Esthetics in FPD
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Transcript of Esthetics in FPD
ESTHETICS IN
FIXED PARTIAL PROSTHODONTICS
Presented by : Hemal Patel
Guided by : Dr. Smita Athavale
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CONTENTS
1.Definitions2.General principles of Esthetics3.Factors of esthetic dentofacial composition4. Esthetic considerations for Pontics5. Esthetic considerations for Connectors6. Surgical & non-surgical methods to improve
esthetics7. Types of esthetic restorative materials8. Esthetic fixed restorations9. References
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ESTHETICSBranch of philosophy dealing with beauty.
Esthetic dentistryArt and science of dentistry applied to create or enhance the
beauty of an individual within functional and physiological limits.
Why needed in fixed partial prosthodontics? ? ?
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Appearance Zone :
•This is the anterior oral area where esthetics is of prime
concern & which is visible on smiling, from maxillary premolar to
premolar (usually 1st molars also),.
•Depends on the person’s self-image, mouth size, teeth size,
smile width, lip size and tightness.
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GENERAL PRINCIPLES OF ESTHETICS1.Composition :
Facial composition Dentofacial composition Dental
composition
2.Unity:
i. Static unity ii. Dynamic unity
The following visual forces play a role in unity.i. Cohesive forces
ii. Segregative forces5
Thus, to achieve unity, the teeth are arranged with tectonic
spacing, that is, an esthetic and functional arrangement.
Centric occlusion Anterior protrusion of the mandible
3. Symmetry: Regularity in the arrangement of forms or
objects.
i. Horizontal symmetry
ii. Radiating symmetry
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4. Color, form and lines:
These provide dominance to a composition.
Color predominates over forms, lines and angles.
According to A. H. Munsell,
CHROMA
HUE
VALUE
Specific color produced by a specific
wavelength acting on the retina.
SATURATION : Purity of a color.
BRILLIANCE : Lightness or darkness of a color.
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MUNSELL’S COLOR WHEEL
Many factors that are part of biologic or structural beauty
depend on the visualization of LINES.
The direction of lines can also create optical illusions.
Vertical lines = longer tooth
Horizontal lines = wide and short tooth
Imaginary anterio-posterior line
of the incisal edges/cusps tips
representing the curve of Spee
Lines & Planes
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Any FORM can be created from the three basic shapes of a
circle, triangle and square.
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5. Proportion and Ratios:
Golden Proportion: The Golden Proportion results from the
division of a straight line in such a way that the shorter part is
to the longer part as the longer part is to the whole. Each ratio
equals 0.618.CB/AC = AC/AB = 0.618
AC
B
A/B = A+B/ C = C/B = B+C/A
= 1.618 = phi
Golden Rectangle
Golden mean gauge
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FACTORS OF ESTHETIC DENTOFACIAL COMPOSITION
A. FACIAL COMPONENTS
B. DENTAL COMPONENTS
C. GINGIVAL COMPONENTS
D. PHYSICAL COMPONENTS
A.FACIAL COMPONENTS:
1. References:
a. Horizontal references
-Interpupillary line
-Ophriac line
-Commissural line
b. Vertical references:
-Facial midline
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c. Sagittal references:
Upper and lower lip contours
E-line
d. Phonetic references:
"M" sound: amount of incisal display at rest.
"F" or "V" sounds: lingual tilt of the maxillary central incisor
length.
"S" and "Z" sounds: vertical dimension of speech.
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2. Facial Proportions:
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3. Visibility:
•The amount of tooth exposure when lips part slightly in a
relative rest state governed by muscles.
•Age
•Short upper lips : upper incisors
•Long upper lips: lower incisors
4. Components of the Smile:
a. Lip line :
Upper lip line:
• Exposure of teeth at rest/smiling and gingival margins on
smiling.
• Evaluate the need for esthetic gingival contouring/crown
lengthening in anterior area.15
Young Old
Lower lip line helps to evaluate buccolingual position of the
incisal edge of the maxillary incisors and the curvature of the
incisal plane.
b. Incisal plane:
Convex
Gull wing effect
c. Incisal edge position:
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INCISAL EDGE POSITION AT REST ON SMILING
d. Smile line or incisal curve is composed of the incisal edges
of the maxillary anterior teeth and parallels the inner curvature
of the lower lip.
•Degree of curvature more pronounced
in women than in men.
e. Negative space:
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f. Smile symmetry:
•Perceived in reference to central midline.
•Horizontal and radiating symmetry.
•In a natural pleasing smile, pleasing tooth symmetry is found
close to the midline and pleasing irregularity away from the
midline, creating a balance between idealism and diversity.
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B. DENTAL COMPONENTS:
1. Dental midline :
•Anatomical landmarks like the incisive papilla or
the labial frenum..
•Not necessarily should coincide with facial midline.
•Balance and symmetry.
2. Tooth proportion:
•Golden proportion (61.8 %)
•Proportion determined by face form
•Proportion by statistical averages
(75-89%)
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“A” 85% ratio, square appearance.“B” 78% ratio, normal ratio.“C” 65% ratio, teeth appear taller.
3. Axial inclination:
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4. Teeth arrangement:
10.2 mm
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Arch form
5. Gradation :
Front-back progression
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6. Teeth morphology :
a. Contact area:
b. Texture :
• Texture can be noted by the light reflection
pattern.
• The surface texture of a crown should simulate
the reflectance pattern of the adjacent natural teeth.
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c. Characterization :
According to age, sex and
personality.
d. Embrasure form : facial, lingual, incisal and gingival
embrasures.
•Affects perception : large embrasures make tooth appear
smaller and vice versa.
•Incisal embrasures increase in size from central incisor to
canine.
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Frush and Fisher Rufenacht
e. Line angles:
•Transition from the labial surface at the
mesial and distal lobes to the interproximal
embrasures.
•Changes in their positions control
the appearance of the width of the tooth
and affect light reflection pattern.
f. Emergence Profile:
A tooth's emergence profile is the angle at which the tooth
emerges from the gums when viewed from the side.
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7. Symmetry:
Automatically obtained if previous
principles are followed.
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C. GINGIVAL COMPONENTS:
•Gingival line
•Gingival apex/zenith
•Gingival contour and scalloping
•Gingival embrasure
•Gingival symmetry
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D. PHYSICAL COMPONENTS:
Perception:
Visual perception is:
•· Increased by increasing contrast
•· Increased by increasing light reflection
•· Increased by decreasing light deflection
Illusion:
•Is the art of changing perception making an object appear
different than it actually is.
•Principle of Illumination
•Principle of Lines
•Solve/hide esthetically difficult situations.
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NARROWING
WIDENING
SHORTENING
LENGTHENING
COLOR:
1. BASE COLOR :Base color is selected on the basis of hue, chroma and value selectionusing shade guides and tabs, comparing with adjacent teeth.
2. INTERPROXIMAL :Interproximal color provides a silhouette for the tooth.Dark colors makes teeth look smaller while no change in color will give abroader appearance.
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3. GINGIVAL THIRD :•Enamel gets thinner in the gingival third of teeth so darker dentinshows through and the area looks more yellow.•Staining .
4. INCISAL EDGE :The incisal edge is translucent enamel resulting in translucency, a haloeffect, or no change as it is worn away with age.
5. CHARACTERIZATION :•There are many different colors which can occur within a tooth asmight be seen with craze lines or hypocalcifications.•Staining.
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TRANSLUCENCY:
•Degree to which light is transmitted rather than reflected.
OPALESCENCE:
•Important component of the perceived enamel colour•Subtle bluish gleam characteristic appearance.
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Guidelines for shade selection:
• Stains and deposits must be cleaned off the tooth, and the tooth must be kept wet throughout shade determination.
•Remove bright make-up like lipstick and use neutral-colored drape to avoid distraction.
•The teeth should be viewed at eye level so that most color-sensitive part of the retina will be used.
• The color of the luting agent must also be taken into consideration.
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•· Shade evaluation :
-First visit after cleaning OR Next visit after tooth preparation or bleaching or a strenuous appointment, but following color stabilization.
-Under different lighting conditions and wet conditions.
•· Hue, chroma and value should be matched in that order.
•· When in doubt, always select higher value and lower chroma, since it is easy to lower the value and increase the chroma.
•First impression of the chosen color is best and sometimes, squinting may help to choose the right value of color.
•Shade tabs :
•Custom shade guides •Photographs
ESTHETIC CONSIDERATIONS FOR PONTICS
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FACTORS AFFECTING PONTIC DESIGN
A. Pontic spaceB. Residual ridge contourC. Occlusal load
A
B B C
SURGICAL MODIFICATION FOR RIDGE DEFECTS
ROLL FLAP TECHNIQUE
•The Roll Flap Technique to Improve Esthetics in Anterior Ceramic Fixed Partial
Dentures: Perio-Prostho Relationship - A Case Report
Kalpesh Vaishnav, Anita Panchal, Dipti Shah
POUCH TECHNIQUE
INTERPOSITIONAL GRAFT
Free gingival
graft
PONTIC DESIGN
B. Mesiodistal width C. Gingival interface
A. Inciso-gingival height
ESTHETIC PONTICS
Saddle / Ridge lap pontic
•Esthetics : Resembles a tooth &
replaces all the contours of the
missing tooth .
•Concave tissue surface.
•Overlaps the residual ridge
buccolingually.
•Disadvantage : Difficult flossing due
to concave tissue surface.
Modified ridge lap pontic• It combines the best features of the hygienic
and saddle pontic designs, combining esthetics with easy cleaning.
• Overlaps the residual ridge facially only.
• Lingual surface has a slight deflective contour to prevent food impaction and minimize plaque accumulation.
.
• “T” shaped tissue contact whose vertical arm ends at the crest of the ridge.
Ovate pontic
• First described by DEWEY and
ZUGSMITH in 1933.
•Most esthetically appealing pontic
design and ease of hygiene.
•Convex tissue surface resides in a softtissue depression or hollow in theresidual ridge.
•Appears to grow out of ridge.
PONTIC INDICATION ESTHETIC CONCERN
HYGIENE DIAGRAM
Saddle-ridge lap
Anterior and Posterior teeth
Reasonablygood esthetics
Difficult
Modified ridge lap
Easier than above
Ovate
Anterior and Posterior teeth;
High lip line
Excellent esthetics & emergence profile
Easier than above
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Use of a Modified Ovate Pontic in Areas of Ridge Defects
CHIUN-LIN STEVEN LIU:J Esthet Restor Dent 16:273-283, 2004
A modified ovate pontic has the following advantages:
•Excellent esthetics•Fulfilled functional requirements•Greater ease of cleaning as compared with the ovate pontic•An effective air seal, which eliminates air or saliva leakage•The appearance of a free gingival margin and interdental papilla•Elimination or minimization of the "black triangle" between the teeth•Little or no ridge augmentation required.
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Ponticsystem
Advantages Disadvantages Indications Contraindications
Metal-ceramic
Esthetics
Biocompatible
Difficult if an abutment is not metal-ceramic Weaker than all metal
Most situations Long spans with high stress
All metals Strength Non-esthetic Mandibularmolars especially under high stress
Where esthetics is important
Fiber-reinforced all-resin
Conservative when used with inlay preparations
Esthetics
Easy to repair
Long-term success unknown Limited to short spans
Areas of high esthetics concern
Long-span FPDs
Facings Rarely used
Available Pontic Systems
ESTHETIC CONSIDERATIONS FOR CONNECTORS
A. Connector size
B. Connector shape
C. Connector position
Connectors are components of FPD that connect the pontic(s) to retainer(s).
-Rigid-Non-rigid
Fig 1 Fig 2
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ESTHETIC PERIODONTAL CORRECTIVE PROCEDURES
Inadequate tooth structure for restoration:1.surgical crown lengthening2.Forced eruption with fiberotomy.
Recession:1.Free gingival / lateral pedicle graft2.Subepithelial connective tissue graft3.Guided tissue regeneration
Edentulous ridge defects:1.Onlay/inlay grafts2.Synthetic bone grafts
Gingival overgrowth:1.Gingivectomy / Gingivoplasty2.Apically postioned flap with or without ostectomy
Electrosurgery/laser for
esthetic contouring
•Pontic design:-Tooth-colored-Pink ceramic in cervical area
•Gingival mask
•FPDs with pink porcelain flanges
ESTHETIC NON-SURGICAL CORRECTIONS
TYPES OF ESTHETIC RESTORATIVE MATERIALS
1. Ceramic :- Aluminous- Feldspathic reinforced with Zirconia- Feldspathic reinforced with Leucite- Ceromers
2. Composite : - Conventional- Fibre-reinforced (glass, polyethylene, carbon)
3. Gingiva-colored materials:- Ceramic like d.SIGN- Acrylic- Silicone
ESTHETIC FIXED RESTORATIONS
Missing teethCrowding/Malaligned anteriorsMild rotationsStains/DiscolorationAbrasions/Attrised anteriorsErosions/Destructed toothSpacing
BridgesOnlaysCrownsVeneers/Laminates
INDICATIONS
ESTHETIC FIXED RESTORATIONS
Full-coverage FPDPartial-coverage FPDResin-retained FPDFibre-reinforced composite FPDImplant-supported FPD
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Metal-ceramic All-ceramic
METAL-CERAMIC RESTORATIONS
Facial Tooth Reduction:
•A minimum reduction of 1.5 mm typically is required for optimal
appearance.
Reduction in 2 distinct planes Adequate porcelain thickness
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Incisal Reduction:
•An incisal reduction of 2 mm is recommended for translucency
at the incisal 1/3rd.
•Excessive incisal reduction must be avoided because it reduces
the resistance and retention form of the preparation.
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Proximal Surface:
The proximal surfaces of these
anterior metal-ceramic crowns are
restored in porcelain, which allows
light to be transmitted for
maximum esthetics.
Margin Placement:
Should follow free gingival contour.
Supragingival margins :
Easy to prepare, finish, maintain hygiene, make impressions
and evaluate on recall visits.
Low lip line.
Subgingival margins:
Caries/restorations involving root High lip line.57
Proximal margin:
Mesial margin: just buccal to the proximal contact area, where
metal will be hidden by the distal line angle of the neighboring
tooth.
Facial margin:
•Just beyond the occlusofacial line angle.
•Short bevel (to prevent enamel chipping)
•Chamfer (for more bulk of material in molars, if needed)
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PARTIAL-COVERAGE RESTORATIONS
Fiber-reinforced composite fixed partial restoration
Consists of a fiber-reinforced composite substructure veneered with a particulate composite material.
Resin-retained fixed partial restoration
Short span FPDs supported by thin metal retainers bonded linguallyand proximally to the abutment enamel.
Etched resin-retained (Maryland bridge)
Cast perforated resin-retained fixed
IMPLANT-SUPPORTED BRIDGES
LAMINATES/VENEERS
AFTERBEFO
RE
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BEFORE AFTERPORCELAIN
COMPOSITE
ARTICLES
Collarless metal ceramic fixed partial denture: Clinical
report.
W. Matsumoto et al.
Braz Dent J (2001) 12(1) 215-218.
• Advantages:
- Esthetic
- Excellent biocompatibility of the glazed porcelain
- No special equipment required.
- Less plaque because of smooth glazed porcelain collar.
• Although, it requires skill and there is always the risk of
producing restorations with poorer marginal fit.
•An Alveolar Bone Augmentation Technique to Improve Esthetics in Anterior Ceramic FPDs: A Clinical ReportBurak Taskonak and Yasar OzkanJ Prosthodont 2006;15:32-36.
This article describes an alvelolar bone augmentation technique so as to preserve the edentulous space after extraction which is nothing but the pontic space.
Tissue sculpturing: An alternative method for improving esthetics of anterior fixed prosthodonticsJacques et al.J Prosthet Dent 1999;81:630-3.
•An unfavorable relationship between residual ridge, pontic, and gingival papilla commonly compromises the final result.
•This article describes a technique for the improvement of esthetics with conditioning of the tissue beneath the pontics, by displacing tissue with a treatment restoration.
•Lateral displacement of tissue under gradual, controlled pressure enhances the interdental papilla, which improves esthetics.
References
1. Fundamentals of Fixed Prosthodontics: Shillingburg 3rd
Edition.
2. Contemporary Fixed Prosthodontics : Rosenstiel 3rd Edition.
3. Library dissertation “Esthetics in FPD” by Dr. Guruprasad
Handal ; Dr. DY Patil Dental College.
4. South African Dental Technology Journal : Aesthetic s
Issue,Vol 1 Issue 3.
5. The art of a beautiful smile.
Journal of Cosmetic Dentistry, Fall 2008 Volume 24 Number
3.
6. Collarless metal ceramic fixed partial denture: Clinical
7. Use of a Modified Ovate Pontic in Areas of Ridge Defects:
Case reports.
Liu CS.
J Esthet Restor Dent 16:273-283, 2004.
8. Levin El. Dental Esthetics and the Golden Proportion.
J Prosthetic Dentistry 40:244-252 1978.
9. Lombardi RE. The principles of visual perception and their
clinical application to dental esthetics.
J Prost Dent. 1973;29:358-381.
10.McLaren EA and Tran Cao P. Smile Analysis and Esthetic
Design: “In the Zone”. Inside Dentistry- Esthetics,
July/August 2009.
11.The updated application of the golden proportion to dental
aesthetics.
THANK YOU
Next seminar by Dr. on
Resin-retained fixed partials:
Fiber-reinforced fixed partials:
Short span FPDs supported by thin metal retainers bonded lingually and proximally to the abutment enamel.
Consists of a fiber-reinforced composite substructure veneered with a particulate composite material.
Etched resin-retained (Maryland bridge) Cast perforated resin-retained fixed