Good Morning

Esthetics In Dentistry
Dr. PRANSHU TOMER
PG 1ST YEAR
DEPT. OF ORTHODONTICSAND DENTOFACIAL ORTHOPEDICS
Contents:
• Historical • Cosmetic • Clear Aligners
perspective of Contouring • Esthetic RPDs
dental esthetics. • Colour modifiers • Metal ceramic
• Social context of & Opaquers crowns
dental esthetics. • Porcelain • All ceramic crowns
• Fundamentals of laminate veneers • Zirconia crowns
esthetics. • Composite resin • Pediatric Crowns
• Tooth biometrics restorations • Depigmentation
• Ceramic inlays • Gummy smile
• Facial and dental
appearance and onlays • Crown lengthening
• Teeth whitening • Conclusion
Esthetic Dentistry can be defined as:
“The skills and techniques used to improve the art and symmetry of the
teeth and face to enhance the appearance as well as the function of
the teeth, oral cavity and face.”
- Mosby’s Dental Dictionary
Historical perspective of dental esthetics:
Over 4000 years ago, the Etruscans
demonstrated the earliest treatment related
to esthetic dentistry. They used gold wire to
save diseased teeth & maintain beauty of the
smile.

The Japanese custom of decorative tooth‐

staining called ohaguro ,practiced around
500 AD, in which people stained their teeth
to be black in color.
 In Mayan civilization, a system of dental decoration evolved in which
some teeth were filed into complicated shapes and others were
decorated with jadeite inlays.

A 2000-year-old Mayan skull showing The Mayans also used

jadeite inlays used for cosmetic, rather than special tooth carvings to enhance
functional, purposes. physical appearance.
 An ancient Etruscan appliance, showing gold
soldered rings and rivets to hold dental
replacements as a bridge. In this specimen there
are two natural teeth and one riveted ox-tooth.

Ticuana tribal tooth mutilation was

common among both sexes, and tooth
mutilation is still practiced in some
societies.
Social context of dental esthetics
• In today’s technology‐driven society, social media
contributes to a person’s image being viewed more than
ever.
• High definition has driven many television personalities to
improve their physical appearance.
• More and more people are considering esthetic dentistry
as a necessity to maintain an appealing look.
 (A)The patient once thought that showing gold was
desirable, and it was accepted in her socioeconomic
peer group.

(B) When her status changed 10 years later, so did

her attitude, and the gold crowns were removed.

(C) This lady was happy with her diastema,

thinking it was “cute” and part of her
personality.
An individual during contemporary times who defines
good-looking teeth best when adorned with an inlaid
diamond and multiple open-faced gold crowns
depicting various shapes.
Esthetics: a health science and service:
• The direct and indirect relationship of how looking one’s best is a key
ingredient to a positive self‐image, which in turn relates to good
mental health.
• There is a relationship between psychosocial well‐being and body
image.
 A 13-year-old girl reported that Bleaching was attempted, but bonding
boys “called her names,” referring the four maxillary incisors was required
to her tetracycline-stained teeth. to properly mask the tetracycline stains.

Unless attention is paid to esthetics in young people, severe personality

problems may develop. Improving one’s self-confidence through esthetic
dentistry can make a difference in having a positive outlook on life.
Fundamentals of Esthetics:
• Dentist manipulates light, color, illusion, shape, and form
to create an esthetic outcome.
• In 1915, Albert Henry Munsell created a system of color
description that is still the standard today.
• In this system color is divided into three parameters:
1. Hue
2. Chroma
3. Value.
Hue:
• Hue is the name of the color.
• In younger permanent dentition, hue tends to be similar
throughout the mouth.
• With aging, variations in hue often occur because of
intrinsic and extrinsic staining from restorative materials,
foods, beverages, smoking, and other influences.
 Chroma:
• Chroma is the saturation or intensity of hue.
• Chroma of teeth increase with age.
• For Eg; to increase the chroma of a porcelain restoration, more of that
hue is added.
• In general, chroma of teeth increases with age.
Value:
• Value is the relative lightness or darkness of a color.
• A light tooth has a high value; a dark tooth has a low value.
• It is not the quantity of the “color” gray, but rather the quality
of brightness on a gray scale.
Anterior esthetics:

Lombardi described a theory of anterior esthetics in which

he proposed that the age, gender, and personality of a
person was reflected in the shape and form of the teeth.
Age:
Older teeth:
• Are smoother.
• Are darker.
• Have a higher saturation.
• Are shorter incisally.
• Are longer gingivally.
• Exhibit more wear, even on
incisal edges.
• Have wider, more open
gingival embrasures.
Younger Teeth:
• Are more textured.
• Are lighter
• Have a lower saturation.
• Have a gingival margin approx. at
CEJ.
• Have incisal edges that make laterals
appear shorter than incisors or
canines.
• Have significant incisal embrasures.
• Have small gingival embrasures.
1. Incisal display of maxillary central incisors diminishes with age.
2. Incisal display of mandibular central incisors increases
3. Mandibular incisors exhibit flat broad incisal edges, showing a
dentin core.

Exposure of the anterior teeth Exposure of the anterior teeth

corresponding to the rest corresponding to the rest
position – at a young age position – at an advanced age
Gender:
Feminine Teeth:
• More rounded on the incisal edges
and at transitional line angles.
• Incisal embrasures are more
pronounced.
• The incisal edges are more
translucent.
• The translucency on the incisal edges
appears as a gray line in incisal one
eighth.
Masculine Teeth.
• More angular and rugged.
• In older men, chroma is greater
and body color often extends to
the incisal edges.
• Incisal embrasures more squared
and not as pronounced.
• Characterization is often stronger,
incorporating darker craze lines
Tooth biometrics:
• A smile is defined as a pleased, kind, or amused facial
expression, typically with corners of the mouth turned
up and front teeth exposed.

• Amount of tooth exposure is defined by the smile line.

• Smile line is an imaginary line connecting incisal edges

of the maxillary anterior teeth, and typically follows the
border of the lower lip.
Facial Midline:
• Determined by the line between nasion, to base of the philtrum.
• If incisal midline can’t coincide with facial midline, then midlines
should be made parallel.
• Nonparallel midlines can be highly unesthetic and should be
avoided.
Maxillary lip line:
High Maxillary Lip Line.

A lip line is considered high if it displays more than 3-4 mm

of gingiva.
 Standard maxillary lip line

This is the most common anatomic configuration and occurs when

between 75% to 100% of the each tooth in the labial display is
exposed.
 Low maxillary lip line

A low lip line displays less than 75% of each tooth in the
labial display teeth
Maxillary lip curvature:
Upward Maxillary Lip Curvature:

• A maxillary lip that curves upward.

• Corner of the mouth is higher than

the center of the lower border of
the maxillary lip.

• Display more of the posterior gingiva

than other types of lip curvature.
Straight Maxillary Lip:

• Corner of the mouth and center

of the lower border of the
maxillary lip are on a straight
line.

• Exposes a similar degree of

anterior and posterior gingiva.
Downward Maxillary Lip Curvature.

• Corner of the mouth is lower than

the center of the lower border of
the maxillary lip.

• It displays less of the posterior

gingiva than other types of lip
curvature.
Smile Line:

• It refers to the line of the inferior border of the lips

compared with a reference line drawn between the pupils of
the eyes.

• Ideally the two lines should be parallel and the incisal plane
should also be parallel to this line.
 The smile line classification (Liebart and Deruelle 2004)
• Class 1: Very high smile line – more than 2 mm of the
marginal gingiva visible.
• Class 2: High smile line – between 0 and 2 mm of the
marginal gingiva visible.
• Class 3: Average smile line – only gingival embrasures
visible.
• Class 4: Low smile line – gingival embrasures and
cementoenamel junction not visible.
Parallelism of the Maxillary Anterior
lncisal Curve with the Smile Line:

• Differences in parallelism of the maxillary anterior

incisal curve relate to both sexual bias as well as age
bias.

• Parallel and straight smiles are considered more

esthetic than a reverse smile
 Parallel (concave) Straight Reverse (convex)

The incisal edges of the The incisal edges of the

The incisal edges of
maxillary anterior teeth maxillary anterior teeth
the maxillary
are parallel to the curved in reverse to the
anterior teeth are in
maxillary border of the maxillary border of the
a straight line.
lower lip. lower lip.
Relationship Between the Maxillary
Anterior Teeth and the Lower Lip:

The relationship between the maxillary anterior teeth

and the lower lip controls the degree of exposure of the
incisal edges of the maxillary incisors.
 Slightly Covered Touching Not touching

The incisal edges of the The incisal edges of The incisal edges of the
maxillary anterior teeth the maxillary anterior maxillary anterior teeth
are slightly covered by teeth just touched the do not touch the lower
the lower lip lower lip. lip.
The Number of Teeth Displayed in the Smile:

Displayed teeth include

the canine region

Displayed teeth include

the first premolar region
Displayed teeth include
the second premolar
region.

Displayed teeth include

the first molar or second
molar region.
Incisal Embrasures:
• The incisal embrasure is defined as the
space existing on the incisal aspect of
the interproximal contact area
between adjacent anterior teeth.

• Both the size and volume of the incisal

embrasures progressively increase
posteriorly from the midline.
Anterior Contact Area:
• It is the area between two adjacent
teeth that lies between gingival and
incisal embrasures.
• Ideal esthetic results can be
achieved when the contact space
area:
1.between the central incisors is 50%
2.Between the central and lateral
incisors is 50/40%.
3.Between the lateral incisors and
canines is 40/30%
 Gingival zenith:

• The gingival zenith is the most apical area of the clinical crown
• Its shape and location is determined by the anatomy of tooth and
gingival architecture.
• It is located at the junction of the middle and the distal third of the
facial aspect of a tooth.
• Manipulation of the gingival zenith usually requires modification of
the gingival tissue and may require alveolar bone surgery.
Facial and dental appearance:
A systemic examination of facial and dental appearance should be
done in the following steps:

Macro Micro
esthetics: Facial Mini esthetics: esthetics: The
proportion in Dentition in teeth in
all three planes relation to face relation to one
of space another
Facial proportions: Macro esthetics
Frontal examination:
• An ideally proportional face can be divided
into central, medial and lateral fifths.
• Separation and width of eyes, determine the
central and medial fifths.
• Nose and chin should be centred within
central fifths.
• The inter pupillary distance should equal
width of the mouth.
 Composite photographs are the best way to illustrate normal facial
asymmetry.

For this patient, whose mild asymmetry rarely

would be noticed and is not a problem, the
true photograph is in the center (B).

On the
patient's right On the left (C)
(A) is a is a composite
composite of of the two left
the two right sides.
sides.
Vertical facial proportions in the frontal and lateral views are best evaluated in
the context of the facial thirds, which are equal in height in well proportioned
faces.

The lower third has thirds: the mouth should be one-third of the way
between the base of the nose and the chin.
 Profile analysis:
o Establishing whether jaws are proportionately positioned in
anteroposterior plane of space.

Profile convexity or concavity results from a disproportion in the size

of the jaws but does not by itself indicate which jaw is at fault.
A convex facial profile A concave profile (C)
(A) indicates a Class II indicates a Class III
jaw relationship. relationship, which
Caused either by a results from either a
maxilla that maxilla that retrudes
protrudes forward or back or a mandible
a mandible that that protrudes
retrudes back. forward.
 o Evaluation of lip posture and incisor prominence

Bimaxillary dentoalveolar protrusion is seen in the facial appearance in

three ways:

A. Excessive B. Excessive effort

separation of the to bring the lips
lips at rest (lip into closure (lip
incompetence). Lip strain) and
separation at rest prominence of lips
should be not in the profile view
more than 4 mm. (as in A & B).

All three soft tissue characteristics must be present to

make the diagnosis of dental protrusion, not just
protruding teeth as seen in a ceph of the same girl (C)
 Lip prominence is evaluated by observing the distance that
each lip projects forward from a true vertical line through
soft tissue points A & B.
The lips should be on or slightly in front of the E-line.

For this girl with Class II malocclusion, retraction of the

maxillary incisors would damage facial appearance by
decreasing support for the upper lip, making the
relatively large nose look even bigger.
 Throat form is evaluated in terms of the contour of the submental
tissues, chin-throat angle and throat length. Both submental fat
deposition and a low tongue posture contribute to a stepped throat
contour, which becomes a "double chin" when extreme.

A. This patient B. This patient with

has a mild more chin
mandibular projection, throat
deficiency, throat contour is affected
contour and the by submental fat &
chin-throat angle chin-throat angle is
are good, but obtuse, but throat
throat length is length is good.
short .
o Re-evaluation of vertical facial proportions and
evaluation of mandibular plane angle

The mandibular plane angle can be

visualized clinically by placing a
mirror handle along the border of
the mandible. For this patient, the
mandibular plane angle is normal,
neither too steep nor too flat.
 Mini esthetics: Tooth-lip
relationship:
• Tooth-lip relationship

The usual cause of excessive display of maxillary gingiva is a long face due to
excessive downward growth of the maxilla (A), which moves the maxilla down
below the upper lip and results in a disproportionately long lower third of the
face.(B), or with gingival display due to a combination of incomplete eruption and
a short upper lip (C).
A cant to the occlusal plane can be seen in both frontal (A) and
oblique (B) views. This is a "roll deformity" that results from the
orientation of the jaws and teeth rather than their position. It
becomes an esthetic problem if it is noticeable.
 • Amount of incisal and gingival display

Display of the Less display of

maxillary incisors maxillary incisors
and some gingiva and some gingiva is
on smiling is a less attractive,
youthful and although it is not
appealing considered
characteristic. objectionable by
lay observers.
 There is a considerable range of maxillary incisor display that
observers consider acceptable.

In these images created with computer alteration; Maximum

acceptable display is shown in C, midrange (ideal) in D, and minimum
acceptable in E
 Transverse dimensions of the smile, relative to the upper arch.

A. Prior to treatment, B. On 5-year recall, the

this girl had a broader smile (with
narrow maxillary narrow but not
arch with wide obliterated buccal
buccal corridors. She corridors) is part of the
was treated with esthetic improvement
arch expansion. created by orthodontic
treatment.
 The width of the maxillary dental arch, as seen on smile, should be
proportional to the width of the midface. (A) a broad smile is
appropriate for a face with relatively large width across the zygomatic
arches, but a narrower smile (B) is preferred when the face width is
narrow.
 The smile arc:
The smile arc is the relationship of curvature of the lower lip to the curvature of
the maxillary incisors. The appearance of the smile is best when the curvatures
match
A) A flat smile arc,
which is less B) In the same girl
attractive in both after treatment, a
males and females, proper smile arc can
prior to treatment be seen.

The improvement in her smile was created solely by lengthening her maxillary
incisors with dental laminates.
Dental appearance: Micro esthetics:
• Tooth proportions

The smile reveals the maxillary anterior teeth and two

aspects of proportional relationships are important
components of their appearance:
• The tooth widths in relation to each other
• The heightwidth proportions on individual teeth
 Width relationships and the“Golden
proportion”
Ideal tooth width proportions when viewed from the front are one of
many illustrations of the "golden proportion," 1.0:0.62:0.38:0.24, etc.

The width of the lateral incisor is 62% of the width of the central incisor; the
(apparent) width of the canine is 62% of the width of the lateral incisor, and
the (apparent) width of the first premolar is 62% of the width of the canine.
 Height-Width Relationships:

Height-width proportions for maxillary central incisors,

with the normal range of widths and heights. The width
of the tooth should be about 80% of its height.

The patient's central incisors look almost

square, because their width is normal but
their height is not.
 Gingival Height, shape and contour:

For ideal appearance, the contour of the gingiva over the maxillary central incisors
and canines is a horizontal half-ellipse, with the zenith distal to the midline of the
tooth. The maxillary lateral incisor, in contrast, has a gingival contour of a half-
circle, with the zenith at the midline of the tooth. The canine gingival contour is a
vertical half-ellipse, with the zenith just distal to the mid-line.
 Connectors and embrasures:

1. The contact points of maxillary teeth move progressively gingivally

from central incisors to premolars, so that there is a progressively
larger incisal embrasure.
2. The connector is the area that looks to be in contact in an
unmagnified frontal view.
 Embrasures: Black triangles
A. Crowded and B. After alignment
rotated maxillary of the incisors, a
incisors at the black triangle was
beginning of present between
orthodontic the central
treatment for an incisors.
adult.

C. The incisors were reshaped so that when

D, After the space was closed the black
the contact point would be moved apically
triangle was no longer apparent.
the midline connector would be lengthened.
Esthetic treatments in
Conservative dentistry:
Cosmetic Contouring:
• Cosmetic contouring is the reshaping of the natural teeth to create an
illusion of straightness for esthetic purposes.

• Such reshaping consist of filing and leveling the incisal edges and
shaping the mesial, distal, labial, and lingual surfaces as well.
 Alterations of tooth structure

The most frequent use of cosmetic contouring is in the reshaping

of fractured, chipped, extruded, or overlapped teeth to give them
a more pleasing appearance. Reshaping and repolishing chipped
incisal edges also decreases the chance of additional fracturing.
 Correction of developmental abnormalities.

Often teeth that are malformed can be reshaped to

correct unattractive areas at the incisal edges, such
as nonfused mamelons.
 Removal of stains and other discolorations

Reshaping can cause light to be deflected at different angles and

effectively “remove” a superficial hypocalcified area or make a
stain appear lighter in certain cases.
 Bruxism

The teeth can be reshaped by rounding the corners to make the

lateral and central incisors look more feminine, especially where
the incisal embrasures have been obliterated by wear.
Colour Modifiers and Opaquers:
• Color modifiers can be mixed with composite resins to change their
shades.
• The most frequently used color modifiers are pink, white, gray, yellow,
yellow-brown, blue, and red.
 Colour Modifiers and Opaquers
Colour Indications
Yellow-orange Creates illusion of narrowness
Simulates craze lines
Yellow-brown Masks blue tetracycline stains
Blue, grey, violet Simulates translucency
Decreases value or brightness
White Increases the brightness of any color modifier
Simulates craze lines
Simulates enamel hypocalcifications; white spots
Masks yellow spots

Red, pink Simulates gingival tones

Enhances vitality
Masks blue tetracycline stains
Yellow and Yellow-Brown:

These shades are often used in the cervical third of the crown.
• Yellow and Yellow-Brown
• Can be used to simulate craze lines.
• It is effective in neutralizing and masking blue-gray tetracycline stains.
• Also used in combination with white to mask brown tetracycline stains.

Sometimes they are used along proximal

surfaces to create the illusion of narrowness.
Blue, Gray, or Violet:
• Blue, gray, or violet shades are used on the incisal third of
the tooth to simulate translucency.
• They can also be used to reduce value (brightness).
White:

• White is used to
increase the value
(brightness) of any
color modifier.
• It can be effectively
used to simulate
craze lines and
enamel
hypocalcifications.
 White:

A maxillary right central incisor White color modifier is used to

with intrinsic yellow mask the yellow background.
discoloration.
Porcelain laminate Veneers:
Porcelain laminate veneers can be used to change any or all of
the following characteristics of a single tooth or multiple teeth:

1. Color
2. Size
3. Shape
4. Position within the arch
• Correcting diastemata. • Patients with tooth wear due to
• Masking discolored or stained bruxism.
teeth. • Short teeth.
• Masking enamel defects. • Teeth with inadequate enamel for
• Correcting malaligned or retention.
• Endodontically treated teeth with
malformed teeth.
little remaining tooth structure.
• Patients with oral habits causing
excessive stress on the restoration.

Indications: Contraindications:
 1. Initial clinical 2. Minimally invasive 3. Veneers on the
situation. preparations, limited to the control model
enamel thickness.

4. Veneers made using the 5. Clinical views of veneers one 6. Cemented veneers:
refractory die. week post-cementation. palatal view.
Composite resin restorations:

In materials and science, the word “composite” refers to a

solid formed from two or more distinct phases that have
been combined to produce properties superior to those of
individual constituents.
-Sturdevant
 lingual shelf placed to
Preoperative
replace the missing Maxillary deciduous canine
view of a left now appears to be
enamel, to restore the
lateral anterior permanent canine.
occlusion & incisal
open occlusion.
length.
Preoperative and postoperative view of Lower right 1st molar with
extensive distal-occlusal-buccal caries.
Composite resin restorion was done to restore the tooth function
and esthetics.
Left maxillary central incisor Incisal edge restored with white
with incisal chip. composite

Teeth 3 to 6 with Composite restores normal gingival

abfraction and emergence profile & eliminate
abrasion lesions. sensitivity.
Restoration of Gingiva using pink composite resin:
The patient was very unhappy with the aesthetic appearance of ‘‘elongated
teeth.’’

Facial view of the patient showing open

Facial view of the patient prior
gingival embrasure between the maxillary and
to restoration
mandible central incisors.
 Prosthetic gingival restoration with gingival coloured ‘‘pink’’
composite resin materials can overcome the limitations of
grafting and can be a good alternative for reconstructing
tissue lost due to ridge deformities

Facial view of the completed The definitive restorations exhibited a

direct pink gingival composite harmonious, natural form and achieved the
aesthetic expectations of the patient.
 Ceramic inlay and Onlay
• For patients demanding esthetic restorations, ceramic inlays and onlays
provide a durable alternative to posterior composite resins. The procedure
consists of bonding the ceramic restoration to the prepared tooth with an
acid-etch technique
 Indications Contraindications:

Demand for esthetics High caries index

Low caries rate Poor plaque control

Intact buccal and lingual

Bruxism
enamel
Teeth Whitening
• The lightning of the colour of a tooth through the application of
chemical agents to oxidise the organic pigmentation in the tooth is
refered to as bleaching.
- Sturdevant
• Esthetics of the teeth is of great importance to patients, including
tooth colour.

• The colour of the teeth is influenced by a combination of their

intrinsic colour and the presence of any extrinsic stains that may form
on the tooth surface.

• Intrinsic tooth colour is associated with the light scattering and

adsorption properties of the enamel and dentine.
• Extrinsic stains tend to form in areas of the teeth that are less
accessible to tooth brushing and the abrasive action of a
toothpaste.
• Often promoted by smoking, intake of tannin-rich foods & use of
certain Cationic agents(eg. Chlorhexidine), or metal salts(eg. tin
and iron)
• These extrincic stains can be removed by the help of teeth
whitening.
 Non vital bleaching Vital Bleaching

Pre-treatment Post-treatment
Before After
Esthetic treatments in
Orthodontics:
Clear Aligners:
• Recently there has been an increase in demand for appliances that
are both more aesthetic and more comfortable than conventional
fixed appliances.
• As with fixed appliance systems, the term Clear Aligner Therapy (CAT)
embraces a wide range of appliances.
CA can be broadly grouped into the following categories:
• Minor tooth movement (MTM) with limited clinical applicability.
• Direct to consumer alternative.
• Make your aligners.
• Complex and comprehensive system.
Minor tooth movement (MTM) with limited clinical
applicability

Positioned as a cheaper, faster alternative to comprehensive

orthodontic treatment, this category includes products such as
Originator, Simpli 5, MTM Clear Aligner, and Clearguide System.
Direct to consumer alternative
• “At home” treatment for the patient with a dental professional
possibly offering remote oversight.
• Positioned as a “convenient and 50% cheaper” solution.
• This category includes Crystal Braces and Smile Care Club.
Make your aligners
• 3D treatment planning software, integrated with scanners and 3D
printers, enables full in-house or laboratory fabrication.
• Available products include Orchestrate, 3 Shape and Suresmile.
Complex and comprehensive system
• Incorporating 3D CAD CAM tooth movements, a computerised 3D
interactive treatment planning and appliance design, bonded resin
attachments and possibly additional features, designed for more
complex, comprehensive tooth movements, improved control of
tooth position in all planes of space.
• These products include Invisalign, ClearCorrect , ClearPath , K Line and
Orthocaps.
 Invisalign:
• It is the most complex CAT appliance currently available.
• Offers the utility of both scan or impression submission.
• A doctor-adjustable computerised treatment plan and appliance design.
• A computerised 3D model manipulation.
• Pressure-formed toothborne aligners which are accompanied by a wide range
of specifically computer-analysed and power ridges for improved axial root
control and torque control, respectively.
Esthetic treatments in
Prosthodontics:
Esthetic RPDs:

• Denture esthetics as defined by Glossary of prosthodontics terms is

the effect produced by the prosthesis that affects the beauty and
attractiveness of the person.

• When planning treatment for partially edentulous patients, both

masticatory function and esthetics should be taken into
consideration.

• The term esthetic zone is used to describe the teeth and gingiva as
they are observed when a patient emits a hearty laugh.
Designing of RPD
• Designing for an RPD should be such that all its components are as
inconspicuous as possible to further enhance esthetics.

• Clasps are the only components which are placed on visible surfaces
of the teeth.
• Following are the esthetic alternatives to conventional clasps
to eliminate visible display of metal and improve esthetics:

1. Equipoise system
It is an esthetic retentive
concept for distal extension
situations. Rests are placed
away from edentulous span.
2. Spring clasp/ twin clasp:
It consists of a wire clasp
soldered into a channel that is
cast in the major connector.

3. Saddle lock clasp:

Also called as Hidden clasp. It uses
the more pronounced mesial/ distal
concave surfaces of the abutment
adjacent to the denture saddle.
4. Round-rest distal depression clasp:
It is suggested as an esthetic alternative
to a conventional clasp for maxillary
anterior teeth serving as abutments for
a removable partial denture.

5. Metal free clasps:

Are ideal for flexibility and
esthetics, thus allowing esthetic
functional care in true sense.
Crown Restorations

A dental crown restoration can offer a remarkable service for a dental

patient. The objectives of a crown are to restore function and esthetics
for a treated tooth.
Metal Ceramic Crowns:

• In many dental practices the metal-ceramic crown is one of the most

widely used fixed restorations.

• The restoration consists of a complete-coverage cast metal crown that

is veneered with a layer of fused porcelain to mimic the appearance
of a natural tooth.
 Indications: Contraindications:
• Esthetics • Large pulp chamber
• Teeth requiring • Intact buccal wall
complete coverage • When more
• If all ceramic crown in conservative retainer is
contraindicates technically feasible
• Gingival involvement • Patients with active
caries
• Patient with untreated
periodontal disease
All ceramic crowns

• All-ceramic crowns can provide some of

the most esthetically pleasing
restorations currently available.

• They can be made to match natural

tooth structure accurately in terms of
color, surface texture, and translucency.
 • High esthetic requirement
• Incisal edge reasonably intact
Indications • Endodontically treated teeth with post-
and-cores
• Favourable distribution of occlusal load

• High caries index

• Insufficient coronal tooth structure for
Contraindicat support
ions: • Thin teeth faciolingually
• Unfavourable distribution of occlusal load
• Bruxism
Endodontically treated
central incisor had
darkened over time A full coverage
and was restoration to block
unsightly to the the darkened
patient. cervical region. The final result
Zirconia Crowns:
• Zirconia crowns are made from zirconium dioxide, a very durable type
of ceramic material.

• These are stronger than porcelain and some metal alloys, and get
fewer sharp edges from the normal "wear and tear" that happens
over time.
• Zirconia crowns tend to cause less stress and damage on opposing
pieces than their porcelain counterparts
 Advantages: Disadvantages:
• strength and • Can be hard to
durability
• Biocompatibility match
• Longevity • Potential wear on
• Same-day procedure other teeth
•Esthetic treatments in Pediatric
Dentistry:
 Esthetic crowns used in Pediatric patients
• Cheng crown
SS crown • Kinder Krowns
• Dura crowns
modifications:
• Pedo pearls

• Policarbonate crowns
Bonded crowns: • Strip crowns
• Shell crowns

Recent development • Pedo jacket

for anterior crowns in • New millennium
• Artglass crown
pediatric dentistry:
Cheng Crowns
These are SS pediatric anterior
crowns faced with a high quality
composite, mesh-based with a
light cured composite.

Dura Crowns
These rowns can be crimped
labially and lingually, can be
easily trimmed with crown
scissors and have got a full-
knife edge.
Kinder KrownsTM
They offer the most natural shades and
contour available for the pediatric patient

Pedo Pearls:
These are beautiful heavy gauge aluminum crowns
coated with FDA food grade powder coating and
epoxy resin.

Polycarbonate Crowns
Polycarbonates are aromatic linear polyesters
of carbonic acid. They exhibit high impact
strength and rigidity
Strip Crowns:
These are celluloid crown forms that are the
most effective for use in pediatric patients
with extensive caries in anterior teeth.

Shell Crowns:
A novel technique for esthetic rehabilitation of the
maxillary anterior teeth with custom made
composite shell crowns with an indirect approach.
Pedo Jacket
It is a tooth colored copolyester material which is
filled with resin and left on tooth after polymerization
instead of being removed.
• New millennium:
• These crowns are made up of lab
enhanced composite resin material
or Zirconia.

Artglass Crowns
• These are preformed crowns for pediatric
usage.
• High inorganic filler, makes Artglass color
stable and plaque resistant.
Esthetic treatments in
Periodontology:
Gingival Depigmentation:
• Gingival depigmentation is a periodontal plastic surgical procedure
whereby the gingival hyperpigmentation is removed or reduced.

• The first and foremost indication for depigmentation is patient

demand for improved esthetics.
Dummett–Gupta Oral Pigmentation Index
(DOPI): (Dummett 1971)
• No clinical pigmentation (pink gingiva)
• Mild clinical pigmentation (mild light brown color)
• Moderate clinical pigmentation (medium brown or mixed
pink and brown)
• Heavy clinical pigmentation (deep brown or bluish black).
Preoperative view showing physiologic melanin
pigmentation of upper labial gingiva.

Immediately after depigmentation, No. 15 blade being

used to remove the pigment layer and frenectomy done

3 months postoperative view. Depigmented

gingiva that is pink and healthy
 Preoperative view showing highly pigmented
upper labial gingival

Immediate postoperative view, using

electrocautery

3 months postoperative view

Gummy Smile:
• Excessive gingival display, also known as a “gummy smile” is a
common esthetic concern among dental patients.

• The excessive gingival display while smiling has been largely viewed as
unaesthetic, leading to many patients seeking some form of
treatment to address this issue.
 Potential causes of excessive gingival display
• Short lip length
• Hypermobile/hyperactive lip
• Short clinical crown
• Dentoalveolar extrusion
• Altered passive eruption
• Vertical maxillary excess
• Gingival hyperplasia
Treatment options
Pre-Treatment Post-Treatment
Crown lengthening:
• Crown lengthening is one of the most common surgical procedures in
periodontal practice.

• The main indications of crown-lengthening surgical procedure include

treatment of subgingival caries, crown or root fractures, altered
passive eruption, cervical root resorption and short clinical abutment.
• The rationale of crown lengthening is to re-establish the biologic
width (e.g. the natural distance between the base of the gingival
sulcus and the height of the alveolar bone) in a more apical position
to avoid a violation that may result in bone resorption, gingival
recession, inflammation or hypertrophy.
Esthetic considerations:

The presurgical and surgical variables to be considered to achieve these

objectives are:
• The vestibular incision should be mostly guided by considering the final
position of the mucogingival line after flap suturing, with the purpose
of obtaining a uniform band of keratinized tissue around the anterior
teeth.
• The interdental soft tissues should be left in place if no interproximal
crown lengthening is required.
 An uneven free gingival A submarginal incision was Full-thickness reflection
margin is evident on the made to create revealed uneven alveolar
provisional restoration. symmetrical margins. crests on the abutment teeth.

Ostectomy performed around The flaps were apically An esthetic restoration

the tooth roots created positioned and after 2 months
symmetric alveolar crests. sutured into place.
Conclusion:
• Dentists and dental technicians alike must be aware of the general
concepts of esthetics and the current technologies and techniques in
their field and be able to use it to their and their patient’s advantage.
• Without doubt, dental esthetic treatment has the capacity to enhance
an individual’s appearance and persona. However accurate treatment
planning is crucial for ensuring that therapy achieves health, function
and finally esthetics.
• Creating esthetic restorations but omitting or ignoring health and
function is a recipe for disaster and one that compromises durability
and long term success.
 References:
• Aboucaya WA. The Dento‐Labial Smile and the Beauty of the Face [thesis]. No. 50. Academy of Paris,
University of Paris VI; 1973.
• Goldstein RE. Esthetic dentisty—a health service. J Dent Res 1993:3:641–642.
• Ronald E. Goldstein’s Esthetics in Dentistry, Third Edition. Edited by Ronald E. Goldstein, Stephen J. Chu,
Ernesto A. Lee, and Christian F.J. Stappert.
• Stephen F. Rosenstiel, Martin F. Land, Junhei Fujimoto’s Contemporary fixed prosthodontics, Third edition.
• Kenneth W. Aschheim’s Esthetic Dentistry: A Clinical Approach to Techniques and Materials, Third Edition.
• William R. Proffit, Henry W. Fields, David M. Sarver, James L. Ackerman’s Contemporary Orthodontics, Fifth
edition
• Berneburg M, Dietz K, Niederle C, et al. Changes in esthetic standards since 1940. Am J Orthod Dentofac
Orthop. 2010;137:450.e1–450.e9, discussion 450–451.
• Kokich VO Jr, Kiyak HA, Shapiro PA. Comparing the perception of dentists and lay people to altered dental
esthetics. J Esthet Dent. 1999;11:311–324.
• Munsell AH: A grammar of color, New York, 1969, Van Nostrand Reinhold.
• Feigenbaum NL: Aspects of aesthetic smile design, Pract Periodontics Aesthet Dent 3(3):9, 1991.
• Lombardi RE: Visual perception and denture esthetics, J Prosthet Dent 29:363, 1973.
 ACKNOWLEDGEMENT

A sincere thanks to

Dr. HIMANSHU AERAN

Director Principal
Professor and Head
Department of Prosthodontics And Crown And Bridge

139
 A SINCERE THANKS TO

Dr. P. NARAYANA PRASAD

Dr. SEEMA DIXIT
Guide
Co-Guide
Professor And Head Professor
Department Of Department of Conservative
Orthodontics And And Endodontics
Dentofacial Orthopedics

140
WITH AN EFFECTIVE SUPPORT OF

Dr. TARUN SHARMA Dr. TARUN KUMAR

Professor Professor
Department Of Orthodontics Department Of Orthodontics
And Dentofacial Orthopedics and Dentofacial Orthopedics

141
 Dr. S. KARPAGAVALLI

Professor And Head

Department Of Oral Medicine And
Radiology

Dr. AVANTIKA TULI

Dr. AMRINDER TULI
Professor And Head
Professor And Head Department Of Pedodontics
Department Of Periodontology

142
A SPECIAL THANKS TO ALL MY SENIORS
AND MY BATCHMATES

143