esthetics in fpd
DESCRIPTION
esthetics in fixed partial dentureTRANSCRIPT
Considerations in
Fixed Prosthodontics
Esthetic
Contents
•Introduction
•Artistic and Scientific Principles Applied to Esthetic Dentistry
•Esthetic Diagnosis And Treatment planning
• Color and Shade Selection
•Replacement Of Deficient Crowns
•Metal Ceramic Crowns
•All Ceramic Crowns
•Tissue Management & Impression Making for Maxillary Anterior Region
•Provisional Restorations
•Communication with the Dental Laboratory And Try in
•Conclusion
•References
Introduction
Artistic and Scientific Principles
Applied to Esthetic Dentistry
Factors of Esthetic Dentofacial Composition
Frame and Reference: the constructional system that gives shape;a standard for measuring or constructing.
Proportion and Idealism: the relation of one part to another or to the whole
with respect to magnitude,quantity,or degree;a standard of perfection,beauty,or excellence.
Symmetry: the correspondence in size,shape,and relative position of parts on opposite sides of a dividing line or median plane or around a center or axis.
Perspective and Illusion: the technique or process of representing on a plane or curved surface the spatial relation of objects as they might appear to the eye.
Inter pupillary line
• Incisal plane
• Gingival margin
• Maxilla
• canting
Horizontal References
Frame and Reference
Vertical references
Facial Midline
•Location and axis of midline
•Mediolateral discrepancies in tooth position
Golub 1988 said that dental midline perpendicular to the interpupillary line offers one of the most striking facial contrast, serving to anchor the smile
Saggital references
Upper lip support
Lower lip relation
Maritato & Douglas 1964 suggested that lip support is a better guide of tooth position than of Incisal edge position.
Occlusal plane
Phonetic references
M sound
F-V sounds
S-sound or Z sound
Smile elements Lip and Lip Lines
Upper lip line
Length of Maxillary Incisors
Vertical position of the gingival margins
Low Medium High
Lower lip line
Buccolingual position
Curvature of incisal plane
Vig and Brundo 1978 demonstrated that the average maxillary incisor display with the lips at rest
Men 1.91mm Women 3.4mm
Long lips 0.56mm Short lips 3.37mm
Younger pt upto 29 yrs
3.37mm Middle aged 30-50 yrs
1.26mm
Smile
Negative Space
Passive
Active(Moderate)
Laugh
Gummy smile
Smile Line
Youth
Aged
Gull wing appearance
Straight smile line
Proportion and Idealism
Lombardi RE 1973 pointed to the importance of the proportion between width and length in the dimensions of individual teeth and between the respective size of the anterior teeth.
Golden Proportion
Symmetry and Diversity
Patients preferences
Brisman 1980 demonstrated that many patients prefer equilibrated smile arrangements with either alike teeth on a straight incisal plane or a normal sized teeth on a mildly convex incisal plane.
Pleasing natural symmetry
Natural Varitions
•Dental midline Miller et al 1979
•Maxillary central incisors
Mavroskufis F,Ritche GM 1980
•Maxillary lateral incisors
•Maxillary canine
Perspective and illusion
Altering perception of an individual tooth
Normal Widening Narrowing shortening lengthening
Altering perception between teeth
Perspective by contrast
Shading perspectiveParallel perspective
Esthetic Diagnosis and Treatment planning
Diagnosis
Preliminary analysis
Patient History
Clinical Examination
Diagnostic Records
Total Smile analysis
Visual analysis
Space analysis
Profile analysis
Computer analysis
Space Analysis
Profile Analysis
Computer Analysis
• Initial Therapy
• Scaling and Root planning
• Replacement of Deficient crowns
• Mock up
Color and Shade Selection
“Light that enters the human eye from that object”
Dimensions of Color
Color of Human teeth
•Clark 1931was the first to accurately describe the color of the teeth
He found Hue range 6YR-9.3Y Value 0-7
•Sproull Hue range of 7.5YR-2.7Y Value 5.8-8.5 Chroma 1.5-5.6
•Lemire and Burks Hue 8.9YR-3.3Y Value 5.81-7.98 Chroma .8-3.4
Shade Selection
• Timing
• Lighting
• Patient preparation
• Shade guides
Conventional
Custom made
Technology based shade guide systems Shofu shade master-ex chromameter
Coretex machina shade scan
Shade matching with VITAPAN 3D-MASTER
Step 1 : Value determination
Step2 : Chroma determination
Step 3 : Hue verification
Color communication form
Orthodontic considerations
Inclined Incisal plane
Deviated Midline
Periodontal considerations
Restorations for a previously restored dentition
Reestablishing proper “biologic width”
Violation of “biologic width”
“Biologic width”
Correction of Non inflammatory periodontal defects
Replacement of Deficient Crowns
• Frequent mistakes found in Deficient crowns
Incisal plane – Too Straight, CantedIncisal length –C I too narrow L I too wide
Incisal profile- over contoured
• Retreatment of Deficient Crowns
Phase 1
Phase 2
Phase 3
Remove the existing crowns, Reprepare the abutments, Scale and root plane
Determine the proper shape and incisal edge position in the provisional and refine accordingly
Harmonize anterior guidance
Reevaluate pulp status, gingival defects, anterior guidance, and tooth mobility
Finalize crown build ups,axial reduction and margin placement.
Complete final restorations
Restorative dentistry considerations
• Bleaching
• Direct composite resin bonding
• Porcelain laminate veneers
• Resin-bonded Fixed Partial Denture
• Full coverage crownsMetal ceramic crowns
All ceramic crowns
Office
Home
Vital tooth (Power bleach)
Non vital tooth (walking bleach)
10-15% Carbamide peroxide
35% Hydrogen peroxide
35% Carbamide peroxide
•Bleaching
Direct composite resin bonding
Advantages
Immediate esthetic result
Patient satisfaction in one to two visits
Conservative
Relatively low cost
Dis advantages
Repeated chipping
Discoloration
Porcelain laminate veneers
Porcelain laminate veneers
Tetracycline stains
Peg shaped lateral
Resin-bonded Fixed Partial Denture
Metal ceramic crowns
Finish lines
Butel EM,Campbell J C,Difiore PM 1991 conducted a survey of 51 Dental schools
Flat shoulder 38% 45 beveled shoulder 24% 135 shoulder 15% Chamfer 10% Deep chamfer 6%
Margin placement
• Color rendition
Facial reduction 1.4mm
Tooth thickness 2.9mm
Thickness requirements according to shade
Facial reduction 1.7mm
Tooth thickness 3.2mm
Dark Shade
Light Shade
Ideal Difficult
Compensation for thin teeth
Opposing teeth reduction
Lingual stop Lingual plate
All Ceramic crowns
Selection
Esthetic Performance
Semi-translucent
Semi-opaque
Indications
All anterior teeth where esthetics is of prime importance
Contraindications
Para function Short clinical crown Insufficient support from tooth preparation Faulty occlusion
• Preparations for All Ceramic Crowns
Incisal Reduction
Facial and Lingual Reduction
Shoulder
Taper
Impressions for Anterior Dentition • Gingival Retraction
• Retraction TechniquesSingle String technique
Selective Double String technique
Double String technique
Loe and Silness 1963 showed that with normal pressure, Strings had the potential to be pushed into the supracrestal connective tissue
Dargoo and williams 1981 demonstrated that retraction cord placement following sub gingival preparation often tore the epithelial and connective tissue attachments
Albers 1990 said that aluminium chloride is the chemical of choice to prevent recession of thin delicate gingival tissues in the anterior region
Communication with the Dental Laboratory
• Goals
•Predictable try-in
•Minimum adjustment of crown restorations
• Methods of Achieving Goals
•Proper Occlusion and Orientation of the Master cast
•Determination of Incisal edge position
•Communication of tooth shape and arrangement
•Proper shade Prescription
Orientation of the Master Cast
Esthetic orientation
Occlusal orientation
•Roach RR,Muia Lee 1990
•PJ 1988
•Orientation Techniques
• Face bow Transfer
•Inter Occlusal Recording
•Anterior Guidance
Conclusion
References1. Esthetics of Anterior Fixed Prosthodontics
Gerard chiche
2. Esthetic Dentistry
Ratnadeep patil
3. Perspectives in Dental Ceramics: Proceedings of the fourth international symposium on ceramics, Chicago 1988 Quintessence
4. Fundamental in Esthetics
Claude R Rufenacht
5. Fundamentals of Fixed Prosthodontics 3rd edition
Herbert T. Shillingburg
6. Johnston’s
Modern Practice in Fixed Prosthodontics 4th edition Ronald w. Dykema 7. Contemporary Fixed Prosthodontics 3rd edition Stephen F.Rosensteil
8. J Prosthet Dent 1955 ;5:586
9. J Prosthet Dent 1956;6:441
10. J Prosthet Dent 1961;11:743
11. J Prosthet Dent 1964;14:848
12. J Prosthet Dent 1973;29:358
13. J Prosthet Dent 1980;43:254
14. J Am Dent Assoc 1988;38
15. Int J Periodont Rest Dent 1988;8(3):45-55
16. J Esthet Dent 1994;6(2):47-60
17. Int L Prosthodont 2002;15:524-528
18. J Prosthet Dent 2003
19. J Prosthet Dent 2003
A smile is a curve that brightens several hearts
-So keep smiling always