E- Extra-oral factors
S- Smile line
T- Tooth-tooth proportions
H- Harmonious centrals
E- Incisal embrasures
T- Tonality and texture
I- Axial inclination
C- Canting & midline
S- Soft tissue factors
What does
esthetics
stand for?
Brachyfacial, mesiofacial, dolichofacial
three face profiles
Facial thirds: from the hairline to the glabella, glabella to just under the nose, and from under to nose to the lower border of the chin are the boundaries for the facial thirds
What are the boundaries of the facial thirds?
o Females: 20-22mm
o Males: 22-24mm
What are the average female and male lip lengths?
Lower lip should cradle the border of the incisal edges of the maxillary teeth
how should the lower lip lie in relation to the incisal edges of the maxilalry teeth?
o 1-2mm for men
o 3-4mm for women
How much incisal edge display is normal in males and females?
- The golden proportion is 1.618:1:0.618
To make it easier, we do 1.5:1:0.6 where the central is 1.5, lateral is 1, and canine display is 0.5
what is the golden tooth proportions?
The ratio of height to width of a maxillary central incisor is 1.2:1 (or a 75-85% L/W ratio)
What is the ratio of height to width of a maxillary central incisor?
- Gradation: as you move posteriorly, it should appear that the teeth are gradually getting smaller
what does 'graduation' means in terms of proportional tooth sizes?
- Average central incisor is 10-11mm long
average central incisor is how long?
- Illumination: the principle that light approaches and darkness recedes (aka a light tooth looks like it is more buccally oriented than a dark tooth)
what is the principle of illumination?
- The mesial contact area is 50% of the proximal surface of #8 & 9, then between 9&10 it is 40%, and between 10&11 it is 30%
describe the incisal embrasures of anterior teeth
- The incisal 1/3rd is more translucent in younger people
- Younger people have more texture
incisal 1/3 of teeth are more translucent in younger or older patients?
younger or older people have more texture in their teeth?
- As you move posteriorly, the vertical line bisecting the midline of the teeth should tip towards the distal
As you move posteriorly, the vertical line bisecting the midline of the teeth should tip towards what direction?
If teeth are overly inclined to the
palate
, the buccal corridor is larger
Inclination of the teeth in what direction can make the buccal corridor larger?
To determine midline, draw a line from the glabella through the philtrum, then draw a line 90 degrees from that to determine the horizontal
Its ok if the midline is off 1-2mm, but if the midline is canted then the teeth look horrible (aka if 8 or 9 is cro
how do you determine the midline?
Horizontal reference: interpupillary line
Maxilla and incisal edges should be parallel to this
what is the horizontal reference to determine if teeth are canted?
Papila progression: as you move posteriorly, the papilla migrates apically
as you move posteriorly the papilla should move what direction?
The gingival contours around the teeth is parabolic in shape
The height of this contour is called the zenith, and it tips to the distal
The gingival contours around the teeth is what shape?
the hieight of contour of the gingiva is called what? this tips to what direction?
7% of men and 14% of women have a gummy smile
what % of men and women have a gummy smile?
1. Short upper lip
2. Hyperactive upper lip
3. Altered passive eruption
4. Dentoalveolar extrusion
5. Vertical maxillary excess
6. Combination
List the possible etiologies of a gummy smile (6)
Could be caused by wear, normal short variation, or altered passive eruption
A central that is 9mm or shorter is considered clinically short
What could cause a short clinical crown, resulting in a gummy smile?
- Lip should be 20-22mm in females and 22-24mm in males
- Treatment options: none
If the etiology of a patients gummy smile is a short lip what is the treatment option?
- Normal lip movement from repose to smile is 6mm
- Treatment options: lip switch technique (a surgery) or botox
what is the normal lip movement in response to smile?
what if you have hyperactive lip causing a gummy smile, what are the treatment options?
- Passive eruption: when the bone starts to recede form teeth and the tissue followes apically
- altered passive eruption occurs when the tissue does not recede sufficiently, so soft tissue is still covering enamel
what is altered passive eruption?
- If a patient has short clinical crowns, you need to feel for the CEJ with your probe. If you cannot feel the CEJ, then the have altered passive eruption (aka tissue still covering the enamel)
Treatment options: gingivectomy or crown lengthening
From the
Patient comes in with short clinical crowns what do you need to do?
- Draw an imaginary line from the free gingival margin of maxillary canine to canine
- The free gingival margin of the centrals should be on this line. If they aren't, then there is dentoalveolar extrusion
- Treatment options: ortho intrusion- may have to
How do you measure/diagnose and treat dentoalveolar extrusion?
oral surgery
What is the treatment for vertical maxillary excess?
Class I: mild extrinsic stain
o Good candidate for trays or in office bleaching
Class II: mild intrinsic to severe extrinsic stain
o Moderately good candidate for bleaching, lower expectations
Class III: moderate to severe intrinsic stain, dense vital tee
Three categories of staining?
- Sodium perborate combined with either 30% H2O2 (superoxol), water, or 3% H2O2
o Superoxol is not recommended because it will cause cervical resorption
o 3% H2O2 used in severe cases
what is the material used for walking bleach (non vital tooth)?
- Steps: seal gutta percha 2-3mm below CEJ with GI cement to help prevent internal root resorption, place pellet with the sodium perborate combination in the chamber, then replace in 1 week
- He usually does at least 2 treatments
What are the steps to non vital bleaching?
- 15-40% hydrogen peroxide
Remember 10% carbamide=3.5% hydrogen peroxide
What material is used for power bleaching?
1. The molecular reaction of bleaching is the H2O2 breaks down chromophors, which break double and single bonds into colorless molecules
2. Adding a light enhances this process. A ferrous activator that has a yellow hue will absorb the blue light and will
describe the mechanism of action of zoom whitening
- Xeroderma pigmentosum is a contraindication to using a light for whitening
what disorder is a contraindication to using a light for whitening?
Step 1
: Tray impressions
- For the fabrication of custom bleach trays. If the patient is very sensitive after the in office treatment, you can send the patient home in the trays filled with potassium nitrate to reduce the sensitivity
- You want to send t
What are the 11 steps of Zoom whitening ?
- Isthmus width is 2mm minimum
- Cusp reduction is 2.5mm
- Gingival box is 1.5mm in a molar, 1.2mm in a PM
- All internal line angles are rounded
what are the dimensions of the onlay prep?
over exposed
What error occurred?
underexposed
What error occurred?
canted
What error occurred?
image from an inferior angle and the patient's right
What error occurred?
image taken from a superior angle
What error occurred?
lack of focus- image blurry
What error occurred?
anterior teeth are in focus but posterior teeth are our of focus: F-stop too low - imporer depth of field
What error occurred?
improper angle - image taken from a facial perspective, without a mirror
What error occurred?
unreflected teeth visible, fogging of mirror, debris visible in teeth
What error occurred?
improper framing - edge of mirror and unreflected teeth visible
What error occurred?
excessive magnification for full face view
What error occurred?
inadequate magnification for full face view
What error occurred?
full face image taken without uniform back drop
What error occurred?
improper framing and inadequate retraction
What error occurred?
Improper angulation- lateral view should be exposed perpendicular to the lateral incisor
What error occurred?
inadequate retraction, superior angle and maxillary and mandibular teeth inadequately separated
What error occurred?
(x)= magnification for cameras with smaller lenses, smaller lenses will require approximately a 1.5 times increase in the setting on the lens barrel
Non-Retracted Views:
1. Natural Full Face- frontal view - 1:10 (1:15) magnification
2. Full Natural Smile
what are the views and magnifications (12)
� In the same plane as the tooth, where the incisal edge of the tab is against the incisal edge of the tooth.
� When communicating with the ceramist, you are usually using photography to show them color of the tooth (which is polychromatic) in relation to
Where do you hold a shade tab when color matching a tooth?
� If tooth is very dark, make sure you tell the technician so they can mask out the darkness
i. The name of this tooth shade is a STUMP shade�you should give this routinely to the ceramist
What do call the shade of your prep?
Color in dentistry defined using shade guides from 1898 Albert Munsell (painter) theory
color in dentistry defined using shade guides from who?
Hue: basic shade of tooth
Chroma: degree of saturation of hue
Value: luminosity
what are the three parts of color?
- VITA Shade guide= 4 basic hues and 4 chromas for each hue
how many hues and chromas in VITA shade guide?
- Classic 3D master family: Linear guide, bleach guide and tooth guide
Class 3D master family includes what shade guides?
- Enamel= short waves (white-blue waves) dominate
- Dentin= longer (yellow-orange waves)
What wavelengths dominate in enamel and dentin?
Degree of enamel translucency depends on thickness which affects value of tooth
What determines enamel translucency?
Changes with age
o Young teeth= thicker enamel= high density, low translucency, high luminosity (value), and high reflectivity
o Old teeth= thin enamel. Opposite of the above
How does translucency change with age?
- Area in tooth where there is only enamel= creates opalescence effect which creates incisal halo
what creates the incisal halo?
- Dentin is responsible for hue and chroma
o Also responsible for fluorescence which reduces metamerism
Dentin is responsible for what 2 parts of color?
Saturation decreases from cervical to incisal
saturation of color decreases in what direction on a tooth?
1.
Chromaticity
a. Hue and chroma of the dentin body
b. In anterior teeth chromaticity desaturates from cervical to incisal and from palatal to buccal
c. Lower in young teeth, higher in old
2.
Value or Luminosity
a. Related to enamel
b. More mineralized a
What are the 5 dimensions of color and what do they mean?
.3mm reduction at the cervical portion of tooth
.5mm reduction at middle third to incisal portion of tooth
1mm reduction of incisal edge (2mm in premolars)
elbow in the proximal
chamfer is default margin unless .....
1. Existing small Class III
2. Closing
what are the veneer prep instructions?
On tooth:
1. Pumice and etch enamel
2. Apply bonding agent to enamel
3. Apply luting resin
On veneer:
1. Etch veneer
2. Apply silane to veneer
3. Apply bonding agent to veneer
6 steps of veneer cementation
The type of porcelain dictates how the lab treats it
-If you get veneer back from lab and it's frosted, not glossy, you need to etch it because the lab has not
-If you have to etch the veneer, use hydrofluoric acid
How does the lab treat the porcelain?
� Not like a crown
� Doesn't ONLY seat on the incisal
� Seat it incisal-gingivally and fold it into place
� Cannot have undercuts!
How do you seat a veneer?
� Bonds the resin to the porcelain
� It's a primer, usually found in Rely X veneer kit
� You brush it on the etched surface of the veneer before applying bonding agent
why do we treat the veneer with silane?
Bite-X: It is water soluble
o It is painted on the tooth in the mouth and it marks the veneer where the contact is- adjust w/soflex disc as needed
-Classic disclosing solutions contain oil which is bad because it affects the bond
What disclosing solution do we use with veneers?
Glycerol on the margin to prevent O2 inhibition layer and open margin
It is found in the Variolink kit "liquid strip
What is used to remove the air inhibited layer at the margin of a veneer prep?
Tack cure the cement and loosen it w/ a blade (#12 blade interproximally, #15 blade lingually). Cure completely, remove bead
How do we clean up cement?
try in your veeners 3 times--2 times for fit and one for color
1: try in one at a time
2: try in all together
3:try in for color (using a try in paste)
How many times do you try in a veneer?
technique for seeting veneer provisionals
Know spot etch technique�treat it with optibond or another bonding agent (NOT A SELF ETCH) after rinsing the etch
Once you deliver the provisional after spot etching, you are not removing them�you adjust margins i
What is the spot etch technique?
8mm
If a tooth is showing 2mm in repose, how much should the lip travel to be normal in smile?-
If bleaching, and you know the pt is going to be sensitive, have them start using a PN toothpaste for TWO weeks prior to tx
If bleaching, and you know the pt is going to be sensitive, have them start using a PN toothpaste for how long?
Potassium nitrate prevents repolarization
Fluoride seals tubules
how does fluoride and potassium nitrate work?
Can't bleach 7 days (minimum) to 14 days before bonding
Residual oxygen reduces bonding
Bleaching procedure should cease how soon prior to bonding veneers and why?
� of HP is released in the first 30 min�it takes 2-3 hours for � of CP to be released
we use 4-10% HP in office
How long does it take half of HP and CP to be released?
Hue: A-D (A=red, B=yellow, C=gray, D=reddish gray)
hue on vita classical shade guide is measured A-D...what do these letters stand for?
Bleaching usefulness is measured in SGU (shade guide units)
bleaching usefulness is measures in what?
Determine if you need to reduce based off the diagnostic wax up and stent
If you reduce the incisal edge, it becomes an INTERNAL line angle and needs to be rounded
how do you know if you need to reduce the incisal edge of your veneer prep?
� Do a WINDOW prep on a tooth with wear�or a TACO prep
o Same prep, just without the incisal reduction (window) on per-molars usually
which veneer prep is done on a tooth with wear?
360 degrees
Patient has a large C3 what kind of veneer prep do you do?