anterior - zweig Flashcards
in general patietns are very
demanding and high expectations
old bleach was
35% hydrogen peroxide - superoxol
aesthetics same as cosmetics?
different
aesthics - fits into the environment
- cosmetics- fitting them into the envionment
cosmetic dentistry definition
generally used to refer to ANY DENTAL WORK that improves apearance (though not necessarily the functionality ) of teeth, gums, and / or bite
-primarily focuss on imprvement DENTAL AESTHETICS in color, position, shape, size, alignment and overall smile apearance
aesthetics is
the formal study of the prinicples of art and beauty
shows picture of gold fillings is this aesthtic?
no?
picture of gold crowns cosmetic?
yes - changed whole environment
old guy with improvements looks like new crowns -
cosmetic dentistry
- argument is some people age does not have teeth look like that
how do you asses aesthetic risk? whose risk is it?
patient point of view vs ours
- physical characteristics
- high / low lip line
- narow / wide smile - emotional characteristics
- does pt think it will change their life? - level of patient demand
- how fussy is pt.
- is patient holding hand mirror 1/2 inch from their nose - skill of practitioner
high lip line
a 2mm or above display of gingival tissues
medium lip line
gingival margin and the lip line is congruent
low lip line
a 2 mm or more below the cervical line of the upper central incisors
less of an aesthetic risk at the margins
what is absolutley essential when doing a cosmetic case?
communication and informed consent
aesthetic zone?
where does it begin and end?
physical characteristics
- wide/ narrow smile
- patient demand
really depends on patient
- can be whole mouth with dentistry today
wide smile – will show more teeth in buccal vestibule
importance of shape
golden proportion?
height and width of teeth relation
a/b = (a+b) / a = 1.6
centrals = 1.6 laterals = 1 canines = .6
length width ratio of 75-80%
wifth 8 mm then length 10 mm
most important aspect of cosmetic - arguably
shape
central incisor width / height ration
if too short?
if too long?
implication of wear?
75 - 80 %
as teeth get worn down gets closer to 1:1 ratio
over 80% eans that the tooth is too short
under 75 % means shows a long tooth
10.3 vs 7.9
or 11mm with 8.5 mm width
width remains constant with wear **
male vs female
variable
male – generally flatter with squarer incisal angles
female - usually smaller with rounded incisal angles
embrasure space flow
sould follow a natural and progressive increase in size from the central to the cuspid
can look like one single tooth without
black triangles mainly correlated to
location of contact point
implication on the location of the contact point
** have to know this — according to tarnow - when the distance from the contact point to the alveolar bone was less or equal to 5 MM, THE PAPILLA WAS PRESENT 98% OF THE TIME
- while at 6mm it dropped to 56% and at 7mm it was only present 27% of the time
contact point location in central
incisal 1/3
lateral - more apical - apical to the contact point
cuspid - more apical
and incisal embrasure increaseing the more distal you go
axial inclination of teeth
all teeth should have a MESIAL INCLINATION – point towards the belly button
this should be MORE EXAGGERATED as we go more posteriorly
- SUBTLE AT CENTRALS and less so on the canines
apex of giniva on canines and centrals?
on laterals?
on laterals the apex of gingiva should be towards the mesial
on canines and centrals - should be towards the distal
line angle on central vs lateral
central - line angles are more towards the contact / proximal and on laterals they are more exxagerated
central incisor features
total symmetry
midline V with line angles
defined “grind zone”
mesial inclination
slight longer than the lateral incisors
lateral incisors features
set lingual to central incisor plane
line angles more toward center of tooth
larger “grind zone”
mesial inclination
slightly shorter than centrals
grind zone?
find the line angle and proximal contact and that area can contour to create better shape if think tooth looks too flat
connecting the two lines
line angle to the proximal contact
buccal anatomy also related to
reflective pattern
want to reflect light in same pattern
hints for taking shade
- always take shade at the beginning of the appointment
- do not stare at the teeth or shade tab for more than a couple of seconds at a time
- take a shade near a window if possible
- dont use the dental light
- use color corrected light bulbs in the room
- shade mapping
tooth symmetry
most important is central
some lateral incisors - have assmetry here
older - less symmetry
gingival symmetry
should follow the upper lip
the canines and centrals should be the SAME HEIGHT
the laterals should be slighlty more incisal
achieve gingival symmetry
often requires crown lenghtening
gingval biotype implication on material
thin and thick
the more thin – the more you need to make sure you have a translucent biotype
thin - thin band of keratinized tissue and scalloped gingival contour - thin bony arhitecture
thick - broad zone of keratinized tissue
flat gingival contour - thick bony architecture
more resistance to inflammation and trauma
principles of prep design in anterior
plane of reduction
3 planes of reduction
- gingival 1/3
- middle
- incisal 1/3 –
after buccal reduction? how ou know your done? area usually chronically under reduced
look at adjacent tooth
lingual aspect towards incisal area
- contact point
- like palatal fossa
T/F three planes of reduction M-D
Yes m- d too - helps get the line angles
anterior corwn reduciton basics
1.5 mm axial reduction
2mm incisal
3 planes of reduction gingiva;- incisal
- be sure incisal edge of prep is lingual to adjacent unprepped teeth
3 planes of reducitno M-D
be sure to have adequate reduction in concave portion of lingual prep!!!
incisal edge of prep should be
lingual to the adjacent unprepped tooth
fully prepped veneers
reduction related to
related to tooth position
- like if lingually positioned and adding to bucccal might not need to prep that much
PRESERVE ENAMEL
veneer prep break contact?
interproximal contact only maybe need to be broken
incisal prep of veneer?
1.5 to 2mm reduction with BUTT JOINT MARGIN
closing diastema with venner?
PREP CANNOT END SUPRA-GINGIVALLY – the wider the diastema the more sub g your prep has to be in order to avoid black triangles
- this is true for crowns too
digital incisal preps
need to be wider than milling burs 1-1.2 mm
ROUNDED AND SMOOTH
conservative aesthetic options
- incisal recontouring and re-establishing embrasures
- bleaching
- no prep porcelain veneers
- chairside composite veneers
if give patient cosmetic anterior - end tx with?
protect them
- fabricate some sort of night guard to protect anterior tooth restorations
a lot of times minimum number of teeth to have successful cosmetic case
8 teeth
- multi-discplinary approach
