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ESTHETICS AND ADVANCED TECHNOLOGY

Presented by:Dr Amit Gupta2

TABLE OF CONTENTS INTRODUCTION HISTORY ORIGIN OF ESTHETICS AND PERCEPTION THE PRINCIPLES OF ESTHETICS FACTORS OF ESTHETIC DENTOFACIAL COMPOSITION FACIAL COMPONENT DENTAL COMPONENT GINGIVAL COMPONENT PHYSICAL COMPONENT

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A Thing Of Beauty Is A Joy Forever The science of esthetics literally means the scienceof beauty in nature and arts

Beauty in itself is a combination of reality andpersonal perception.

Thus the science of esthetics remains inexact and asubjective domain.

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The Origin Of Esthetics And Its Perception: What is esthetics? The Dorland English dictionary describes it asThe science of beauty in nature and arts

According to GPT Esthetics1. The branch of philosophy dealing with beauty 2. In dentistry , the theory and philosophy that deal with beauty and the beautiful , especially with respect to the appearance of a dental restoration , as achieved through its form or color. Those subjective and objective elements and principles underlying the beauty and attractiveness of an object , design and principle

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ESTHETIC PRINCIPLES:COMPOSITION:The physiologic property of eye is vision. Vision is possible if eye can differentiate. Which is possible only if there is contrast. Increase in visibility is proportional to increase in contrast. The relationship between object made visible by CONTRAST is called

Dental composition

Composition.

Terminologies in our field of interest are dental, facial and dentofacial composition.

Dentofacial composition

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The prime requisite of composition is unity. It gives different parts of the composition the effect

UNITY:

of the whole. STATIC UNITY UNITY

DYNAMIC

- composed of regular and geometric shapes E.g drops of water, snow Flake crystals - Is passive and inert and (without motion)

Plants and animals

Active, livinggrowing7

COHESIVE FORCES Elements that tend to unify

SEGREGATIVE FORCESOpposite of cohesive

forces a composition A border is a cohesive force They provide variety in unity as well as arrangement of elements in a definite form or according to a principle.

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SYMMETRY:

It refers to regularity in the arrangement of form andobject.(Furtwangler,1964).

It is and can be totally differentiated from balance in thesense that in balance things that are farther from the center grow in importance and weight..

But in case of symmetry all the elements are alike with

references to there position in relation to a central point.9

HORIZONTAL SYMMETRY

RADIATING SYMMETRY is a result of design of an object extending from a central point and the right and left side are mirror images Represents segregating forces that brings life and dynamism to a composition

Occurs when a design containssimilar elements from left to right in a regular sequence

Is psychologically predictable andcomfortable tends to be monotonous

PRINCIPLE- SYMMETRY MUST BE INTRODUCED IN THE DENTOFACIAL COMPOSITION TO CREATE A POSITIVE PSYCHOLOGIC RESPONSE

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Horizontal symmetry

Radiating symmetry

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Dental esthetics and golden proportion (Edwin I. Levin JPD 40;3, 1978) The concept of beauty has most often corresponded to aharmony in proportion

Proportion :

The true value of proportion inesthetics, is its usefulness as a key tool in providing the unitywith-variety quotient in dental composition.Parthenon

Golden proportion has beenused since time immemorial.Square of the ancients Leonardo da Vinci 12

Proportion between teeth In its simplest form it is the proportion between the larger partand smaller part.0.618A1 1 B

When ratio between B and A is in the golden proportion, then Bis 1.618 times larger than A.

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Berry postulated : mesiodistal width of tooth = 1/16th bizygomaticwidth.

= 1/20th length of face

The geometric theory was challenged by Frush andFisher (1956). They introduced Dentogenic theory in which the tooth selection is governed by Sex, Personality and Age.

4) Golden proportion: This implied that maxillary central incisors approximately 60% wider than lateral incisors Lateral incisors 60% wider than mesial aspect of the canine. Lateral negative space also in golden proportion to half the width of the anterior segment.14

" The HEIGHT of the central incisor is in the Golden Proportion to the WIDTH of the TWO central incisors."

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BALANCE:-

It can be defined as the stabilization resulting from exact adjustment of opposing forces. Our visual sense is used to maintain or induce equilibriumif not established leads to visual tension. To relieve tension or to reestablish balance 2 possibilities are left to the operator /viewer:1) move the causative element towards the line of force until the magnitude of visual tension is totally relieved. 2) introduce an opposite element in the line of force to promote equilibrium

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LINES:It has been stated that many factors that have been a part of structural or biologic beauty depends on visualization of lines. Parallel lines are most harmonious as they do not exhibit conflict Perpendicular suggest psychological relationship and strong segregative forcesVarious lines exists in dental composition: occlusal plane incisal plane midline tooth direction

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DOMINANCE:-

Just as unity is the prime requisite for a good composition, dominance is prime requisite for providing unity dominance provides static unity dynamic unity ( monotonous) (vigorous)

Color, shape and lines are characters that create dominance. e.g.. thecentral incisor must be the most dominant element in the dental composition.

The mouth is the dominant feature of the face. It dominates by virtueof its size, mobility and psychic association. The amount of dominance to be given to the mouth by the dental composition depends on patients personality and strength of background facial features

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FACTORS OF ESTHETIC DENTOFACIAL COMPOSITION AND THERE CLINICAL SIGNIFICANCE: An organized systematic approach is required to evaluate, diagnose and resolve esthetic problems. Two main aims of esthetic treatment:1) create teeth in harmonious proportion to one another 2) to create a pleasing teeth arrangement in harmony with the lips, gingiva and face of the patient.

These factors may be applied to or in treating both edentulous and dentulous patients. The various components of dentofacial complex are: FACIAL COMPONENT DENTAL COMPONENT GINGIVAL COMPONENT PHYSICAL COMPONENT19

Facial Component The esthetic orientation of dental composition with the entirefacial composition can be achieved by taking into consideration the references. References: An artist in his creation of facial form makes use of established guidelines. The dentist as an artist also has to consider a number of established guidelines and make use of available references to orient his creation. The references can be classified as: Horizontal Vertical Sagittal and Phonetic20

Horizontal and vertical references

Axial inclination

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Facial features:

Tooth visibility:

Presence of grooves perpendicular to direction of pull of the muscles is a constant of facial anatomic features. Three important Facial grooves Nasolabial groove. Labial groove. Mento-labial groove.

Vij & Brundo in 1972 made an interesting study related to tooth exposure according to gender, racial factors, age and lip length shows extreme variability of factors. 1. Tooth exposure according to gender appears to be significantly important for females than for males. Exposure in males 1.91mm. Exposure in females 3.40mm (of maxillarycentral incisors).22

2. Race-tooth exposure shows an increase from BlacksAsians-Whites in maxillary central incisors and from Asians-Blacks-Whites for mandibular central incisors. 3. Liplength-people with short upper lip expose maxillary central incisors, whereas people with long upper lip expose mandibular central incisors. 4. With age there is significant decrease in maxillary tooth length exposure.

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Components of smile:A pleasant smile is an expression of joy. The anatomy of smile(Matthews.T.G,JPD1978; 39:128-134) smile expresses it self in oral region and eyes.

The relationship exists between teeth and lips during smile and its harmonious integration in facial composition. The smile can be classified as:

Passive Slight parting of the lips showing incisal portion of the anterior teeth

Active Shows more teeth, some gingiva and negative space with lips slightly stretched at the corner

Laugh Maximum exposure of teeth and gums in an enlarged smile window

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The amount of tooth exposure during smile

Lip Lines:

depends on variety of factors Upper lip line helps to evaluate maxillary incisors exposed at rest and during smile and a vertical position of the gingival margins during the smile. Classified as:

Gummy smile

Low, moderate and high.

Smile can be Toothy or gummy. Lower lip lines helps to evaluate buccolingual position of the incisal edges of the maxillary incisors and curvature of the incisal plane. Smile line: hypothetical curved line drawn along the edges of the four anterior maxillary teeth. the degree of curvature of the incisal line is more pronounced for women than men.

Feminine type of smile line

Masculine type of smile line25

High lip line

Moderate lip line

Preoperative

Low lip linePostoperative26

The incisal plane is said to have Gull-wing appearance. A straight smile line is associated with wear and aging.

Upper lip curvature: Is expected to run upward from the central position to the corner of the mouth depending on the sequence and degree of implication of facial muscles in the development of a smile. Dark spaces that appear between the jaws, at the corner of the mouth or around the facial surfaces of the posterior teeth during laughter and mouth opening. Lateral negative space. Buccal negative space.Absence of negative space 27

Lateral negative space ( gives depth and mystery to the smile)

Negative Space:

Dental components: Facial midline is located in the center of the face pependicular to the interpupillary line.

It has been defined as vertical line drawn through the forehead, nose columella, dental midline and chin.

Heartwell defines it as an imaginary vertical lines that does not necessarily coincide with facial midline.28

SYMMETRY:

A dental symmetry relates to the right and left of the midline. Goal is to strike a pleasing balance between ideal and the deviation.

Axial inclination: Is the direction of the teeth with respect to the central midline. There is a definite mesial inclination of all anterior teeth as well as the premolars and the first molars.

Tooth arrangement: Anterior teeth helps in achieving lip and associated muscle support, enables the fulfillment of esthetics, phonetics and function requirement. Tooth placement is usually obtained by 3 different methods empirical, phonetic, and according to anatomic landmarks. Phonetic method has proved to be important means in determining the vertical dimension.

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Use of anatomic landmarks: Canine papilla canine line (CPC) line drawn from the tip of the canine invariably bisects the middle of the incisive papilla in 92% of the cases (Schiffman, 1984). The distance from the line to the outer labial surface of the central incisor is 10.2mm. Ortman et al,1979 posterior border of incisive papilla is at an average distance of 12.48mm to the labial surface of the maxillary central incisors. Distance between base of the sulcus to the tip of maxillary incisors = 22mm (Turbyfill W.F., Dourdakin J 1989).30

DENTAL MORPHOLOGY 1.TextureThe characterization of the tooth surface is a function of two types of convexities and concavities.

-Anatomy grooves, facets, prominencesthat exists in various degrees.

-The perikymata, stippling and ripplingthat may affect the enamel surface.

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Surface texture The surface topography of young teeth causes

them to reflect more light & appear bright In older teeth due to wear surface is smooth & lower in value Texture has horizontal & vertical components The horizontal components is a result of lines of retzius leaving fine parallel strips on enamel surface called perikymata The vertical component is defined by superficial segmentation in developmental lobes32

2. Shape of the tooth average tooth outline square, ovoid, tapering and mixed (Proposed by Leon Williams 1914). 3. Mesiodistal width This dimension is much more critical dimension than inciso-gingival length for anterior tooth placement.33

Contact Points (ICP) &

Interdental contact areas (ICA): A broad zone in which two adjacent teeth appear to touch Interdental contact area. The 50-40-30 rule (Morley JA, 2000) indicating relationship between anterior teeth applies to 50% of the length of maxillary central incisors and is defined as ideal connector zone. This needs that 40% of the length of central incisors is the ideal connector zone between maxillary lateral and central incisors and is 30% between laterals and canines.

Interdental contact areas

50-40-30 rule

Contact points34

Embrasures / Interdental spaces: The conical portion of thecontact area, the interproximal wall of the adjacent teeth and the interdental papilla formed the interdental embrasure.

As the dentition progressesaway from the midline, the size and volume of incisal embrasure increases.

Incisal embrasure between CIis smallest in area and shortest in angle.

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Dento-gingival unit & Biologic width Unique anatomic feature concerned with attachment of gingiva tothe tooth.Connective tissue compartment Represents fibrous attachment of the gingiva to the hard tissue wall and support to the epithelium of the dentogingival junction.

Epithelial compartment Gingival epithelium Sulcular epithelium sulcus depth (avg. 0.69mm) Junctional epithelium 0.97mm

Determined in a study by Garginlo et al (1961)

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In 1962 Cohen defined Biologic Widthof supracrestal gingival tissue as those junctional epithelium and connective tissue elements of dentogingival unit that occupy the space between the base of the gingival crevice and the alveolar crest. The total dimension would be 2.04mm.

By Nevin & Skurov Biologic width = supracrestal fibers + junctional epithelium + gingival sulcus.

It was better termed as biologic zoneby Kois = 3mm in healthy normal gingivae.37

Physical Components The art of creating illusion consists of changingperception to cause an object to appear different from what it actually is. The use of optical concepts to create optical illusion may be best way to solve or hide an esthetically difficult situation.

The tooth may be made to appear smaller, larger, wider,narrower, shorter, longer, younger, older, masculine or feminine.

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PRINCIPLES OF ILLUSION:Principle of illumination shadows create depth and light creates prominence. Unidirectional artificial light throws no shadow therefore displays only length and width. Multidirectional light throws shadows promoting a feeling of depth.

Principle of line Vertical lines accentuates length and horizontal lines accentuates width. This can be brought about by Tooth Contouring and Color Manipulation. 2.

Limited to angles, natural grooves and prominences, incisal and gingival lines and incisal edges.

Is best applied in there natural location-gingival inclines, interdental areas and selected tooth surfaces39

Principle of illumination Light approaches & dark recedes Produces illusion of depth Illusion of contour is produced as cosmetics are applied or shadows are drawn

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Principal of line Horizontal lines created bycervical staining texturing straight incisal edges create illusion of width Vertical lines by narrowing tooth carving incisal edge to slope cervically deepening incisal embrasure creates illusion of length

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In restorative dentistry the vertical

characteristics must be achieved first Horizontal growth lines be reproduced only after finishing

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Colour

An age is called dark, not because light fails to shine, but because people refuse to see it - James Michener

THE PHYSICAL SPECIFICATIONS OF OBJECTCOLOR Light is a form of radiant energy consisting of electromagnetic waves including UV, visible & IR light When the light strikes an object, a range of possibleinteractions are seen.

1. Reflection 2 types diffused reflection and regular reflection. 2. Refraction is bending of light waves as they pass from one medium to another.43

3.Deflection is the reflection of light from a surface in direction different from the entry of light.

4.Absorption is phenomenon in which light is absorbed fully or partially by the object. 5.Scattering is the random deflection of light rays by fine particles. 6.Translucency is transmission and diffusion of light through an object so that definite image beyond the object cannot be seen. Enamel more translucent than dentin.44

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Transparent is the quality of an object by which light passes entirely through it. 8. Opacity quality of an object by which it absorbs or completely reflects all the light on its surface. 9. Fluorescence is the capacity of an object to emit light waves after absorption of light. 10. Gloss is an optical property associated with smooth surface that produces lustrous surface appearance and thus increases the effects of color difference. 11. Metamerism is phenomena in which the color of an object exposed to two different light sources appears different under each conditions.

Shade viewed under different lighting conditions

Under fluorescent light

Under incandescent light

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Dimensions of color:

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HUE, CHROMA, VALUE & TRANSLUCENCY

1) HUE Is simply the colour tone i.e. RED, BLUE, YELLOW etc. The term is synonymous with the term colour but is not colour itself.

In Munsells words it is that quality by which wedistinguish one color family by another. Six Hue families V, B, G, Y, O, R e.g. Vita shade guide has a 4 hues.

A Reddish brown. B- Red yellow. C- Grey. D Reddish grey. 2) CHROMA Is intensity or saturation of color tone (Hue) i.e. light blue or dark blue. In Munsells words- it is the quality by which we distinguish a strong color from a weak one. Human teeth fall into yellow to yellow-red area of Munsell colour order system.

E.g. In HUE A of Vita shade guide A1- lowestchroma, A4 Highest chroma.47

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) VALUE (BRILLIANCE):Is the relative lightness (brightness) or darkness of the hue. On a scale of black-white High value = white & Low value = dark Midway between white & black is medium grey. Value is the only dimension of color that can exist by itself. E.g. Hue A of Vita shade A1-brightest; A4- darkest

4) TRANSLUCENCY: Is a 3-D representation of value. It is best represented by value differences. Highly translucent teeth tend to be lower in value.. Translucency and value are most important parameters in shade selection. Value differences are easy to identify since they are more rods than cones in the anatomy of human eye. Chroma = 1 / value Chroma - value E.g. A4 has high chroma and low value shade. A1 has low chroma and high value shade.

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SPECTAL COLOURS:

COMPLIMENTARY COLOURS: Primary colors: Red, Yellow, Blue

Light passing through a prism is refracted (Sir. Issac Newton 1676) and light energy is dispersed into various wavelength of white light. Acronym VIBGYOR (cones of the eye perceive only these wavelength of light visible light spectrum). 390 800.

These colors cannot be formed by mixing othercolors. They occur naturally by themselves.Are formed by mixing primary colors. RED + Yellow = Orange Yellow + Blue = Green Blue + Red = Violet.

Secondary colors:

Complimentary colors: They look good together they enhance appearance of one and another. Red Green; Yellow-Violet; & Blue-Orange. E.g. A3 shade contains orange hue + blue stain.

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Color matching methods Preliminary Ask patient to remove any ( large jewelryeyeglass facial makeup) that could distract the dentist Shade matching be performed at the beginning of the appointment Rubber dam should not be placed & tooth should not be dried too much Tinted eyeglass & contact lens should not be worn during shade matching50

Dentist position Tooth should be viewed along the long axis To avoid Metamerism the choice be verified under different light source & from different angles

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Tab placement Tab be placed parallel to the tooth & same relative edge position Tab carrier should be put along its normal axis to avoid impact on tab color

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Time length & pause First impression is usually the best match Trials be limited to 5 sec It has been recommended to Relax theeyes by observing a blue card ( because yellow& blue are complimentary colors)

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THANK YOU54