2. Esthetics and Anterior Tooth Preparation Flashcards
Factors of Esthetic Composition
wFour factors n \_\_\_\_ and reference n Proportion and idealism n \_\_\_\_ n Perspective and illusion
wAssist in determining n Tooth \_\_\_\_ n Tooth size n Tooth \_\_\_\_ n Orientation to face
frame
symmetry
display
arrangement
Frame and Reference wTeeth must harmonize with 3 frames: n \_\_\_\_ n Lips n \_\_\_\_
wThere are different reference lines
n ____ n Vertical
n ____
face
gingiva
horizontal
sagittal
Vertically, face is organized around facial ____
Horizontally, ____ reference lines perpendicular to midline create an organized network
midline
several
Frame and Reference
Horizontal Reference Lines
w ____ line
____ line
interpupillary
lip
Frame and Reference
Horizontal Reference Lines
wInterpupillary line serves to evaluate orientation of: n \_\_\_\_ n Gingival margins n \_\_\_\_
incisal plane
maxilla
Frame and Reference
Horizontal Reference Lines
Slant of incisal plane caused by inclination of ____
-Gingival plane follows direction of ____ (needs surgical correction)
- Severe misalignment of incisal plane
- ____ treatment needed
maxilla
maxilla
multidisciplinary
Frame and Reference
Horizontal Reference Lines
wLip lines
n Length and curvature of lips significantly influences amount of ____ at rest and in function
n Average maxillary incisor display with lips at rest
l____mm in men
l____mm in women n More tooth display in
____ smiles
lMany older patients prefer a more youthful smile
tooth exposure
1.91
3.40
youthful
Frame and Reference
Horizontal Reference Lines
wUpper lip line serves to evaluate:
n Length of ____ exposed at rest and during smile
n ____ position of the gingival margins during smile
maxillary incisor
vertical
Frame and Reference
Horizontal Reference Lines
wLower lip line serves to evaluate:
n Buccolingual position of the incisal edge of ____ incisors
n Curvature of the ____
lIncisal plane follows ____ line during smiling
maxillary
incisal plane
lower lip
Frame and Reference
Horizontal Reference Lines
wWhen incisal edges of canines and central incisors are aligned on a convexity, incisal plane is ____
w Esthetically pleasing
Progression of size of incisal embrasures from central incisors to ____ (youthful appearance)
convex
canines
Frame and Reference
Horizontal Reference Lines
wWhen incisal edges of canines and central incisors are aligned, but longer than ____, incisal plane has ____ smile line
w Esthetically pleasing
Gull wing, ____, and ____ are esthetically pleasing
lateral incisors
gull wing
convex
combination
Frame and Reference
Horizontal Reference Lines
w Youthful appearance
n Prominent and well-developed ____**
n Well-defined ____
n Convex or gull wing smile line
central incisors
incisal embrasures
Frame and Reference
Horizontal Reference Lines
wIncreasing age
associated with:
n Reduced ____
n ____ of gull wing effect
n ____ smile line
incisal embrasures
leveling
straight
Frame and Reference
Horizontal Reference Lines
Displeasing ____ configuration of incisal plane
Cosmetic and restorative correction to reduce ____ and create mild ____
concave
concavity
convexity
Frame and Reference
Horizontal Reference Lines
w Orientation of gingival plane is evaluated in relation to ____ line and ____ line
interpupillary
upper lip
Frame and Reference
Horizontal Reference Lines
w Exposure of gingival margins must be evaluated at various smile positions n Moderate smile lUpper lip border may cover \_\_\_\_ aspect of maxillary incisors or expose up to \_\_\_\_mm
n Gummy smile
lMore than ____mm of gingival tissue exposed during moderate smile
cervical
3
3
Frame and Reference
Horizontal Reference Lines
w Gingival asymmetry of the maxillary central incisors requires special attention n Low lip line lNo \_\_\_\_ n Moderate to high lip line \_\_\_\_ or orthodontic correction
correction
surgical
Frame and Reference
Vertical Reference Lines
wThe facial midline serves to evaluate:
n The ____ of the dental midline
n ____ discrepancies in tooth position
location and axis
mediolateral
Frame and Reference
Vertical Reference Lines
w Ideally, maxillary central incisal midline should coincide with ____ of face
w Slight discrepancy may not affect ____
w Appears ____ is more critical than mediolateral position
midline
esthetics
verticality
Frame and Reference wSagittal reference n \_\_\_\_ support n \_\_\_\_ relation n \_\_\_\_ plane \_\_\_\_ reference
upper lip
lower lip
occlusal
phonetic
Frame and Reference
Vertical Reference Lines
wSagittal references
n Profile analysis should evaluate ____ of upper and lower lips
lUsed as a guide to tooth position
contours
wUpper lip support
n Somewhat controlled by position of ____ teeth
n Gingival ____ of teeth contribute to main support of lip
maxillary
2/3
Frame and Reference
Vertical Reference Lines
wLower lip relation
n Relationship of maxillary incisal edges to lower lip is guide for general assessment of ____position and length
n F or V position
lPosition at which incisal edges of maxillary anterior teeth permit most fluent ____
lIncisal edges should make definite contact at ____ of lower lip
incisal edge
pronunciation
inner vermilion border
Frame and Reference
Vertical Reference Lines
wF or V position (continued)
n Valuable in determining facial position of \_\_\_\_ of maxillary central incisors
lMust conform to path of closure of \_\_\_\_maxillary central incisors
lower lip
Frame and Reference
Vertical Reference Lines
wPhonetic references
n 4 sounds aid in esthetic diagnosis
l(1)M sound used to achieve ____ postion
l(2,3)F or V sound to determine ____ of incisal third of maxillary central incisors and whether abnormally ____
relaxed rest
lingual tilt
elongated
Frame and Reference
Vertical Reference Lines
l(4)S sound determines ____ dimension of speech
wMaxillary and mandibular incisal edges come in near contact and determine ____
wposterior speaking space varies with amount of mandibular ____ necessary to bring ____ teeth in near contact for S sound
vertical
anterior speaking space
protrusion
anterior
Frame and Reference
Vertical Reference Lines
wOcclusal plane
n Established by incisal and occlusal surfaces of teeth and conventionally coincides with ____
l Extends from inferior border of ____ to superior border of ____
n Incisal plane may not correspond to posterior plane of occlusion if ____ of maxillary anterior teeth
n If posterior plane of occlusion is correct, may help diagnose faulty ____
camper's plane ala of nose tragus of ear supraeruption incisal length
Proportion and Idealism
w Proportion
n Implies ____ and arithmetic
l Associating beauty with numerical values conforms to the concept that beauty is fundamentally exact
wBeauty is equated with a harmony of ____
w Idealism
n Serves to study and ____ ideal tooth
forms before creating variation and
characterization
geometry
proportions
replicate
Proportion and Idealism
wIn esthetic dentistry, proportion and idealism serve to determine:
n (1)the optimum size of the ____
n (2)the optimum relationship between the dimensions of the maxillary ____, lateral incisor and ____
maxillary central incisors
central incisor
canine
Proportion and Idealism
wTooth proportion is computed by dividing the width of clinical crown by ____
n As a rule, pleasing width:length ratios for maxillary central incisors
are between ____%
l<65% central incisor
may appear too ____ length
l>85% central incisor may appear too ____ and ____
length 75-80 narrow short square
Proportion and Idealism
wGolden Proportion
n Geometric basis for proportionality in beauty of art and nature
A smile is esthetic when each tooth in the smile is approximately ____% of the size of the tooth immediately ____ to it
n Exact proportion of smaller tooth to larger tooth is ____
60
mesial
0.618
Symmetry and Diversity
w Symmetry
n Regularity or ____ of tooth arrangement
n Harmonious facial features
lmore symmetrical close to facial ____
lmore ____ away from facial midline
lFor a pleasing smile, the ____ to the dental midline, the more symmetrical the smile must be
w Goal in a natural smile
n achieve pleasing balance between idealism and
____
lnatural dentitions almost always ____
balance midline asymmetrical closer diversity asymmetrical
The central incisors are mostly ____ with subtle minor asymmetries
More ____ as move farther from midline is still esthetically pleasing
symmetrical
asymmetry
Perspective and Illusion
w Perspective n How the perception of the \_\_\_\_ of an individual tooth may be altered w Illusion n How the elements of an esthetic composition may \_\_\_\_ one another
shape
affect
Perspective and Illusion
wAltering the perception of an individual tooth
n ____ and narrowing
n Shortening and ____
wIllusion of larger or narrower teeth in the same space is created by varying the ____ or silhouette form, which then affects ____ reflection
widening
lengthening
outline
light
Perspective and Illusion
Altering Maxillary Incisors
Widening
Displace line angles ____ ____ facial outline
Highlight texture and gloss with ____ lines and ridges
Decrease facial ____
Displace proximal contacts ____
Narrowing
Displace line angles ____
Increase ____ of facial outline
Highlight texture and gloss with ____ lines and ridges
____ facial embrasures
Displace proximal contacts ____
____ proximal aspects with extrinsic staining
laterally flatten horizontal embrasures labially
medially convexity vertical increase lingually shadow
Perspective and Illusion
Altering Maxillary Incisors
Applications for widening To increase narrow \_\_\_\_ space To improve tooth \_\_\_\_ To correct elongated clinical crowns after \_\_\_\_ or implant surgery
Applications for narrowing
To close ____
To reduce large ____ space To control tooth ____
pontic
proportions
periodontal
diastema
pontic
proportions
Perspective and Illusion
Altering Maxillary Incisors
Shortening Emphasize prominence of cervical \_\_\_\_ Displace cervical convexity \_\_\_\_ Accentuate \_\_\_\_ tilt of incisal third Highlight texture and gloss with \_\_\_\_ lines and ridges Emphasize the \_\_\_\_
Lengthening \_\_\_\_ the cervical convexity Displace the cervical convexity \_\_\_\_ \_\_\_\_ the cervical aspect Highlight texture and gloss of the \_\_\_\_ angles and create vertical ridges
convexity coronally downward horizontal CEJ
flatten
apically
lighten
line
Perspective and Illusion
Altering Maxillary Incisors
Applications for Shortening \_\_\_\_ of the maxillary central incisors Long \_\_\_\_ To control \_\_\_\_ To correct elongated clinical crowns after \_\_\_\_ or implant surgery
Applications for
Lengthening
____ of the maxillary central incisors
To correct a ____ maxillary central incisor that cannot be lengthened surgically
asymmetry
pontics
proportions
periodontal
asymmetry
short
Perspective and Illusion
Altering Perception
wShading perspective n Natural dentition
lFour ____ have same shade
____ appear darker
n Prosthetically, may be too abrupt color change
lPreferable to create ____ transition with progressive shade saturation from central incisor to canine
wAlso emphasizes dominance of maxillary central incisors because ____ is higher than laterals
maxillary
canines
smooth
value
Perspective and Illusion
Altering Perception
w Central incisors are restored with a ____ shade than the laterals to highlight prominence of centrals
n Softens ____ between laterals and darker canines
lighter
contrast
Color
wMunsell Color Order System n Popular method of visually describing color l \_\_\_\_ phenomenon n 3 attributes l \_\_\_\_ l Chroma \_\_\_\_
3-dimensional
hue
value
Color
Hue
w Particular variety of color w Distinguishes one ____ of colors from another
n Example green from blue
w Determined by ____ of reflected and/or transmitted light observed
n Shorter wavelength, closer to ____
n Longer wavelength, closer to ____
family
wavelength
violet
red
Chroma
w ____ of a hue
w = ____
w Quality by which distinguish a strong color from weak one
n The more intense, the higher the ____
intensity
saturation
chroma
Value
w relative lightness or darkness of a color or the ____ of an object
n Brightness is direct consequence of amount of ____object reflects and/or transmits
w Quality by which we distinguish a light color from a ____ one
brightness
light energy
dark
Color
V alue
wA restoration that has too ____ a
value (too bright) is a common esthetic problem in metal-ceramic prosthodontics
high
Color Replication Process
wProcess by which color of adjacent teeth is replicated in an all-ceramic or porcelain- fused to metal restoration
wConsists of ____ phase and ____ phase
wIf visually perceptible differences between restoration and teeth, ____ characterization can adjust discrepancies
shade-matching
shade-duplication
surface
Guidelines for Shade-Matching
w Use ____ lighting
n Diffuse and comfortable to eyes n daylight?
l May not be constant (variable)
l Standard ____ lighting recommended
w Remove ____ and/or cover brightly covered clothing
w Teeth should be ____
n ____ if necessary
w Shade matching at ____ of visit
n Tooth color ____ in value when teeth dry
balanced full-spectrum lipstick clean prophylaxis beginning increases
Guidelines for Shade-Matching
w Use shade guide to select shade
n May use several shade guides to expand choices
w View patient at ____ level
w If tooth and shade guide have different surface characteristics, ____ both
eye
wet
Guidelines for Shade-Matching
wVita classical
n Select hue by matching with ____ chroma
n Select chroma within ____ group
n ____-ordered shade guide
high
hue
value
Guidelines for Shade-Matching
wVita toothguide 3D master n \_\_\_\_ lightness levels n Each level varies in \_\_\_\_ and hue n \_\_\_\_ selected first lThen chroma and then, \_\_\_\_
5
chroma
lightness
Guidelines for Shade-Matching
w ____ shade guide is used to communicate the color of the prepared tooth to the technician when ____ ceramic systems are used
dentin
translucent
Guidelines for Shade-Matching
w Should make quickly due to ____ fatigue
n Less than 5 seconds
n Tab directly next
to tooth
n ____ eyes during viewing
w To select hue, ____ recommended due to highest chroma
eye
rest
canine
Guidelines for Shade-Matching w Dentist can select value by \_\_\_\_ w Reduce number of shade tabs to \_\_\_\_ (quickly) and then, to one or two w Confirm at one or \_\_\_\_ more visits n Possibly with auxiliary staff member
squinting
three
two
Guidelines for Shade-Matching
w If exact match cannot be selected, a shade tab with the ____ CHROMA and ____ VALUE
n ____ characterization can be used to increase chroma and reduce value
lower
higher
extrinsic
Guidelines for Shade-Matching
w Dentist should map polychromatic nature of tooth being matched n Special characteristics l \_\_\_\_ l Hypocalcification \_\_\_\_ of incisal enamel
n Submit
lShade \_\_\_\_ chart -or-
lDigital image with shade tab near tooth
-or-
\_\_\_\_ of shade tab
cracks
translucency
distribution
staining
Instrumental Color Analysis
w Color matching generally done ____
w Various clinical color- measuring devices available
n Generally colorimeters, spectrophotometers, or spectroradiometers
n Only different versions of Vita Easyshade are available
w In vitro testing
n Reliability (90%) and accuracy varies (60%-90%)
n Initial clinical testing shows ____ values
visually
similar
Instrumental Color Analysis
w Image analysis
n Software approach with image ____ and calibration
analysis
PFM Preparation
Shoulder: marginal ____ and structural ____
Vertical lingual wall: ____ and resistance
Concave cingulum reduction: structural ____
Shoulder: marginal ____ and structural ____
Axial reduction: ____ and resistance; structural ____
Rounded angles: structural ____
integrity
durability
retention
durability
integrity
durability
retention
durability
durability
Criteria for Evaluation
All Ceramic Crown Preparation
w Incisal reduction
n ____mm
w Facial axial reduction (shoulder) n ____mm
w Interproximal axial reduction (shoulder)
n ____mm (M and D)
w Lingual axial reduction (shoulder)
n ____mm
w Correct lingual reduction (incisal to cingulum)
n ____mm
w Correct linguo-axial wall height n Minimum ____mm
w Correct occlusal-gingival placement circumferentially
n ____mm supragingival
1.5-2 1 1 1 1.5 2 0.5
