Esthetic

Considerations
in
Fixed Prosthodontics

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.

Frame and Reference

Horizontal References
Inter pupillary line

Incisal plane

Gingival margin
Maxilla
canting

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

Maritato & Douglas 1964 suggested that lip support is a better guide of tooth
position than of Incisal edge position.

Lower lip relation

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
Passive

Active(Moderate)

Gummy smile

Laugh
Negative Space

Smile Line
Youth

Gull wing appearance

Aged

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

Narrowing

Widening

shortening

lengthening

Altering perception between teeth

Perspective by contrast

Parallel perspective

Shading 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

Biologic width

Violation of biologic width

Reestablishing proper biologic width

Correction of Non inflammatory periodontal defects

Replacement of Deficient Crowns

 Frequent mistakes found in Deficient crowns

Incisal plane Too Straight, Canted

Incisal length C I too narrow
L I too wide
Incisal profile- over contoured

 Retreatment of Deficient Crowns

Phase 1
Determine the proper shape and incisal edge position in
the provisional and refine accordingly
Remove the existing crowns, Reprepare the abutments,
Scale and root plane
Harmonize anterior guidance
Phase 2 Reevaluate pulp status, gingival defects,
anterior guidance, and tooth mobility
Phase 3

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 crowns

Metal ceramic crowns

All ceramic crowns

Bleaching
Office
Vital tooth (Power bleach)
Non vital tooth (walking bleach)
35% Hydrogen peroxide
35% Carbamide peroxide
Home
10-15% Carbamide peroxide

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

Peg shaped lateral

Tetracycline stains

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
Thickness requirements according to shade
Dark Shade

Facial reduction 1.4mm

Tooth thickness

2.9mm

Light Shade

Facial reduction 1.7mm

Tooth thickness

3.2mm

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
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

Retraction Techniques
Single String technique
Double String technique
Selective Double String technique

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
Roach RR,Muia Lee 1990
PJ 1988
Orientation Techniques

Occlusal orientation
Face bow Transfer
Inter Occlusal Recording
Anterior Guidance

Conclusion

1. Esthetics of Anterior Fixed Prosthodontics

References

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 3 rd edition
Herbert T. Shillingburg
6. Johnstons
Modern Practice in Fixed Prosthodontics 4 th 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