 3. Loss of Tooth Substance Erosion Loss of tooth structure by non bacteriogenic acid 3. Loss of Tooth Substance Abrasion Loss of tooth structure caused by foreign object friction 3. Loss of Tooth Substance Attrition Loss of tooth structure caused by tooth to tooth contact 3. Loss of Tooth Substance Abfraction Loss of cervical tooth structure caused by heavy mechanical stresses from grinding, clenching or biting 4. Tooth Discoloration A. Extrinsic Stains - Stains located on outer surfaces of teeth. - Stains may be related to poor oral hygiene, existing restorations, plaque accumulation or eating/drinking habits. - Most surface stains can be removed by routine prophylactic procedures such as polishing or microabrasion. 4. Tooth Discoloration A. Extrinsic Stains Plaque stained teeth 4. Tooth Discoloration A. Extrinsic Stains Brownish stained teeth caused by tobaco 4. Tooth Discoloration B. Intrinsic Stains - Intrinsic discolorations are caused by deeper (not superficial) internal stains or enamel defects. - Causative factors include hereditary disorders, medications (particularly tetracycline), excess fluoride, high fevers associated with early childhood illnesses, and other types of trauma. - Mostly more difficult to treat and require more advanced procedures. 4. Tooth Discoloration B. Intrinsic Stains Enamel Hypoplasia or Amelogenesis Imperfecta is a hereditary condition which can cause white narrow horizontal bands and lines of discoloration to teeth varying from yellow to dark brown. 4. Tooth Discoloration B. Intrinsic Stains Dentinogenesis imperfecta is a genetic disorder of tooth development that affect the dentin. This condition causes the teeth to be discolored (most often a blue-gray or yellow-brown color) and translucent. 4. Tooth Discoloration B. Intrinsic Stains Staining by tetracycline drugs. severity of the staining depends on the dose, duration of exposure, and the type of tetracycline drug used. Discoloration varying from yellow-orange to dark blue-gray. Dark blue gray stained teeth are more difficult to treat. 4. Tooth Discoloration B. Intrinsic Stains Fluorosis is a hypoplastic defect caused by excessive fluoride intake during teeth formation that can result in hypocalcified white/yellow spots. High fevers and trauma to the tooth during its development, Poor oral hygiene or poor oral hygiene during orthodontic treatment can also results in these decalcified defects. 4. Tooth Discoloration B. Intrinsic Stains Non-vital teeth can become discolored intrinsically. The pulp may become infected, degenerates and darken as a result of trauma, deep caries, or irritation from restorative procedures. Trauma resulting in calcification of the pulp also can produce yellowing of the tooth. RCT and materials such as root canal sealer also can cause tooth discoloration. 5. Anatomical Abnormalities Anatomical abnormalities in teeth size, form and position such as midline diastema, crowding or peg shaped incisors can cause problems to dental esthetics. 5. Anatomical Abnormalities Diastema most frequent site is between maxillary central incisors. Causative factors include a prominent labial frenum, congenitally missing teeth, undersized or malformed teeth, arch to tooth size discrepancie, supernumerary teeth. 5. Anatomical Abnormalities Peg shaped teeth a genetic condition that cause underdevelopment of the form of lateral incisors. This will lead to undersized, tapered, maxillary lateral incisor. 5. Anatomical Abnormalities Crowding is the lack of space for teeth to fit normally within the jaws. The teeth may be twisted or displaced. Crowding can be caused by early or late loss of primary teeth, or improper eruption of teeth. 6. Missing Teeth Loosing one or more teeth due to extraction, trauma, or congenital anomalies can cause significant damage to the esthetic of the face and smile. Limiting Problems in Restoring Esthetics Dentists may face some difficulties when restoring anterior dental esthetics. This includes: 1. Exact color matching 2. Gingival & periodontal health 3. Establishment of adequate retention 4. Abnormal occlusion or biting habits 1. Exact Color Matching Exact duplication of color of a particular tooth is a very difficult step because it requires duplicating the combined color of two optically different tissues, enamel and dentin, in one restorative material. Each of the three substances has different optical characteristics. 1. Exact Color Matching The surrounding background and the observer’s eye are significant variable factors, which may affect color selection. A ceramic crown against a dark background appears considerably lighter than against a light background. 1. Exact Color Matching The type and intensity of illumination used for color determination can affect shade selection. Color determination should be done under natural or neutral light illumination. Neutral Light Fluorescent Light Incandescent light 1. Exact Color Matching Metamerism a phenomena in which tooth appear color matched under one type of light source and different under another type of light. Neutral Light Fluorescent Light Incandescent light 1. Exact Color Matching The restoration in the mouth will be subjected to discoloration influences (e.g. food, drinks, smoking) which may affect its color and complicate shade selection. 1. Exact Color Matching Lab technician may not reproduce the exact color blending determined by the operator in case of ceramic restoration. This is because a technician did not examined the patient or evaluated shade features. 1. Exact Color Matching Detailed shade analysis and proper communication (e.g. photographs, shade prescription sheet) between the operator and technician is very important to the outcome of anterior esthetic restorations. 2. Gingival & Periodontal Health Gingival Inflammation & Periodontal Disease Gingival inflammation and associated periodontal destruction are leading factors that can reverse the esthetic outcome in the long term. 2. Gingival & Periodontal Health Gingival Inflammation & Periodontal Disease Establishing definitive restorations when inflammatory periodontal problems are present not only restrains esthetic success, but also accelerates the rate of periodontal destruction. 2. Gingival & Periodontal Health Gingival Inflammation & Periodontal Disease Elimination of gingival inflammation and periodontal disease is mandatory before initiation of any restorative treatment. 2. Gingival & Periodontal Health Restoration Margin and Finish Line The position of the restoration finish line is a crucial step to the health and integrity of the gingiva. 2. Gingival & Periodontal Health Restoration Margin and Finish Line For better esthetic outcomes, margins of crown or veneer restorations in the esthetic zone should be placed subgingivally without violating the biological width. (BW is the distance from the junctional epithelium and connective tissue attachment to the root surface= 2.04 mm) 2. Gingival & Periodontal Health Restoration Margin and Finish Line The standard today is to prepare the finish lines of the restorations slightly below gingival margin (0.5 mm below the marginal gingiva if the sulcus depth is 1 mm, 0.5 to 1 mm if the sulcus depth is exceeding 1.5 mm) 3. Establishment of Adequate Retention Establishment of adequate retention may present a problem if the tooth is extensively damaged and the remaining tooth substance becomes inadequate to provide enough retention for the restoration. 3. Establishment of Adequate Retention Procedures such as full coverage preparation and intra radicular retention may be indicated for both retention and support for extensively damaged or endodontically treated anterior teeth. 4. Abnormal Occlusion or Biting Habits Excessive occlusal forces cause wear of the tooth structure and put a tremendous amount of forces to teeth and restorations. Abnormal occlusal habits such a burxism, clenching and habitual biting on hard objects can cause fracture of esthetic restoration. 4. Abnormal Occlusion or Biting Habits Esthetic restoration such as laminate veneers are contraindicated in case of abnormal occlusal forces is present till the condition is controlled. Bruxism: Excessive teeth girding typically during sleep

Conservative Esthetic Procedures PDF

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