2. Esthetics and Anterior Tooth Preparation Flashcards by J L

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Vertically, face is organized around facial ____

Horizontally, ____ reference lines perpendicular to midline create an organized network

midline

several

How well did you know this?

Not at all

Perfectly

Frame and Reference
Horizontal Reference Lines
w ____ line
____ line

interpupillary

lip

How well did you know this?

Not at all

Perfectly

Frame and Reference
Horizontal Reference Lines

wInterpupillary line serves to evaluate orientation of:
n \_\_\_\_
n Gingival
margins 
n \_\_\_\_

incisal plane

maxilla

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Frame and Reference
Horizontal Reference Lines
wIncreasing age
associated with:

n Reduced ____
n ____ of 􏰆gull wing􏰇 effect
n ____ smile line

incisal embrasures
leveling
straight

How well did you know this?

Not at all

Perfectly

Frame and Reference
Horizontal Reference Lines

Displeasing ____ configuration of incisal plane

Cosmetic and restorative correction to reduce ____ and create mild ____

concave
concavity
convexity

How well did you know this?

Not at all

Perfectly

Frame and Reference
Horizontal Reference Lines
w Orientation of gingival plane is evaluated in relation to ____ line and ____ line

interpupillary

upper lip

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Frame and Reference
  wSagittal reference 
n \_\_\_\_ support 
n \_\_\_\_ relation 
n \_\_\_\_ plane
\_\_\_\_ reference

upper lip
lower lip
occlusal
phonetic

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

wUpper lip support
n Somewhat controlled by position of ____ teeth
n Gingival ____ of teeth contribute to main support of lip

maxillary

2/3

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Frame and Reference
Vertical Reference Lines
      w􏰆F􏰇 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

How well did you know this?

Not at all

Perfectly

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 􏰆____􏰇 w􏰆posterior 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 ```