Prosthodontics Guided by: Self, not the mentioned name. That is just protocol, adding the name of the assigned staff.

1. ESTHETICS
IN
FIXED PARTIAL PROSTHODONTICS
Presented by : Hemal Patel
Guided by : Dr. Smita Athavale
1

2. CONTENTS
1.Definitions
2.General principles of Esthetics
3.Factors of esthetic dentofacial composition
4. Esthetic considerations for Pontics
5. Esthetic considerations for Connectors
6. Surgical & non-surgical methods to improve
esthetics
7. Types of esthetic restorative materials
8. Esthetic fixed restorations
9. References
2

3. ESTHETICS
Branch of philosophy dealing with beauty.
Esthetic dentistry
Art 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? ? ?
3

4. 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.
4

5. GENERAL PRINCIPLES OF ESTHETICS
1.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

6. 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
6

7. 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 o
7

8. MUNSELL’S COLOR WHEEL

9. 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
9

10. Any FORM can be created from the three basic shapes of a
circle, triangle and square.
10

11. 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 = 0.618A
C
B
A/B = A+B/ C = C/B = B+C/A
= 1.618 = phi
Golden Rectangle
Golden mean gauge
11

12. 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
12

13. 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.
13

14. 2. Facial Proportions:
14

15. 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

16. 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:
16
INCISAL EDGE POSITION AT REST ON SMILING

17. 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:
17

18. 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.
18

19. 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%)
19
“A” 85% ratio, square appearance.
“B” 78% ratio, normal ratio.
“C” 65% ratio, teeth appear taller.

20. 3. Axial inclination:
20
4. Teeth arrangement:
10.2 mm

21. 21
Arch form

22. 5. Gradation :
Front-back progression
22

23. 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.
23

24. 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.
24
Frush and Fisher Rufenacht

25. 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.
25

26. 7. Symmetry:
Automatically obtained if previous
principles are followed.
26

27. C. GINGIVAL COMPONENTS:
•Gingival line
•Gingival apex/zenith
•Gingival contour and scalloping
•Gingival embrasure
•Gingival symmetry
27

28. 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.
28

29. NARROWING
WIDENING
SHORTENING
LENGTHENING

30. COLOR:
1. BASE COLOR :
Base color is selected on the basis of hue, chroma and value selection
using 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 a
broader appearance.
30

31. 3. GINGIVAL THIRD :
•Enamel gets thinner in the gingival third of teeth so darker dentin
shows through and the area looks more yellow.
•Staining .
4. INCISAL EDGE :
The incisal edge is translucent enamel resulting in translucency, a halo
effect, or no change as it is worn away with age.
5. CHARACTERIZATION :
•There are many different colors which can occur within a tooth as
might be seen with craze lines or hypocalcifications.
•Staining.
31

32. TRANSLUCENCY:
•Degree to which light is transmitted rather than reflected.
OPALESCENCE:
•Important component of the perceived enamel colour
•Subtle bluish gleam characteristic appearance.
32

33. 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.
33

34. •· 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.

35. •Shade tabs :
•Custom shade guides
•Photographs

36. ESTHETIC CONSIDERATIONS FOR PONTICS
36

37. FACTORS AFFECTING PONTIC DESIGN
A. Pontic space
B. Residual ridge contour
C. Occlusal load
A
B B C

38. 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

39. POUCH TECHNIQUE
INTERPOSITIONAL GRAFT
Free gingival
graft

40. PONTIC DESIGN
B. Mesiodistal width C. Gingival interface
A. Inciso-gingival height

41. ESTHETIC PONTICS

42. 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.

43. 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.

44. 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 soft
tissue depression or hollow in the
residual ridge.
•Appears to grow out of ridge.

45. PONTIC INDICATION ESTHETIC
CONCERN
HYGIENE DIAGRAM
Saddle-
ridge lap
Anterior and
Posterior
teeth
Reasonably
good
esthetics
Difficult
Modified
ridge lap
Easier than
above
Ovate
Anterior and
Posterior
teeth;
High lip line
Excellent
esthetics
&
emergence
profile
Easier than
above
45

46. 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.
46

47. Pontic
system
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 Mandibular
molars
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

48. 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

49. Fig 1 Fig 2
49

50. ESTHETIC PERIODONTAL CORRECTIVE PROCEDURES
Inadequate tooth structure for restoration:
1.surgical crown lengthening
2.Forced eruption with fiberotomy.
Recession:
1.Free gingival / lateral pedicle graft
2.Subepithelial connective tissue graft
3.Guided tissue regeneration
Edentulous ridge defects:
1.Onlay/inlay grafts
2.Synthetic bone grafts
Gingival overgrowth:
1.Gingivectomy / Gingivoplasty
2.Apically postioned flap with or without ostectomy
Electrosurgery/laser for
esthetic contouring

51. •Pontic design:
-Tooth-colored
-Pink ceramic in cervical area
•Gingival mask
•FPDs with pink porcelain flanges
ESTHETIC NON-SURGICAL CORRECTIONS

52. 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

53. ESTHETIC FIXED RESTORATIONS
Missing teeth
Crowding/Malaligned anteriors
Mild rotations
Stains/Discoloration
Abrasions/Attrised anteriors
Erosions/Destructed tooth
Spacing
Bridges
Onlays
Crowns
Veneers/Laminates
INDICATIONS
ESTHETIC FIXED RESTORATIONS
Full-coverage FPD
Partial-coverage FPD
Resin-retained FPD
Fibre-reinforced composite FPD
Implant-supported FPD

54. 54
Metal-ceramic All-ceramic

55. 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
55

56. 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.
56

57. 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

58. 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)
58
PARTIAL-COVERAGE RESTORATIONS

59. Fiber-reinforced composite fixed partial restoration
Consists of a fiber-reinforced composite substructure veneered with a
particulate composite material.

60. Resin-retained fixed partial restoration
Short span FPDs supported by thin metal retainers bonded lingually
and proximally to the abutment enamel.
Etched resin-retained (Maryland bridge)
Cast perforated resin-retained fixed

61. IMPLANT-SUPPORTED BRIDGES

62. LAMINATES/VENEERS
AFTER
BEFO
RE
62
BEFORE AFTER
PORCELAIN
COMPOSITE

63. ARTICLES

64. 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.

65. •An Alveolar Bone Augmentation Technique to Improve Esthetics
in Anterior Ceramic FPDs: A Clinical Report
Burak Taskonak and Yasar Ozkan
J 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.

66. Tissue sculpturing: An alternative method for improving esthetics of
anterior fixed prosthodontics
Jacques 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.

67. 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.

68. 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.

69. THANK YOU
Next seminar by Dr. on

71. 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