Esthetic and Operative Dentistry Course

Asso.Prof.Dr. Ameer Hamdi Al-Ameedee

BDS, HDD, MsC in Operative Dentistry (Bagdad).PhD in Esthetic and Operative Dentistry (Labanon).

Asso.Prof.Dr. Ameer Hamdi Al-AmeedeeBDS, DDS, MsC, Ph.D, in Esthatic and Operative Dentistry.

ESTHETIC CONSIDERATIONS

Smiling in the face of your brother

Are “ charity” ((Prophet Mohamed ))

Does beauty really come from the inside out or does your physical appearance play the greater role?

Do we really think beauty is only skin deep or are our brains hard wired to think otherwise?

What is beauty?

The secret of beauty and attractiveness has been a quest of humans for as long as we have been civilized

Many women – even some men - spend up to one-third of their income on improving their looks

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Smile: is the ability of person to express a range of emotions with the structure and movement

of the teeth and lips

Is that portion of the discipline that deals with achieving the ultimate in appearance.Escape from artificiality.

EstheticBranch of philosophy dealing with beauty.

Art and science of dentistry applied to create or enhance the beauty of an individual within functional and physiological limits.

Esthetic dentistry

Appearance Zone: This is the anterior oral area where esthetics is of prime concern and 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.

Factors Affecting Esthetics

1- SOFT TISSUE MANAGEMENT A-FINISH LINE FORMATION. B-IMP RESSION PROCEDUR. C - THE TEMPORARY RESTORATION.

2 -TOOTH REDUCTION3 -SHADE SELECTION4 - COLOR VARIATION

5- TRANSLUCENCY

6 -SURFACE CHARACTERIZATION

7 -DEGREE OF GLOSS8-TOOTH FORM,SIZE AND ARCH POSITION

9 -OPTICAL ILLUSON

1 -SOFT TISSUE MANAGEMENT

Optimal soft tissue health should be established before any restorative procedures.

Many aspects of prosthetic treatment may cause esthetically detrimental changes in theform of changes in gingival form ,color or position following cementation.

A- Finish line formationWith subgingival margins ….. every effort must be made to produce minimal soft tissueinjury .

Retraction Cord Technique-The preparation is completely established - with a suprra-gingival finish line.-Then a retraction cord is placed in the sulcus and temporarily displace the gingiva laterally and apically

-Finally, the finish line can be lowered without soft tissue injury.-Too large or too many cords --------- excessive trauma.

-Healthy gingival tissue, one thin cord -------- anterior teeth

-Single medium-sized ------------- posterior teeth.

-Excessive instrument pressure exerted in placing the excessively large cords----gingival damage.

-Blanching (evidence of reduced blood supply) is often observed immediately after placement of cord rapidly disappears.

An impression must provide detailed information about :

The prepared teeth, Surrounding intact teeth, Associated soft tissues

B-IMP RESSION PROCEDUR.

-Remove all cord from the sulcus as the impression material is syringed around the prepared teeth.-Removal of the impression from the mouth, then check the gingival sulcus with an explorer and remove any remnants of retained impression material.

-Severe tissue reactions when the impression material is left in the sulcus.

Inadequate soft-tissue management

Causes of finish line not visible in the impression:

Bleeding from inflamed gingiva displacing the impression material

Tendency of the gingival cuff to recoil and displace partially set impression material

because of inadequate bulk Sulcus impression tearing

Retraction cordTwo-cord techniqueRotary curettage

Electrosurgery Laser troughing

C - THE TEMPORARY RESTORATION

1-Properly contoured2-Well adapted to the preparation margin

3-Should possess a very smooth surface4-Establish cervical embrasures to provide access for oral hygiene aids

5-Left not more than two to three weeks6-Overcontouring leads to food trap and hence complicating the periodontal status.7-Interdental papilla is often neglected due to improper design of interdental space.

8-Crown contours should be such that it should not provide any niche for plaque retention and should promote self-cleaning.

9-Open embrasures to allow easy access to the interproximal area for plaque control.10-An over contoured embrasure will reduce the space intended for the gingival papilla

and causing pressure and irritation on the papilla, also inhibits effective oral hygiene

laceration of the gingiva with rotary instruments + poor temporary restoration.

Final restoration …………… fails to vertically reach the finish line of the prepared tooth

Overextended or under extended restoration

plaque accumulation at the margin of the restoration.

A uniform duplication of the form and contours of the natural dentition.

2 -TOOTH REDUCTION

Insufficient tooth reduction poor esthetics

Development of adequate color requires a certain thickness of porcelain

The facial reduction should be 1 to 1.5 mm.

The areas to be considered during preparation :1 -labioincisal aspects.

2 -Cervical portion of the facial surface.

A) The facial surface should be reduced in two planes; one nearly parallel with the path of insertion, and one parallel with the incisal two-thirds of the facial surface of the tooth

B) One plane reduction parallel with the path of insertion may result in insufficient space for porcelain in the incisal 1/3 of the tooth

C) One plane reduction which creates adequate space for the restoration both in the shoulder and the incisal areas, will endanger the pulp entity and produce overtapered restoration.

inadequate facial reduction, the laboratory fabrication can be handled in one of two ways

1- develop proper contour in the restoration, results in a lack of color vitality due to insufficient porcelain thickness: External and internal color modification to enhance the esthetics of the restoration.

2- over-contoured restoration to develop proper color leading to plaque accumulation which affects the gingival health.

3 -SHADE SELECTION

Shade interpretation

Difficulty in color matching …precise matching of a desired shade can be difficult.

The original color of a tooth is the color one sees as a result of the reflection, refraction, deflection, and absorption of light by the enamel, the dentin, and possibly the pulp. The color seen in a tooth is the result of combined optical effects of the layers of tooth structure, the translucency and thickness of the enamel and color of the underlying dentin.

The esthetic dentistry, using a combination of science and art, involves the use of colors to create a natural tooth like restora tion, color and shade are very important because teeth are multi-chromatic with color variations from cervical to incisal, every tooth in the mouth from the central incisors to molars, both upper and lower, varies in color.

Color that is perceived is the result of a light source, the object that absorbs, transmits, reflects or scatters the light from the source, and the interpretation of the result by the human visual system

Light form of visible energy that is part of the radiant energy spectrum. Radiant energy possesses specific wavelengths, which may be used to identify the type of energy

In 1666 Isaac Newton discovered that white light can be broken down into a rainbow of color

In nineteenth century that German physiologist Ewald Hering first described the now familiar color circle.

In 1905, Albert Henry Munsell, an American artist and art teacher, further modified the color circle, devising a system of color organization that centered around three unique aspects of color: hue, chroma, and value. Using these three aspects, was able to construct a three-dimensional color wheel

Color Mixing

Light mixture- primary colors: red, green, blue.Additive mixture system- mixing of two of the light mixture primary colors red + blue = magenta red + green = yellow green + blue = cyan

Pigment mixture system: yellow, cyan, magenta

Color of the Human Teeth

Clark was the first to accurately describe the color of the human teeth in 1931

Dr. E. B. Clark, a dentist, produced the first data in 1931.He indicated the Hue ranged from 6 YR (yellow-red) to 9.3 Y (yellow).The Value ranged from 4 to 8, and the Chroma ranged from 0 to 7.

Lemire and Burk found:The Hue range from 8.9 Y to 3.3 Y, a Value range of 5.8 to 8, and a Chroma range from 0.8 to 3.4

Goodkind and Schwabacher:Identified the Hue range as 4.5 YR to 2.6 Y, the Value range as 5.7 to 8.5, and the Chroma range from 1.1 to 5.

Guidelines for Clinical Shade Selection

1.light2.amount lighting3.location of lighting 4.restricting light5.surrounding colors 6.tone of selection7.patient position 8.tooth condition9.comparison prcds. 10.selectiodistance11.verification 12.diagram13.photograph

Vita 3D stapes 1 (Value)

Vita 3D stapes 1 (Value)

1-Determine the lightness level (value)

2-Hold shade guide to patient’s mouth

3-Start with darkest group moving right to left

4-Select Value group 1, 2, 3, 4, or 5

Munsell color system extends from zero to ten, black is zero and white is ten

Vita 3D stapes 2 (Chroma)

Vita 3D stapes 2 (Chroma)

Select the chroma1-From your selected Value group, remove the middle tab (M) and spread the samples out like a fan

2-Select one of the three shade samples todetermine chroma

Vita 3D stapes 3 (Hue)

Vita 3D stapes 3 (Hue)

Determine the hue

Check whether the natural tooth is more yellowish or more reddish than the shade ample selected

Shade matching using the VITA Easyshade Compact:1-“Tooth areas” mode selected. Note the active dot appearing in the cervical third of the tooth on the screen.2-Wand tip on the buccal surface at the cervical third of the tooth. 3-“OK” signal in the cervical third and active dot in the middle third on the screen. 4-Wand tip on the buccal surface at the middle third of the tooth.

Color research continued to evolve based on the Munsell color model. In 1976, The Commission Internationale de l’Eclairage (CIE), an international color research group founded in 1931, published the CIELAB color system.

In this 3-dimensional color system, L* refers to brightness (0 to 100), a* represents red (+a*) vs. green (-a*) and b* indicates yellow (+b*) vs. blue (-b*). When a* and b* are zero, the L value represents the continuum of black to white. The CIELAB model offers some advantages over other color models. The L*a*b* color space was designed to correlate with perceptions of color.

CIELAB COLOR SYSTEM

Color Differences CIELAB

Is often used to measure changes in color, including changes in tooth color from use of whitening products. Color difference equations are used to quantify the color change. ΔL*, the change in brightness,

Factors can be responsible for poor color matching

1-A poor selection may have been made from available shades, or it may not be possible to match the natural teeth with the available porcelain colors.

2. The dental laboratory may have failed to reproduce the selected shade from the available materials or there may have been insufficient information to effect a satisfactory color modification.

3. The tooth reduction is insufficient in certain areas, or the metal framework or opaque porcelain, or both, may be too thick, leaving insufficient space for dentin porcelain.

4. Also, the porcelain may not have been handled in such a manner as to reveal its inherent coloration.

5- OK signal in the cervical and middle thirds and active dot in the incisal third on the screen.6-Wand tip on the buccal surface at the incisal third of the tooth. 7- OK signal in the cervical, middle, and incisal thirds on the screen. 8-VITAPAN Classical and VITAPAN 3D-Master shades that are closest to the natural tooth structure color shown on screen. Note: The nonslip infection-control shield has been omitted from this series of photos for dem onstration clarity.

COLOR VARIATIONS AMONG TEETH

1- Maxillary anterior teeth

canines pigments

related to the dentine thickness..lateral incisor slightly less pigmentation than the central incisor,related to the faciolingual dentine thickness, which is often slightly less ona maxillary lateral incisor.

cervically : dentin is more than enamel. Incisally the enamel is thicker than the dentin, which increases the translucency.

The canines exhibit the greatest color intensity, with the incisors usually appearing the same.

If a variation in the incisors exists, it is the opposite of that found in the maxillaryincisors.

The lateral incisor pigmentation owing to the larger crown dimension.

Mandibular anterior teeth :

Staining

Not only used to duplicate the natural variation of the tooth color, but also to create and enhance illusion through manipulation of shape.

Darker stains optical illusion of smaller size

Increasing the value ( increase whiteness) closer area

Decreasing the value(increase grayness) less prominent area

5- TRANSLUCENCY

Translucency of the tooth helps to give the appearance of vitality. Translucency is most obvious in the incisal portion, in which the ratio of enamel to dentin is high.

Duplication of this feature in ceramic restoration is to seem “alive.”

Translucency is important during conversation or smiling specially forPatients with a low smile line, only the incisal portion of their teeth isvisible, so duplication of this character is essential for these patients.

Degree to which light is transmitted rather than reflected.

Translucency also affects the esthetic quality of the restoration. The degree of translucency is related to how deeply light penetrates into the tooth or restoration before it is reflected outward.

Normally light penetrates through the enamel into dentin before being reflected outward. This affords the lifelike esthetic vitality characteristic of normal, unrestored teeth.

Shallow penetration of light often results in a loss of esthetic vitality Illusions of translucency also can be created to enhance the realism of a restoration.

Color modifiers (also referred to as tints) can be used to achieve apparent translucency and tone down bright stains or characterize a restoration.

Translucency increases from cervical to incisal. Incisal edges, cusp tips and proximal surfaces are areas of high translucency.

An anterior tooth sometimes has an area of slight incisal opacity. This area is frequentlycomposed of enamel, the opacity is due to an optical effect created by refraction of light as it strikes the incisal edge (halo effect).

Reproduction of this effect by shaping the incisal edge of the ceramic restoration so that it possesses the exact lingual slope and thickness of adjacent teeth.little surface stain applied lingually or incorporated internally, can enhance the desired result. Surface stain located lingually may wear off during function.

6 -SURFACE CHARACTERIZATION

Young teeth characteristically exhibit significant surface characterization, whereas teeth in older individuals tend to possess a smoother surface texture caused by a brasional wear. The surfaces of natural teeth typically break up light and reflect it in many directions .The restored areas of teeth should reflect light in a similar manner to un restored adjacent surfaces.

surface texture controls the reflection of light

When light strikes a restoration surface, it should create a reflection pattern similar to that of adjacent teeth, thus enhancing the color match.

Developing the desired light reflection on a restoration’s surface by meticulous duplication of the height of contours and depressions on the facial surface. The number of depressions, their location, form, and depth can be recorded by close-up photographs taken from different angles and by the working cast.

7 -DEGREE OF GLOSS

1 - Surface gloss on ceramic restoration affects the reflection of light, functions in conjunction with surface characterization to enhance theappearance of the restoration.

2 - Excessive gloss lightens the color

3 -Too long heating or heating at elevated temperatures during glaze firingcan exhibit exaggerated gloss, in addition to excessive flowing of the surfaceand loss of surface characterization.

4 -Combining different degrees of gloss at different areas creates the desirable natural play of reflection of light.

5-Introducing highly glazed wear facets in older patients improves esthetics.

8-TOOTH FORM,SIZE AND ARCH POSITION

Restoration of a single maxillary central incisor is one of the most difficult esthetic situations. By contrast, if the restoration is slightly out of alignment with its contralateralcounterpart, , it is usually better for restorations to be shaped like their contralateral counterpart when they are located adjacent to unrestored teeth.

But if all of the readily visible teeth are being restored andthere is no color-matching problem, it may be estheticallyadvantageous to create slight alterations in form and positionto escape from artificiality.

A "sacred ratio" used in the building of the pyramids of Egypt 2,600 years ago

Both Euclid and Pythagoras referred to the "rectangle of the Divine Section," believing it to be uniquely inspired by the will of God.

Golden proportion

Proportion To be able to give a certain mathematical representation of beauty for numerically expressing the relationship of the various units that combine to make a composition, the term proportion is used. The relationship of the various units which are different from each other in a composition but are associated with each other through a certain repetitive mathematical factor is the Repeated ratio.

Mentioned in the Ahmes Papyrus (also called the Rhind Papyrus) a mathematical handbook, of sorts; dated about 1650 B.C.

Greek mathematician and astronomer Eudoxus of Cnidus (c. 370 B.C.) observed that his friends divided a stick into golden proportions when asked to find the most pleasing placement of a crossbar.

The concept of the „golden proportion‟ has often been offered as a cornerstone of smile design theory. The term „golden proportion‟ has been used for centuries. The golden proportion mathematically denotes that the ratio of a smaller to a larger length is equal to the ratio of the larger length to the total length.

Application of golden proportion to dental esthetics was first documented by Levin in 1978. He explained the association of proportion with an esthetically pleasing dentition and smile.

golden proportion

Lombardi was the first to propose the application of the golden proportion in dentistry, stating, ‟it has proved too strong for dental use‟ also he defined the idea of: 1-A repeated ratio which implies that in an optimized dentofacial composition from the frontal aspect, the lateral to central width and the canine to lateral width are repeated in proportion.

2- Maxillary central incisors, because of their position in front of the arch, should appear to be the widest, whitest, and therefore ,the most predominant teeth when viewed from the frontal aspect.

A mathematical formula has been arrived to calculate:1- The width of the maxillary central incisor for any recurring esthetic dental (RED) proportion given a fixed view width.2- And this width is determined by measuring the frontal view width between the distal aspects of the two maxillary canine teeth which is: (frontal view of the anterior 6 teeth)/2(1+RED+RED2) =width of central incisor.

Esthetics depend on proportion. An object is considered beautiful if it is properly proportioned, Concepts of proportion are probably based on what is found in nature. A ratio of approximately 1.619 to 1 between succeeding terms is considered pleasant, and is known as the golden proportion.

Golden proportion of the tooth restoration

When a line is bisected in the golden proportion, the ratio of the smaller section to the longer one is the same as the ratio of the larger section to the whole line.

We dentists find the proportions of the central incisor very beautiful, but we have not been able to find a Golden Proportion relationship between the obvious width and height. The problem was recently solved when Dr Stephen Marquardt, an eminent Oral surgeon in California, discovered that, “The Height of the central incisor is in the Golden Proportion to the WIDTH of the TWO central incisors.” as below:

Golden proportion of the tooth restoration

The golden proportion is a athematically constant ratio between the larger and smaller length.

The ratio is approximately 1.618:1 In terms of proportion, the smaller tooth is about 62% the size of the larger one.

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.

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.

Golden proportion

The Golden Ratio occurs naturally and abundantly in the physical and biological sciences

Relative proportion of adjacent teeth

For a smile to be considered perfect or near to it, the upper anterior 6 teeth should follow the golden rule of proportions

The lateral incisors should be 60% the width of the central incisors and the canines 60% that of the lateral incisors.

When viewed from the facial, the width of each anterior tooth is 60% of the width of the adjacent tooth (mathematical ratio being 1.6:1:0.6)

In other words each tooth becomes smaller by a fixed percentage as you move back in the mouth.

It states that the width proportion between two adjacent teeth as viewed from the frontal should remain constant progressing successively distally.

9 -OPTICAL ILLUSONIs the art of changing perception making an object appear different than it actually is.

Illusion is the art of changing the perception to cause an object to appear different than it actually is.This concept is particularly useful in solving problems associated with presence of space limitations (too much or too little space) or other problems that may make it impossible to duplicate the original form.

One being subjected to light the most fundamental objects exhibits two dimensions, that is, length and width. ‘Principle of Illumination”.

The principle of illumination: Light approaches and dark recedes. The illusion of contour is produced as cosmetic makeup is applied to the face.The artistic bias of great importance in dentistry is the use of horizontal and vertical lines. A horizontal line causes an object to appear wider, whereas a vertical line causes an object to appear longer. This can be termed the principle of line.

The art of creating illusions consists of changing perception, to cause an object to appear different from what it actually is. Teeth can be made to appear smaller, larger, wider, narrower, shorter, longer, younger, older, masculine or feminine.

Illusion is a figment of imagination where a perception of an object is created.

The artistic predilection of great importance in dentistry is the use of horizontal and vertical lines .

illumination can be maintained to change the size, shape and the overall form of the tooth through illusions.

The principle of line: Horizontal lines created by cervical staining, texturing, white hypoplastic lines, and straight incisal edges create the illusion of width; vertical lines created by narrowing the face of the tooth, carving the incisal edges to slope cervically, and deepening the incisal embrasures create the illusion of length.

The principles of illumination and reflection can be manipulated by the dentist and the technician to change the apparent size and shape of a tooth through illusion.

The law of the face: The face of the silhouette of the tooth is the area on the facial surface of anterior and posterior teeth that is bounded by the transitional line angles as viewed from the facial (buccal) aspect.

The law of the appearance surface

In anterior teeth, the transitional line angles mark the transition from the facial appearance surface to the mesial and distal surfaces, the incisal edge and cervically.

The tooth surface slopes lingually towards the mesial and distal approximating surfaces and towards the incisal edge and the cervical root surface from theseline angles, producing light reflections in different directions corresponding to the sloping direction of each surface, thus creating shadows in these areas.

The face of the tooth andtransitional line angles

Only the appearance surface of the tooth or the silhouette will reflect the light forwards and anteriorly.

The face of a tooth is the area on the facial surface of anterior and posterior teeth that is bounded by the transitional line angles as viewed from the facial (buccal) aspect. The transitional line angles mark the transition from the facial surface to the mesial, cervical, distal, and incisal surfaces. The tooth surface slopes lingually toward the mesial and distal approximating surfaces and toward the cervical root surface from these line angles. Often no transitional line angle appears on the incisal portion of the facial surface; in this situation, the face is bounded by the incisal edge or the occlusal tip. Shadows created as light strikes the facial surface of the tooth begin at the transitional line angles. These shadows delineate the boundaries of the face.

The face of the tooth is bound by the transitional line angles.

The porcelain-fused-to-metal crown restoring the maxillary right second premolar has been darkened at the gingival third to create the illusion of a discolored restoration The root surface appears to recede because it has a lower (darker) value.

By reducing or increasing the portion of the tooth reflecting light forwards (the face) we create the illusion of smaller or wider, shorter or longer teeth respectively

Creating equal apparent faces in two dissimilar adjacent teeth, makes dissimilarly sized teeth look similar; as their faces reflect light in the same way .

Disharmony treated by optical illusion

The concept of the law of the face becomes apparent and more important when dealing with canines and posterior teeth.

From the frontal view only a portion from the canine and posterior teeth are visible. In this view, the canine face is bounded by the mesial transitional line angle, the cervical transitional line angle and the midlabial ridge.

The distal half of the tooth is usually not visible from the frontal view. Moving the midlabial ridge and the incisal tip mesially (a, b), will create the illusion of a narrower tooth.

In addition, moving the distal transitional line angle more mesially ( c) will give the illusionof equal mesial and distal faces and the tooth will look smaller both from frontal and side views.

Principle of line

white hypoplastic lines, accentuated developmental grooves, vertical texturing illusion of height

Stain lines, texturing, straight incisal edges illusion of width

These lines create illusions by breaking up the smooth reflecting surface causing ruptures in the continuity of the linear reading of the surface making the tooth appear longer or shorter, wider or narrower.

Characterized or textured surfaces produces shadows and shadow position can determine how the mind will interpret the form.

Tooth The width of an upper incisor tooth is 75% of its length. Before any changes to width and length are embarked upon ,it’s essential that a diagnostic wax-up is used, if necessary directly placed resin composites can be used for the short term to assess the definitive treatment

Horizontal lines makes the identical crown appears shorter than the crown with vertical Lines.

The principle of a line can be used to create the illusion of a longer or shorter tooth, stain lines, texturing, and modifications to the face and incisal edge all contribute to the illusion.

Arrangement of teeth

The position or arrangement of teeth can create illusion of decrease width.

When teeth are placed in linguo-version, not only its real width is masked by the more prominent approximating teeth, but the effect of increased a hadowing also its size.

Slight lingual rotation of anterior crowns may solve the problem of wide space by narrowing the areas that reflects light forward; thus decreasing the apparent width

Inter-proximal contacts of the anterior maxillary teeth are situated progressively closer to the gingiva the more distal they are located from the midline

Incisal edges of central incisors and cusp tips of the canines lie on the same curved line, with the incisal edges of the lateral incisors 1.0 mm above the same line.

Incisal embrasures becomes progressively larger from central incisor to lateral incisor to canine.

Incisal embrasures found in the younger person become smaller sometimes to the point of disappearing as the teeth wear.

Balance: It is achieved when there is an exact equilibrium between the forces present on either side of the fulcrum in a composition. In dentistry this implies the balance of the elements in relation to the midline.

Visual Tension: is the tension brought about by the presence of certain elements that cause an imbalance in the given composition. Placement of a round form in its background produces visual tension

In moving this form toward the center, visual tension is relieved. The same phenomenon occurs in placing another form in a position of equilibrium.

In a dento-facial composition it creates immaculate unity leading to a harmonious composition (The Factors composition: Color, shape and size).

Components of an Esthetic Smile

A smile design should always include the evaluation and analysis of both facial and dental composition. This divided to:

• facial components

• dental components

1.Facial componentsa-Facial featuresb- Tooth visibility

2. Components of smilea-Lip line b-Smile linec- Upper lip curvatured-Negative spacee- Smile symmetry 3. Dental componentsa-Dental midlineb- Golden rule c-Axial alignment d-Dental morphology e-Contact points

4. Gingival componentsa- Gingival morphology c-Gingival contour

Structural Esthetic Components

It is more important for females than males as the average exposure of teeth is twice in females as that of males.

1.Facial componentsa-Facial features

1.Facial componentsb- Tooth visibility

It is more important for females than males as the average exposure of teeth is twice in females as that of males.

2. Components of smilea-Lip line

refers to height of the upper lip relative to the maxillary central incisors.

2. Components of smileb-Smile lineA hypothetical curved line drawn along the edges of the four anterior maxillary teeth that has to coincide or run parallel with the curvature of the inner border of the lower lip.

The edges of your upper teeth should be parallel to the lower lip when you smile.Lip Line: Is defined as an imaginary line following the lower border of the upper lip when stretched because of smile. It is classified as HIGH, MEDIUM and LOW

2. Components of smilec- Upper lip curvature

In smile, upper lip height is located at the gingival margin of maxillary central incisors. Directed upwards Straight Slightly downwards Pronounced downwards

Upper lip reach the gingival margin displaying the total crown length of central incisor.

2. Components of smiled-Negative space (buccal corridors)

Gradation effect Is the dark space that appears between jaws during laughter and mouth opening. Adequate restoration of the lateral negative spaces will permit the characterization of the smile and enhances personality. The diminution of size and detail must occur gradually to increase buccal corridor space.

A negative space between the buccal surface of the maxillary first pre-molar and the inner point at which the lips join when the patient smiles. Patients with better aesthetics scores had a significantly greater frequency of maxillary 1st molar

2. Components of smilee- Smile symmetry

Evaluation of the symmetric placement of the corners of the mouth in the vertical plane with reference to commissural and occlusal lines. Coincidence of commissural and pupillary line requisite for appraisal of the smile.

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.

3. Dental componentsThe primary elements of beautiful smile are aligned teeth, related to each other and to the surrounding soft tissue that act as their frames.

a-Dental midlineIt is an imaginary vertical line that separates the two central incisors.

Recommended protocol: a) Placing this midline precisely in accordance with facial midline or in the middle of the mouth using the incisive papilla or labial frenum as landmarks. b) Never establish it in a precise midline because it may contribute to an artificial appearance.

3. Dental componentsb- Golden rule

Golden proportion between central and lateral incisor. Type of proportion between lateral incisor and canine disturbs the anterior teeth arrangement.

The golden proportion existing between the elements of the anterior segment produces a steady impression of harmony.

3. Dental componentsc-Axial alignment

Mesial inclination tends to be more pronounced from the central incisors to the canines

Bilateral axial alignment of the teeth of the posterior segment responds to the phenomenon of balance of lines around central fulcrum.

3. Dental componentsd-Dental morphology

It provides one of the basic components of skills needed to practice all apects of dentistry. Without the correct knowledge of tooth morphology it is impossible to accurately replace a tooth or part of a tooth in the oral cavity.

3. Dental componentse-Contact points

it is nothing but a misnomer, when the individual is quite young and the teeth are newly erupted,

some of the teeth come close to having POINT CONTACT only. Eg. Distally on canines and mesially on premolars. Contact area: it is formed because of wear of one proximal surface against another during physiologic tooth movement.

4. Gingival componentsa- Gingival morphology

The location of the gingival zenith in relation to tooth axis is distal in the maxillary central incisors and canines and coincides on lateral incisors

4. Gingival componentsb-Gingival contour

Gum contouring is a minimally-invasive cosmetic procedure that involves reshaping or removing excess gum tissue with the use of laser or other technology. A laser is used in gum surgery to gently remove and seal excess gums without any bleeding, which means no cuts or incisions. In fact, the entire gum lift process is completely painless. Gum surgery is typically only done on the front teeth.Contouring your gums can make a dramatic difference on the overall balance and look of your smile.

Esthetic in the face region

One vertical line divide the face into two facial half's with dynamic symmetry

Five horizontal imaginary line lye parallel to each

other subject facial harmony to the observer:

1-Hair line.

2-Run through the eye brows.

3-Bipupillary line.

4-At the level of the nares (just below the nose).

5-Through angle of the mouth (incisal line)

Through angle of the mouth (incisal line)

On smiling this line appears as straight line or slightly convex line. It is the most dominant

as it separates the white of the teeth from the black of the oral cavity.

Sub division of the lower 3rd of the face.The ratio of the height of the upper lip to the height of the lower lip and chin is 1:2

The face from cranial (hair line) to caudal (below chain line) can be divided into 3 equal thirds.

1-The forehead region.

2-The nasal region.

3-The lip and chin region.

Dominance of one of theses sections can also results in facial harmony

Soft tissue profile:

Harmony should not be restricted to the frontal view , it should be presented in the profile

view as well.

An imaginary line from tangent to forehead, lips and chin could be subjected as the soft

tissue profile which could be straight, convex, concave.

Thank you

Thank you