Restorative Dentistry II Fifth Year

1. Contemporary Esthetic
Restorative Procedure
Restorative Procedure II
5th Year
College Of Dentistry
University Of Dammam

2. Color
• Three Color Dimensions
Hue
Chroma
Value
•
Color Mixing
Primary Hues
Secondary Hues
Complementary Hues

3. Color And Teeth
• Human Teeth are NEVER a single color
• Cervical Third: the Perceived color
close to pure dentin.
• Middle Third: (Body color) mainly the
Dentin Hue, influenced by the thick
layer of overlying Enamel.
• Incisal Third: minimal influence of
dentin, mainly the influence of Enamel.

4. Color Perception
& Shade Selection
• Optical Properties
• Spectral Reflection
• Metamerism
www.logodesignworks.com/blog/
images/eye-perce

5. Sensitivity of
the Observer
Eye
www.logodesignworks.com/blog/images/eye-perce
• Perception threshold & light sensitivity
• Color Fatigue
• Color Blindness

6. Viewing Conditions
• Lightning: Standard day light, Artificial light (color
corrected CRI > 90)
• Surroundings: walls, floors, sealing ..etc
• Time: Initial diagnosis appointment and again at the
beginning of preparation appointment
• Patient Position
• Tooth condition

9. Esthetic/Cosmetic
Dentistry
• Esthetic: relating to sense
perception, judgement and taste
concerning beauty .. a pleasing
appearance or effect”
Webster 3rd International Dictionary
• Cosmetics: The ART of beatifying or
altering the appearance.
Webster 3rd International Dictionary

10. Factors Altering
Esthetics
• Exogenous
• Endogenous
• Defects of Enamel and Dentin
•
•
http://www.sciencephoto.com/images/showEnlarged.html/
P486115-Tooth_enamel,_SEM-SPL.jpg?id=804860115
Environmental
Hereditary
• Other factors
http://www.sciencephoto.com/images/showFullWatermarked.html/
P486153-Tooth_dentine,_SEM-SPL.jpg?id=804860153

11. Esthetic Modification
HEALTH
FUNCTION
ESTHETICS

12. Smile Design

13. Visible Incisal
Length
Incisal edge position with
lips at rest.
Incisal edge position framed
between upper and lower lip.
Maxillary and mandibular
incisal edge relationship.
http://c1-preview.prosites.com/10426/wy/images/Embrasures.gifweb.gif

15. Tooth Position &
Relationships

16. Tooth Access
Zenith Point
http://c1-preview.prosites.com/10426/wy/images/Tooth%20proportionweb.gif

17. Interdental Contact Area
Interdental Contact Point
Incisal Embrasure

18. Tooth Dimension &
Proportions
Tooth Shape

19. Central Incisor
• The length to width proportion
•
•
(10:8)
The rule of 1/16” (tooth &
face)
Size, gender and shape
http://www.confidentsmile.com/smile-design/

20. Symmetry &
Proportionality
•
•
•
The Golden Proportion
Visual Width
Repeated Ratio (more more
practical)
http://c1-preview.prosites.com/10426/wy/images/Embrasures.gifweb.gif
http://c1-preview.prosites.com/10426/wy/images/Tooth%20proportionweb.gif

21. Tooth
Character
•
•
•
•
•
•
Surface Texture
Surface Contour
Surface Luster
Line Angle Position
Embrasure Form
Incisal Edge Form
http://www.confidentsmile.com/smile-design/

23. Gingiva &
Supporting
Tissue
http://www.scielo.br/img/revistas/dpjo/v15n1/en_14f04.jpg
•
•
•
•
•
Lip Line
Lip Profile
Upper & Lower lip interrelationship
Commissure Width & Location
Size of Buccal Corridor

24. Age
Characteristics
of Teeth
• Chroma & Value
• Surface Texture

25. Causes of Esthetic
Defects
• Caries.
• Occlusal Disharmony.
• Loss of tooth substance.
• Discoloration.
• Minor abnormality in size and shape of teeth.
• Missing teeth.

26. Teeth Defects
http://3.bp.blogspot.com/_r2K1IjhvZV0/TB_NX0Y6K-I/
AAAAAAAAADI/8YUuvcQ312g/s1600/erosion.jpg
http://t1.gstatic.com/images?
q=tbn:ANd9GcSoIFfH6j4RLrYKO_QtZDC_7qMc7yeGrD6hPrGm-8d
_b4EjS3H75g

27. Objectives of Restoring
Esthetics
• Restore Affected teeth into normal form,
size, position, alignment, color, surface and
optical characteristics and occlusion.
• Restore normal periodontium

28. Limitation in Restoring
Esthetic
• Color matching.
• Gingival and periodontal health.
• Occlusion
• Available restorative materials

29. Correctable
Defects
•
•
•
•
•
•
Incisal Irregularities
Length/ Width discrepancies
Shape discrepancies
Enamel Defects
Diastema
Slight Malposition
http://boca-raton-cosmetic-dentist.co.cc/wp-content/uploads/2009/01/porcelain_veneers.jpg

30. http://www.knoxsmiles.com/Images/LumineersBA1.gif

31. Treatment
Modalities
•
•
•
•
•
•
•
Visual Mock-ups
Bleaching
Micro-abrasion
Reshaping
Direct Resin Bonding
Indirect Veneers
Crowns

35. Esthetic Treatment
Modalities

36. Mock-up

40. Teeth Re-shaping

42. http://www.drglasband.com/blog/wp-content/uploads/2010/11/after-reshaping1-300x160.png

43. http://dentalclinicintoronto.ca/wp-content/uploads/2010/07/contouring_before_after.jpg

44. http://www.dentalcomposites.com/Recontabc29.gif

45. Diastema
http://www.dentalcomposites.com/Didddaste44.gif

46. http://www.renicholsdds.com/images/gap_smile.jpg
http://www.zimbio.com/go/vGZHexiokZ6/http://www.brooksidedental.com/blog/wp-content/uploads/2008/12/diastema-after-cosmetic-dentistry.jpg

50. Cosmetic Bonding

51. http://www.charlesortiz.net/wp-content/uploads/2009/07/Patients-588x391.jpg
http://bansaldentalcare.com/images/contour.jpg

52. http://www.yourdentistingoa.com/images/Cosmetic-Bonding-3.jpg

53. http://www.dentalcomposites.com/rotate2.jpg
http://www.dentalcomposites.com/rotate5055.gif

54. http://cosmetic-dentistry-and-porcelain-veneers.com/smile-design/gum-shape/gums9drhuefner/
http://eshomdds.com/services/gumcont.jpg

55. http://www.blakesmiles.com/img/before-after/veneer-b-a.jpg
http://2.imimg.com/data2/LL/NO/MY-2113805/bleahingtooth-veeners-250x250.jpg

56. http://sherwooddental.ca/images/smilegallery/6.png

57. Direct Composite
Veneers

62. Black Triangle

64. Esthetic Cavity
Design
•
Should reflect the
concept of esthetics.
•
Modified Designs.

65. Restorative Materials &
Techniques

66. Natural Tooth
Bleaching

67. Tooth Bleaching
•
•
As early as 1890’s (Pyrozone)
•
•
•
•
1940’s (Hydrogen Peroxide + ether)
1910 in-office bleach (Hydrogen
Peroxide)
1950’s (Pyrozone + Na-perborate)
1960’s (10% Carbamide Peroxide)
1989 (Profession Acceptance)

68. Types & Nature of
Staining
•
Poor oral hygiene,
chromatogenic food & drinks.
•
•
•
•
Aging.
Tetracyclic Staining.
Fluorosis.
Some systemic conditions.

69. Factors Altering
Esthetics
• Exogenous
• Endogenous
• Defects of Enamel and Dentin
•
•
http://www.sciencephoto.com/images/showEnlarged.html/
P486115-Tooth_enamel,_SEM-SPL.jpg?id=804860115
Environmental
Hereditary
• Other factors
http://www.sciencephoto.com/images/showFullWatermarked.html/
P486153-Tooth_dentine,_SEM-SPL.jpg?id=804860153

70. Bleaching Agent Mode
of Action

71. Indication for Bleaching
•
•
•
Pt discomfort
Further Treatment
Presence of other
restorations

72. Contraindication for
Bleaching
•
Superficial or extrinsic
Staining
•
Discolored carious
lesion or restoration
•
In-home & pregnant
women or lactating
•
Root of teeth
•
In-office & teeth with
large pulp, exposed
dentin, cracks, caries ...
•
Broxers needs to alter
the wearing time of inhome trays
•
Bonding has to be
delayed for 7 to 10 days

73. • Treatment Planning
• Shade Selection and Record Collection
• Patient Education

74. Current Bleaching
Modalities

75. Non-Vital Bleaching
•
•
Sodium Perborate
10% Carbamide
Peroxide
http://www.scritube.com/files/limba/engleza/health/170_poze/image059.jpg
•
Hydrogen Peroxide
•
•
Thermocatalytic
Walking bleach

76. •
•
•
•
•
•
Hydrogen Peroxide
Heat
Trauma
Cementum
Infection
Seal
http://cro.sagepub.com/content/14/4/292/F3.medium.gif

77. Vital Bleaching
• In-office
• At home
http://img.diytrade.com/cdimg/556049/8452357/0/1271005827.jpg

78. Factors Affecting
Bleaching Process
•
•
•
•
•
•
•
Surface Cleanliness
Concentration of Peroxide
Temperature (in-office)
pH
Time
Sealed environment
Additives

79. In-Office Technique

80. Dentist-Supervised AtHome Technique
• Over Night
• Day Time

82. http://veneerstooth.net/wp-content/uploads/2011/02/laser-whitening.jpg

83. Safety Factors
• Tooth &
Pulpal
Problems

84. •Soft Tissue
Respond

85. •Soft Tissue
Respond

86. Effect on Restorations

87. Enamel Micro-abrasion
•
Indications:
•
•
Extrinsic stains
•
White, hypo-calcified
spots
Cream, yellow &
brown flourosis

88. Mechanism of Action
•
•
•
Physical Removal
Etching
Oxidation

89. Pasts
•
•
•
30% H2O2
36% HCL
18% H2O2

90. Risks
•
Excessive Removal of
Enamel
•
•
•
•
Compounds (36-62
Micron)
Normal Prophylaxis (4-8
Micron)
Chemical Burns
Post-operative Sensitivity

92. http://www.drdanmckay.com/images/results_laser_gum_contouring.jpg

93. http://cosmetic-dentistry-and-porcelain-veneers.com/wp-content/uploads/2010/10/gums6drhuefner.jpg