Fixed lec. Outline Dr.M.

Awad

The Role of Aesthetic Illusions in Solving Aesthetic Problems of Fixed Restorations Main Points:
Factors affecting esthetic How illusion & perception work Possibilities of solving esthetic problems of fixed restoration by illusion & changing perception.

Esthetics:
Teeth interact & must harmonize with three frames Face Lips Gingiva

Factors affecting esthetics:

Horizontal & vertical lines: Upper lip support Lower lip relation Golden proportion Axial alignment Gradation Dental morphology Texture Color Light

Horizontal & vertical lines: Vertically Facial & dental midlines Horizontally: - The hairline - The ophriac line (eyebrows) - The interpupillary line - The interalar line - The commissural line There should be parallelism & harmony between this lines & teeth. Facial midline: Serve to evaluate - The location & axis of the dental midline. - Mediolateral discrepancy in tooth position. Dental midline: - Daily observation reveals that lack of coincidence between location & direction of the two midlines. - Bilateral asymmetry is frequently encountered. Interpupillary line: Incisal plane & gingival margin must be parallel to this line mainly. Strict parallelism is not required. Severe canting involves aggressive treatment. (Ortho,surgery,prostho).

Lip & smile line: - Length & curvature of the lips influence the amount of tooth exposure. - A prominent smile with bright teeth is synonymous to youth & dynamism. - Smile can be classified relating to the height of the upper lip to: 1- High lip line Gummy smile 2- Middle lip line 3- Low lip line 4- Low lip line with posterior gingival display

- Vig & Brundo (The kinetic of anterior teeth) demonstrated that younger patients display more maxillary teeth structures than middle aged patients. - Exposure of teeth & age: Around the age of 40 sagging of facial muscle display less of maxillary teeth, exposure of lower teeth. Around the age of 60 Complete lack of display of upper Around the age of 70 Lower anteriors are appeared only. Incisal plane: Two youthful figures with well defined incisal embrasures: - When the incisal plane is convex. - Gull wing configuration incisal plane of lateral away from central & canine. Straight incisal plane with closed incisl embrasures give the appearing of aging & attrition. Upper lip support: Upper lip support is controlled to a certain extent by the position of the maxillary teeth. Lower lip relation: Feminine smile line Incisal plane of the upper maxillary teeth is parallel to the contour of the lower lip. Masculine smile line Stretched lower lip. F or V position is the position @ which the incisal edges of the maxillary anterior teeth permit the most fluent pronunciation of the "F" or "V" sounds. Golden proportion: - Levin observed that in esthetically pleasing dentitions, viewed from the front, the width of the central incisor is in golden proportion to the width of the lateral incisor, which in its turn is in the golden proportion to the anterior part of the canine. - When golden proportion exists, it produces a steady impression of harmony.

- Preston reported that the golden proportion was found in the relationship between the maxillary central & lateral incisors in only 17% of casts of patients he studies when viewed from the frontal. - Ward derive Recurring Esthetic Dental (RED) proportion which states that the proportion of the successive widths of teeth as viewed from the frontal should remain constant as one moves distally. Axial alignment: - Mesial inclination should become more pronounced from central incisor to canines. - Bilateral axial alignment of posterior teeth should be balanced around the central fulcrum. Gradation - When two similar structures are placed @ different distances, the closest will appear largest. - It gives an illusion of infinite depth. Texture: We are able to evaluate texture optically through the amount of light reflected or deflected so that the surface appears smooth or rough. Color: - It can turn everything into a visual pleasure. - It's a visual effect caused by the way in which light is absorbed or transmitted. - Colors covering a large area appear brighter & more intense than the same colors covering a smaller area. Light: - It is a visual electromagnetic energy with wave length of 380-750nm. - Illusion cant be created unless lighting perspective has been mater by shadow & color. - Transparent material Vs. Translucent material - Surface texture & finish affect how color behaves: Glossy surface high reflection. Matt surface absorbs colors

Illusion and Perception:

Is the art of changing perception to cause an object appear different than it actually is. The contour of the tooth is largely defined by its lateral ridges & perception of this contour is depends upon deflection or reflection of light reaches it. The use of optical concepts to create optical illusion helps to solve or hide an esthetically difficult situation. Computer base imaging processing. Illusion Narrowing contour modification Adjust the lateral prominences toward the center. Increase the curvature of the central prominence mesiodistally. Increase moderately the length of the central prominence. Adjust the lateral prominences proximally. Diminish the curvature of the central prominence mesiodistally. Diminish moderately the length of the central prominence. color modification Increase the staining of the interproximal areas.

Widening

Diminish the staining of the interproximal areas.

Notes: Darker tooth appears narrower and shorter. Longer teeth appears narrower than the shorter one. Darker shade in the cervical area making the tooth look shorter and wider. Lighter shade giving the impression of a longer , narrow tooth. Darker shade cervically & lighter shade interproximally make the teeth appear wider & shorter.

Altering perception by comparison or contrast: Perspective by contrast. Shading perspective. Parallel perspective. Illusive procedures can be summarized as following: 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.

Treatment modalities of esthetic problems:

Various treatment alternatives are available: 1- Porcelain laminate veneers. 2- Full-coverage restorations. (PFM or all ceramic). 3- Resin-retained restorations. 4- Implant supported restorations. Esthetic analysis of deficient restoration: It must be conducted in a logical progression from the incisal edge of definite crown toward the gingival aspect so that tooth structure is evaluated before gingival tissue.

Solving esthetic problems of fixed restoration: 1- Incisal plane:

a- Morphology: A flat incisal plane represents an acceptable pattern in the older age group only. b- Inclination: The incisal plane is generally either parallel to the interpupillary line or slightly to moderately canted. - Slightly canted incisal plane minor incisal reshaping of the incisa edges or no correction at all. - Moderately canted incisal plane partial or full correction of the gingival plane before prosthetic reconstruction. - Severely canted incisal plane aggressive treatment (ortho, surgery, prostho).

2- Incisal length:
a- Determinates: 1ry determinates: - Patient age - Patient gender - Length & curvature of the upper lip - Patient's preference Accessory determinates: - Posterior plane of occlusion - Average anatomic crown length values for the maxillary central incisor which range from 10.4-11.2mm b- Incisal length modification: It's easier to modify tooth length prosthetically with a crown or a porcelain veneer than to surgically alter gingival position.

3- Incisal profile:
The average thickness of a natural maxillary central incisor ranges from 2.5mm for a thin tooth to 3.3mm for a thick tooth. Overcontouring may be suspected when crown thickness exceeds 3.5mm.

4- Tooth proportion:
Computed by dividing the width of the clinical crown by its length.

Pleasing W/L for maxillary central incisor 75-80% Below 65% central incisor may appear too narrow (as with implant or after perio surgery) Above 85% central incisor may appear too short & square (as with attrition or with altered passive eruption. Avoid long tapered, short or square tooth.

5- Optimum tooth-to-tooth relationship:

The ideal proportions between the maxillary incisors may vary within a wide range as long as definite dominance of the central incisors is established.

6- Gingival outline:
The final evaluation of deficient crown is made @ the gingival level. Gingival contour may require alteration to: a- eliminate residual periodontal defects b- Improve symmetry between the maxillary central incisors. c- Enhance tooth proportion. d- Achieve a pleasing gingival outline. e- Reduce excessive gingival display. f- Facilitate the restorative process.

Communication with the dental laboratory:

Diagnostic wax-up Provisional restoration (temporary) Photographs & computerized video imaging For more information, pls. Referred back to Dr.M.Awad's Handout

Shoot for the moon. Even if you miss it you will land among the stars
All the best

Farawlaa