Ronald E. Goldstein's Esthetics in Dentistry E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2018

Seitenzahl: 3516

Beschreibung

Ronald E. Goldstein's Esthetics in Dentistry, Third Edition provides a thoroughly updated and expanded revision to the definitive reference to all aspects of esthetic and cosmetic dentistry, from principles and treatments to specific challenges and complications. * Provides a current, comprehensive examination of all aspects of esthetic and cosmetic dentistry * Presents 23 new chapters from international experts in the field and complete updates to existing chapters * Offers more than 3,700 high-quality photographs and illustrations * Adds clinical case studies and treatment algorithms for increased clinical relevance * Emphasizes clinical relevance, with all information thoroughly rooted in the scientific evidence

Leseprobe

Table of Contents

Cover

Preface to Third Edition

PART 1: PRINCIPLES OF ESTHETICS

Chapter 1: Concepts of Dental Esthetics

What is esthetics?

Historical perspective of dental esthetics

The social context of dental esthetics

Esthetics: a health science and service

Understanding the patient’s esthetic needs

Functions of teeth

Psychology and treatment planning

“Crossroads”

References

Additional resources

Chapter 2: Successful Management of Common Psychological Challenges

Introduction

Brief description of psychological terms and concepts

Mood disorders

Eating disorders

Personality factors in esthetic dentistry

Life event stress and adjustment disorder

The dental patient with body dysmorphic disorder

Conclusion

References

Chapter 3: Esthetic Treatment Planning

Mutual agreement and informed consent

Before the initial visit

The initial visit

The role of the hygienist

The clinical examination

Technology and an integrated digital system

Preparation for the second visit

The role of the treatment coordinator

The second appointment

Problem patients: when not to treat … but refer

How to treat problem patients … and keep your staff sane

Continuous communication

Cost of treatment

References

Additional resources

Chapter 4: Digital Smile Design

Advantages of Digital Smile Design

Digital Smile Design workflow

References

Chapter 5: Esthetics in Dentistry Marketing

What is dental marketing?

Creating a brand

Developing a marketing plan

What is internal marketing?

What is external marketing?

External marketing strategies

Reference

Additional resources

Chapter 6: Legal Considerations

Dentist’s legal obligation to update skills and practices

Informed consent

Guarantee or warranty

“I’m sorry” legal protection

Try‐in appointment

Complete dental records and documentation

Standards of care versus reasonable patient standards

Nonnegligent risks and obligation to treat

Misinformed consent

Dentist’s right to refuse treatment

Patient abandonment claims

Right of a patient to choose a dentist

Refunds

Examples of esthetic malpractice cases

Telephone or e‐mail consultation

Federal requirements and product warnings

Botox

Jury trials

Conclusion

References

Chapter 7: Practical Clinical Photography

Why take clinical images at all?

When to take images

Clinical applications for images

How to select a camera

Setting up the SLR camera

Understanding lighting

Other necessary equipment

Composition of images

Image storage and presentation

Video camera recorders (camcorders)

Conclusion

Additional resource

Chapter 8: Creating Esthetic Restorations Through Special Effects

Seeing teeth in a different light

Illusions

Techniques for resolving various problems

Summary

References

Additional resources

Chapter 9: Proportional Smile Design

The golden proportion

Proportions of the esthetic face

Smile design principles

Size and shape of individual teeth

Digital dental photography

Proportional dental/facial analysis

Use of computer simulation

Patient preferences and individuality

References

Additional references

Chapter 10: Understanding Color

Basics of color

Color in dentistry

Visual color matching

Color matching instruments

Communicating color

Color modification

A look to the future

References

PART 2: ESTHETIC TREATMENTS

Chapter 11: Cosmetic Contouring

Early techniques

Indications

Contraindications

Principles of cosmetic contouring

Treatment planning

Techniques of cosmetic contouring

Summary

References

Additional resources

Chapter 12: Bleaching Discolored Teeth

Bleaching vital teeth

Etiology of discoloration

Sequence of treatment

Matrix bleaching (nightguard vital bleaching)

Maintaining bleaching results

In‐office bleaching of nonvital teeth

Techniques for bleaching pulpless teeth

Planning for continued treatment

Complications and risks

The future of bleaching

References

Additional references

Chapter 13: Adhesion to Hard Tissue on Teeth

Introduction

Basics about adhesion

Adhesion mechanisms to enamel

Historical development

Adhesion to dentin

Classification of adhesive systems

Universal adhesives

Dark‐curing adhesives

Filled adhesives

Valuation of adhesives

Biocompatibility of adhesives

Aging of the adhesive interface

Reliability and degradation of etch‐and‐rinse adhesives

Reliability and degradation of self‐etch adhesives

Technique sensitivity: a problem and its solution

Postoperative hypersensitivities

Failure prevention: clinical application

Recommendations for using etch‐and‐rinse adhesives

Recommendations for using self‐etching adhesives

References

Chapter 14: Composite Resin Bonding

Basic categories of bonding in use today

Restorative uses

Materials

Bonding techniques

Maintaining the restoration

Bonding protection

The future

References

Additional resources

Chapter 15: Ceramic Veneers and Partial‐Coverage Restorations

History

Traditional porcelain veneers

Classification of tooth preparation for anterior veneers

Impressions

Temporaries

Classic porcelain veneers: laboratory procedures

Pressable ceramic veneers: laboratory procedures

Placement of veneers

Post‐treatment care and instructions

Posterior ceramic partial coverage restorations

Alternative techniques

Conclusion

Acknowledgment

References

Chapter 16: Crown Restorations

Indications for a complete coverage crown

Technical considerations

Metal–ceramic restorations

How to choose the right crown for esthetics

Principles for esthetic restorations

Patient maintenance

Appendix ‐ Zirconium‐oxide restorations

Conclusion

References

PART 3: ESTHETIC CHALLENGES OF MISSING TEETH

Chapter 17: Replacing Missing Teeth with Fixed Partial Dentures

Diagnosis

Retainers

Pontics

References

Additional resources

Chapter 18: Esthetic Removable Partial Dentures

Classification overview

Principles of design

Use of a surveyor

Biomechanics

Problem situations

Specific clasp types and esthetic considerations

Alternative treatment modalities

Attachments for removable partial dentures

References

Additional resource

Chapter 19: The Complete Denture

Occlusion: the complete denture

The art of creating esthetic dentures: four esthetic harmonies

Denture base

Clinical examples of esthetic dentures

Bone quantity and quality dictate every procedure

References

Chapter 20: Implant Esthetics

Smile line and lip dynamics

Ridge form and how ridge architecture impacts implant placement

Implant placement and restoration protocols: deciding the best strategy

Delayed or late implant placement (12 weeks or more following extraction)

Early implant placement (4–8 weeks following extraction)

Immediate implant placement (at the time of extraction)

Immediate implant restoration: functional (loaded) or nonfunctional (unloaded)

Implant position: a pivotal point in the treatment blueprint

Implant designs

Gingival biotype: assessment methods and enhancement procedures

Provisionalization: refinement of the gingival tissue architecture

Material choices: final abutments and restorations

References

Appendix A: Esthetic Evaluation Form Summary

Appendix B: The Functional‐Esthetic Analysis

Appendix C: Laboratory Checklist

Appendix D: Pincus Principles

Dedication

Early contributions

Creation of mouth personality

The importance of light

Basic cosmetic principles to achieve ultimate beauty in porcelain

Conclusion

The development of dental esthetics in the motion picture industry

Reference

Additional resources

PART 4: ESTHETIC PROBLEMS OF INDIVIDUAL TEETH

Chapter 21: Management of Stained and Discolored Teeth

Types of stains: causes and treatment options

Stains and discolorations caused by tooth defects

Extrinsic stains

Toothpastes that help maintain whiteness

Intrinsic stains

Treatment

Bleaching

Summary

References

Additional resources

Chapter 22: Abfraction, Abrasion, Attrition, and Erosion

Attrition

Bruxism

Abfraction

Restoration defect

Abrasion

Erosion

Differential diagnosis

References

Additional resources

Chapter 23: Chipped, Fractured, or Endodontically Treated Teeth

Chips or fractures without pulpal involvement

Chips or fractures with pulpal involvement

Life expectancy with composite resins

Posterior restorations

Restoration of endodontically treated fractured teeth

References

Additional resources

Chapter 24: Endodontics and Esthetic Dentistry

Endodontics: an essential part of treatment planning

Clinical evaluation

Diagnosis

Pulpal response to operative procedures

Elective endodontics for pulpal reasons

Endodontic treatment protocols

Various types of restored teeth

Instrumentation/debridement

Bleaching

Trauma

Cracked tooth syndrome

Endodontic surgery

Tissue discoloration (tattoo)

Summary

References

PART 5: ESTHETIC CHALLENGES OF MALOCCLUSION

Chapter 25: Oral Habits

Digit sucking

Negative adult oral habits

Bruxism

Bruxism with temporomandibular joint pain

Chewing habits

Tongue habits

Lip or cheek biting

Mouth breathing

Eating disorders and poor dietary habits

Alcohol and drug abuse

Foreign objects in the mouth

Diagnosis and treatment of damaging oral habits

References

Additional resources

Chapter 26: Restorative Treatment of Diastema

Etiology of diastema

Diagnosis and treatment planning

Treatment options for correction of diastemata

Restorative treatment options

Summary

References

Additional resources

Chapter 27: Restorative Treatment of Crowded Teeth

Treatment considerations

Treatment strategy

Treatment options

Unusual or rare clinical presentations

To bond, veneer, or crown?

References

Additional resources

Chapter 28: Esthetics in Adult Orthodontics

Impact of orthodontic treatment on facial esthetics

Integrating orthodontics into the interdisciplinary treatment plan

Periodontal considerations with adult orthodontic treatment

Occlusal considerations for the adult orthodontic patient

Tooth size–arch length discrepancies in the adult patient

Acknowledgements

References

Chapter 29: Surgical Orthodontic Correction of Dentofacial Deformity

Facial esthetics

Who are the candidates?

First visit

Case presentation visit

Presurgical visit

Postsurgical treatment

Surgical complications and risks

Diagnosis and treatment

Role of orthognathic surgery in treating obstructive sleep apnea

Additional resources

PART 6: ESTHETIC PROBLEMS OF SPECIAL POPULATIONS, FACIAL CONSIDERATIONS, AND SUPPORTING STRUCTURES

Chapter 30: Pediatric Dentistry

Materials and techniques

Laser‐assisted pediatric dentistry: minimally invasive treatment

Esthetic dentistry: operating procedures

Trauma management in primary dentition and in the first phase of mixed dentition

Traumatic injuries to the periodontal tissues

Case studies of trauma

Facial harmony in pediatric dentistry: esthetic keys

The future

References

Additional resources

Chapter 31: Geresthetics:

Demographics: an aging population

From baby boomers to baby zoomers

The mature esthetic dental consumer

Chronic illness and esthetic dental care

Medical/dental history and oral examination

Prevention and risk assessment

Treatment planning in the older patient

Esthetic dental procedures for older adults

Orthodontics

Periodontal therapy

Prosthodontics, endodontics, and implants

The nursing‐home or assisted‐living resident

Conclusion

References

Additional resources

Chapter 32: Facial Considerations:

An esthetic approach to evaluation: enhancement of appearance

Dentofacial analysis: clinical examination

Macroesthetic evaluation of the face: oblique view

Macroesthetic evaluation of the face: profile view

Macroesthetics and smile dimensions

Clinical case study

Acknowledgements

References

Additional resources

Chapter 33: Facial Considerations in Esthetic Restorations

Importance of facial diagnosis

Facial analysis

Facial analysis: frontal view

Facial analysis: oblique view

Facial analysis: profile view

Dentofacial analysis

Conclusion

References

Additional resources

Chapter 34: Plastic Surgery Related to Esthetic Dentistry

Upper face

Midface

Lower face

Nonsurgical

Patient safety

Conclusion

References

Additional resources

Chapter 35: Cosmetic Adjuncts

Facial shape for women

Principles of esthetics

Hair color

Facial shape for men

Makeup

Skin care

Makeup… an illusion

Makeup and color

Corrective makeup and contouring

Lip coloring

Selecting the right lipstick color

Makeup for a disfigured face

Makeup for men with disfigurements

References

Additional resources

Chapter 36: Esthetic Considerations in the Performing Arts

Economic dental procedures

Cosmetic acrylic stent

Composite resin stent/splint

Composite resin direct bonding

Removable porcelain veneers

Dentures: removable partial or full

Overlay dentures

Creating a character with acrylic overlay

Checklist for creating a character

Creating a specific character

Direct composite resin for theatrical makeup

Achieving esthetics in natural teeth

Composite resin restorations

Metal restorations

Orthodontic treatment

Periodontal treatment

Prosthetic treatment

Fixed restorations

Specific issues for performers

Emergency treatment

Long‐distance consultation

Summary of important principles for treating performers

Reference

Chapter 37: Periodontal Plastic Surgery

Esthetics and function

Microsurgery

Root coverage

Etiology of gingival recession

Connective tissue versus allogenic tissues

Indications for gingival augmentation

Furcation involvement

Potential for gingival regeneration

Connective tissue graft surgical technique

Other considerations

Restoration of the lost interdental papilla

Ridge preservation and ridge augmentation

Excessive gingival display: esthetic crown lengthening and sculpting

References

PART 7: PROBLEMS OF THE EMERGENCY AND FAILURE

Chapter 38: Esthetic and Traumatic Emergencies

Long‐term preservation is the goal

Crown fractures

Crown–root fractures

Root fractures

Luxation injuries

Avulsions

Fractured restorations

Prosthesis fracture, failure, and repair

Summary

References

Further resource

Chapter 39: Esthetic Failures

Immediate failure

A compromised treatment plan

Eventual failure: restoration longevity

References

Additional resources

PART 8: CHAIRSIDE PROCEDURES

Chapter 40: Tooth Preparation in Esthetic Dentistry

Tooth preparation for all‐ceramic crowns

Tooth preparation in periodontal problems

References

Additional resources

Chapter 41: Impressions

Preparation of soft tissues

Retraction cords

Electrosurgery

Impression materials

Impression techniques

Digital impressions

Summary

References

Additional resources

Chapter 42: Esthetic Temporization

Esthetic uses of temporization

Specific types of temporization

Temporary splinting

A secondary function

References

Additional resources

Chapter 43: The Esthetic Try‐In

Initial visualization

Adjuncts in therapy and esthetic determination

Written statement of approval

Try‐in principles for fixed restorations

Principles for the esthetic try‐in

References

Additional resources

Chapter 44: Cementation of Restorations

Dental cements

Resin luting agents

Postcementation sensitivity

Preparation of the restoration and tooth surface for cementation

Cementation procedure for metal–ceramic restorations

Cementation technique for all‐ceramic crowns

Cementation procedures for ceramic restorations

Summary

References

Additional resources

PART 9: TECHNICAL ADVANCES AND PROPER MAINTENANCE OF ESTHETIC RESTORATIONS

Chapter 45: Esthetic Principles in Constructing Ceramic Restorations

Abutment–implant platform interface

Abutment–soft tissue interface

Restoration–implant or –tooth abutment interface

Occlusal surface–opposing dentition interface

Summary

Acknowledgements

References

Chapter 46: Digital Impression Devices and CAD/CAM Systems

Concept of dental impression making

From bites to bytes: a brief history

Computer‐aided design/manufacturing versus dedicated impression scanners

Computer‐aided design/manufacturing systems

Dedicated impression scanners

Dedicated impression scanner models

Open versus closed architecture

Computer‐aided design/manufacturing in the laboratory

Clinical cases

Summary

Acknowledgements

Disclosure

References

Chapter 47: Maintenance of Esthetic Restorations

Maintenance of esthetic restorations supported by natural dentition

Maintenance of esthetic implant‐supported restorations

Patient self‐care

Conclusion

References

Index

End User License Agreement

List of Tables

Chapter 01

Table 1.1 Numerical Ranking of Relative Importance of Face Components Using Three Different Research Methodologies

Table 1.2 Impressions About Persons of Higher and Lower Physical Attractiveness

Chapter 02

Table 2.1 Disorders of Special Concern to Esthetic Dentists

Table 2.2 Diagnostic Criteria for Obsessive Compulsive Disorder (OCD)

Table 2.3 Diagnostic Criteria for Anorexia Nervosa (AN) and Bulimia Nervosa (BN)

Table 2.4 Worksheet for the New Dental Patient With a Diagnosed Eating Disorder

Table 2.5 Diagnostic Criteria for Narcissistic Personality Disorder (NPD)

Chapter 08

Table 8.1 Substructure Material Choices and Tooth Appearance

Table 8.2 Guide for Staining to Alter Shade

Table 8.3 Guide for Staining to Add Characterization

Table 8.4 Form and Color to Create Optical Illusions

Table 8.5 Color and Our Perception of Teeth

Chapter 09

Table 9.1 Calculating Anterior Tooth Widths using Relative Tooth Lengths and the RED proportion

Table 9.2 Using RED Proportions to Determine Anterior Tooth Widths and Central Incisor Length

Table 9.3 Chart using ICW/CIW Quotient to Determine Relative Tooth Lengths, RED Proportion, and Anterior Tooth Widths

Table 9.4 Simplified Method using ICW/CIL Quotient Chart to Determine Anterior Tooth Widths and Central Incisor Length

Chapter 10

Table 10.1 Top 10 Concerns Regarding Some Dental Shade Guides

Table 10.2 Top 10 Myths and Facts About Visual Color Matching

Table 10.3 Color‐Related Properties of Dental Materials

Table 10.4 Currently Available Specialized Resources for Color Education and Training

Chapter 13

Table 13.1 pH Values of Self‐Etching Primers and Universal Adhesives

Table 13.2 Groups of Adhesives

Table 13.3 Dual‐Curing Adhesives

Chapter 16

Table 16.1 Troubleshooting Esthetics Guide for All‐Porcelain Crowns

Table 16.2 Clinical Gross Database of All‐Ceramic Units to October 22, 2012

Table 16.3 Advantages and Disadvantages of Bonding Veneering and Crowning

Chapter 18

Table 18.1 Classification of Attachments

Chapter 20

Table 20.1 Ridge Changes and Indications and Contraindications for Ridge Preservation after Tooth Extraction

8,12,13

Table 20.2 Literature Findings and Risk Factors for Immediate Implant Placement Procedure

3,36

Table 20.3 Gingival Biotype: Strengths and Limitations of Assessment Techniques

Chapter 21

Table 21.1 Common Discolorations and Associated Causes

Table 21.2 Clinical Appearance and Causes of Discoloration

Table 21.3 Treatment Options for Stained Teeth

Chapter 22

Table 22.1 Smith and Knight’s Tooth Wear Index

Table 22.2 The pH Values of Acidic Beverages

Table 22.3 The pH Values of Acidic Foods

Chapter 23

Table 23.1 Coronal Chips or Fractures

Table 23.2 Cracked Tooth Syndrome

Table 23.3 Advantages and Disadvantages of Bonding

Table 23.4 Advantages and Disadvantages of Porcelain Veneers

Table 23.5 Advantages and Disadvantages of Crowning

Table 23.6 Materials for Prefabricated Posts

Table 23.7 Core Materials

Table 23.8 Post and Core Options for Anterior Teeth

Chapter 26

Table 26.1 Factors Contributing To Diastemata

Chapter 27

Table 27.1 Treatment Options and Indications for the Correction of Crowded Teeth

Chapter 29

Table 29.1 Classification of Asymmetry

Chapter 30

Table 30.1 Classification of Lasers

Chapter 31

Table 31.1 Aging Throughout the World

Table 31.2 Remaining Life Expectancies: Adults Aged 65 Years and Older in the United States

Table 31.3 Most Common Chronic Conditions in Older Adults

Chapter 32

Table 32.1 Frontal Soft‐Tissue Points

Table 32.2 Profile Soft‐Tissue Points

Chapter 41

Table 41.1 Comparison of Properties of Polyether and Addition Silicone Impression Materials

Table 41.2 Troubleshooting Impressions

Table 41.3 Tips for Improving Impressions

Chapter 45

Table 45.1 Manufacturer’s Recommended Minimal Connector Size for Various Dental Ceramics in Different Situations

Chapter 47

Table 47.1 Recommendations for Prescribing Dental Radiographs

Table 47.2 Summary of Dental Hygiene Care at Maintenance Visits Following Dental Implant Placement

Table 47.3 The Relative Dentin Abrasivity (RDA) Values for Commonly Available Toothpastes

3

Table 47.4 Dental Implant Health Scale

List of Illustrations

Chapter 01

Figure 1.1 Over 4000 years ago, the Etruscans demonstrated the earliest treatment related to esthetic dentistry by using gold wire to save diseased teeth to maintain the beauty of the smile. This reproduction shows copper wire.

Figure 1.2 An example of dental esthetics practiced from ancient times in Japan, likely around 500

AD

, called ohaguro, in which people stained their teeth to be black in color. This practice continued into the Meiji era, which ended in the early 20th century.

Figure 1.3

(A)

This 2000‐year‐old Mayan skull provides some of the best evidence that jadeite inlays were used for cosmetic, rather than functional, purposes.

Figure 1.3

(B)

Aside from jadeite inlays, the Mayans also valued using special tooth carvings to enhance physical appearance. However, there are still cultures that practice filing teeth for cosmetic enhancement (https://anthropology.net/2007/06/01/damien‐hirsts‐diamond‐encrusted‐skull‐jeweled‐skulls‐in‐archaeology/).

Figure 1.4

(A)

Discolored teeth and leaking and discolored fillings marred the smile of this 24‐year‐old internationally known ice skating performer. (Note also the slight crowding of the front teeth, with the right lateral incisor overlapping the cuspid.)

Figure 1.4

(B)

A new sense of self‐confidence and a much more appealing smile was the result of six full porcelain crowns. The teeth appear much straighter, and the lighter color brightens the smile and enhances the beauty of her face and lips.

Figure 1.5

(A–C)

Esthetic values change with social attitudes. (A) This patient once thought that showing gold was desirable, and it was accepted in her socioeconomic peer group. (B) When her status changed 10 years later, so did her attitude, and the gold crowns were removed. It is important to “wear” these temporary acrylic crowns for 1–3 months to make certain the patient will continue to like his or her new look. (C) This lady was happy with her diastema, thinking it was “cute” and part of her personality.

Figure 1.6 Example of an individual during contemporary times who defines good‐looking teeth best when adorned with an inlaid diamond and multiple open‐faced gold crowns depicting various shapes.

Figure 1.7

(A)

This 13‐year‐old girl reported that boys “called her names,” referring to her tetracycline‐stained teeth.

Figure 1.7

(B)

Although bleaching was attempted, bonding the four maxillary incisors was required to properly mask the tetracycline stains. Unless attention is paid to esthetics in young people, severe personality problems may develop. Improving one’s self‐confidence through esthetic dentistry can make all the difference in having a positive outlook on life.

Figure 1.8 Although physical attractiveness and sexiness are two separate traits, this model represents a combination of both.

Figure 1.9

(A and B)

This girl shows why she chose not to smile. Despite the total breakdown of the oral cavity, her motive in seeking dental treatment was esthetic.

Figure 1.10

(A and B)

This woman developed a habit of smiling with her lips together to avoid showing her unsightly maxillary incisors.

Figure 1.11

(A–C)

This young woman refrained from smiling because she was embarrassed by her high lip line that revealed too much of her gums. She said it affected her personality and relationships. She received implants, orthodontics, bleaching, cosmetic contouring, and gum surgery to lengthen her teeth and give her a more attractive medium lip line and overall smile.

Figure 1.12

(A–C)

Before and after full face smile photos: this 22‐year‐old waitress was too embarrassed to smile, which limited her full potential both socially and in reaching her career goals. Porcelain veneers and a resin‐bonded fixed bridge were made without reducing the tooth structure. The result of her new smile and full hair and face make‐over was a life‐changing physical and mental transformation for this young woman.

Figure 1.13

(A)

This patient chose not to smile which affected her self‐image and personality.

(B)

Since our teeth and mouths are critical factors in psychological development in life, it is not difficult to see why this patient chose not to smile.

Figure 1.13

(C)

The smile was restored with an upper‐implant‐supported denture and a lower fixed and removable partial denture. Following a complimentary make‐over, it is easy to see why this lady has a completely different outlook on life with her new self‐image.

Figure 1.14

(A)

This patient reached a point in her life where she realized her smile was looking much older than she felt.

Figure 1.14

(B)

A new smile make‐over helped restore her youthful smile and self‐esteem.

Chapter 02

Figure 2.1 Individuals with mood disorders may present with rampant caries, due to poor oral hygiene and xerostomia from some psychoactive medications.

Figure 2.2 Dental restoration can enhance optimism and self‐esteem in patients with a history of mood disorder.

Figure 2.3 Parotid gland enlargement in bulimia nervosa.

Figure 2.4 Russell’s sign: knuckle calluses resulting from induced vomiting in eating disordered patient.

Figure 2.5 Typical glassy erosion—perimylolysis—seen in bulimic individuals. Note lingual erosion of cuspids and bicuspids, with narrow enamel band at gingival margins.

Figure 2.6 Palatal enamel erosion and “amalgam islands” from frequent vomiting in BN.

Figure 2.7 Angry patient preparing to record conversations with the dental team, due to previous dental experiences that have made her distrustful.

Figure 2.8 Demanding patient using drawing to dictate tooth form.

Figure 2.9

(A)

This patient presented with slight discoloration on her central incisors. Two porcelain veneers were bonded in place after she signed the release form stating she “loved the results.”

(B)

This photo captures one of many tiny complaints as she returned every 7–10 days for 3 months with her explorer. She was diagnosed with Body Dysmorphic Disorder and was successfully treated psychiatrically.

Figure 2.10

(A–D)

Patient with body dysmorphic disorder (BDD) who required four different provisional bridges to wear on different occasions.

Chapter 03

Figure 3.1

(A)

Although it is best for new patients to receive and read

Change Your Smile

before their first appointment, it is important to have copies in your reception room to reeducate your existing patients.

Figure 3.1

(B)

A major advantage of having patients review

Change your Smile

2

before presenting your treatment plan is for them to view realistic fee ranges, advantages, disadvantages, treatment results, and required maintenance for most all esthetic treatments.

Figure 3.2 The advantage of having your patients complete a self‐smile analysis like this one is to help them visualize and communicate to you all potential problems before treatment planning is initiated.

Figure 3.3 Typical sequence of patient office contacts.

Figure 3.4

(A)

A sense of inferiority can create a depression that occasionally causes patients to become desperate about their self‐image. In this case, the 28‐year old woman was so ashamed of her appearance that she balked at even opening her mouth.

Figure 3.4

(B)

The first step was soft tissue management to eliminate inflammation.

Figure 3.4

(C)

Orthodontic treatment corrected the open bite.

Figure 3.4

(D)

The reward of an extended consultation period to help overcome a fear of dentistry is the acceptance of combined therapy to achieve an esthetic result.

Figure 3.5

(A)

The rapport between hygienist and patient often can help uncover a patient’s interest in esthetic dentistry.

Figure 3.5

(B and C)

Both Diagnodent (Kavo) in panel B and Cariescan (Ivoclar) in panel C are hand‐held laser caries devices used to help evaluate any suspicious pits and fissures.

Figure 3.6 Facial evaluations should be made both in person, face to face, and recorded photographically. The digital photograph provides the two‐dimensional silhouette from which it is easier to determine facial deformities.

Figure 3.7 Original esthetic evaluation chart. (Goldstein, R. Esthetics in Dentistry, Ist edition, 1976.) Although there are many newer forms available (see Appendices A–C), many of the conditions listed here are still quite relevant.

Figure 3.8

(A)

Using an intraoral transilluminator is an excellent method of diagnosing microcracks. The intraoral camera can also record these microcracks.

Figure 3.8

(B)

Transillumination is easily accomplished using one the many Microlux (AdDent) tips. One of the most useful ones is a vertical tip that can help visibility and measure post preparations.

Figure 3.9

(A)

This Kodak 1600 intraoral camera has auto focus which can either be wireless or wired, and it makes it easy for both dentist and hygienist to quickly record a patient’s condition including potential caries identification technology.

Figure 3.9

(B)

One of the major uses of the intraoral camera is to record and show your patient severe microcracks that may result in catastrophic tooth fracture. Such an example is seen in the bicuspid photograph.

Figure 3.9

(C)

Another major use of the intraoral camera is the important recording of deep microcracks along the pulpal floor. This recording will be helpful in showing your patient that the tooth was damaged prior to your restorative treatment.

Figure 3.9

(D)

The SOPROLIFE intraoral camera not only provides visual evidence of what you see, but also quickly converts to a light‐induced fluorescence evaluator to help distinguish carious from noncarious tooth structure.

Figure 3.9

(E)

This photo was taken after caries was thought to be removed under a defective amalgam restoration.

Figure 3.9

(F)

A simple click converts to the special blue light, which reveals in red where caries was still present.

Figure 3.10 Although there are a multitude of extraoral cameras that can be used for patient photographs, a Nikon D300 with four flashes is able to provide excellent digital images.

Figure 3.11

(A)

Digital radiographs make it quick and easy to verify the interproximal fit of your prosthetic restorations before final seating.

Figure 3.11

(B)

Digital radiography makes it easy to convert black and white images to color so patients can quickly see and understand what the dentist is describing.

Figure 3.11

(C and D)

The Goldstein ColorVue Probe is more comfortable than the metal probe and more precise since it measures in 0.5 mm increments up to 3 mm.

Figure 3.12 A digital perio‐probing chart is another essential diagnostic tool to be used in treatment. It is easy for both dentist and hygienist to read and compare results.

Figure 3.13 Although there are many ways of showing a patient the results of treatment, esthetic imaging is an excellent method of demonstrating potential results of diastema closure. A disclaimer should always appear on the photos stating: “This photo is for illustration only and does not represent a guarantee of any kind.”

Figure 3.14

(A and B)

Although crowded teeth caused this international tennis star to seek esthetic treatment, computer imaging indicated the need for cosmetic periodontal‐gingival raising therapy for improved facial proportion. Imaging also gave him a much desired alternative to orthodontic therapy by demonstrating the proposed results using porcelain veneer restorations.

Figure 3.14

(C)

The final smile would not have been possible had this patient not been motivated to undergo both periodontal and restorative therapy after seeing the potential results via computer imaging.

Figure 3.15 This computer imaging printout shows the importance of taking a lateral view since this aspect as seen by others is seldom observed by the patient.

Figure 3.16

(A)

Medical history form (page 1).

Figure 3.16

(B)

Medical history form (page 2).

Figure 3.17 There are many digital diagnostic and treatment forms but this simple chart allows easy listing of proposed treatment for each tooth.

Figure 3.18

(A)

It is essential that the dentist meets with the treatment coordinator, making sure all aspects of treatment and fees are correct before presenting the final treatment plan to the patient.

Figure 3.18

(B)

The treatment coordinator presents the final treatment plan and answers all questions, including about financial arrangements, before the patient signs the treatment form.

Figure 3.19 The best interdisciplinary consultation is accomplished when all the various specialists gather in the operatory with the patient to discuss a comprehensive treatment approach. This often must take place late in the afternoon or after hours so that all can attend.

Figure 3.20

(A)

Even with computer imaging it is helpful for patients to be able to see how changes will affect their speaking ability and the appearance of their lip line. This patient was unhappy with his smile and wanted longer teeth.

Figure 3.20

(B)

Tooth‐colored wax applied to the central incisors showed the patient how the final restorations would correct his problem.

Figure 3.20

(C)

Visualizing the improvement motivated this patient to obtain esthetic correction with fixed ceramic restorations.

Figure 3.21 Creating waxed models of the available choices helps the patient understand the treatment options and enhances the dentist’s diagnostic ability.

Figure 3.22

(A)

This patient had an extremely difficult malocclusion requiring orthodontic therapy.

Figure 3.22

(B)

A removable appliance (Snap‐On Smile) was made to create a realistic trial smile that he could wear and visualize the result of his treatment outcome.

Figure 3.22

(C and D)

Note in this occlusal photo how the appliance attaches to the teeth.

Figure 3.22

(E)

The patient was pleased with his trial smile which allowed him to experience the reaction of family and friends to his new look.

Figure 3.22

(F)

The removable appliance was motivating enough for the patient to undergo orthodontic therapy 3 years later.

Figure 3.23 This wall‐mounted mirror is perfect for patients to be able to see their smile and face the way others will be looking at them.

Chapter 04

Figure 4.1 Pre‐operation photo.

Figure 4.2 The DSD protocol can be utilized on the Keynote software or MS PowerPoint using the Digital Face Bow procedure. The face photo is placed on the slide to start the DSD sequence and is adjusted behind the two white dotted lines (the cross), determining visually the ideal facial midline and horizontal reference.

Figure 4.3 The horizontal line is moved to the mouth area and the face photo is cropped showing only the overall smile.

Figure 4.4 The smile and cross are enlarged to fill the whole slide.

Figure 4.5 Three transferring lines are created. Green line: cuspid tips. Red line: incisal edge of the centrals. Yellow line: mesial of the central incisor.

Figure 4.6 The three lines will be used to calibrate the intraoral photo to the facial cross.

Figure 4.7 The first step to calibrate the intraoral photo is to adjust the size and inclination of the photo so that the cusp tips are touching the ends of the green line, exactly as performed on the facial photo.

Figure 4.8 Step 2 is to move the photo so that the incisal edges and mid line are touching the lines, exactly as performed on the face photo.

Figure 4.9 The dotted white lines are reintroduced into the slide and now the intraoral photo is calibrated with the facial cross.

Figure 4.10 The lines and photo are positioned and stretched to fill in the whole slide, improving the visualization of the relation between teeth, soft tissues, and the facial cross.

Figure 4.11 With a caliper measure the real length of the central incisor on the stone model (8 mm). This measurement will be used to calibrate the Digital Ruler.

Figure 4.12 Using the computer again, the Digital Ruler is dragged onto the slide and calibrated according to the 8 mm measurement obtained. The zero on the ruler is placed on one of the yellow horizontal lines and then the ruler is stretched or reduced until the #8 reaches the other yellow line.

Figure 4.13 After calibration, measurements can be performed on top of the photo on the anterior area. For example, the discrepancy between the heights of the cervical of the cuspids is 1.7 mm.

Figure 4.14 Measure the diastema, 1.5 mm.

Figure 4.15 Make the digital drawings over the photo on the slide with the drawing tool.

Figure 4.16 Draw the central incisor.

Figure 4.17 The Digital Mock‐Up. Move the central distally to remove the distal diastema and to improve the match between dental and facial midline.

Figure 4.18 Duplicate the drawing of the central.

Figure 4.19 Flip the drawing and position it symmetrically to the other central. One can immediately visualize the difference between the actual and ideal position of the right central.

Figure 4.20 Draw the left lateral and cuspid to serve as a reference for the ideal position of the contralateral teeth.

Figure 4.21 Flip and position the lateral and cuspid drawings symmetically in order to visualize the discrepancy between actual and ideal position of the six anterior teeth. This can demonstrate to the orthodontist the movements required as well as showing the patient the necessity of orthodontics to allow for minimally invasive preparations for veneers.

Figure 4.22 Situation after orthodontics.

Figure 4.23

(A)

The effectiveness of ortho treatment can be visualized by superimposing the digital planning drawings over the post treatment photo. This helps demonstrate any further corrections needed.

Figure 4.23

(B)

Planning the restorative procedures. Photo protocol for smile analysis after ortho.

Figure 4.24 The profile photo is also important to help analyze the buccal/palatal position of the centrals in relation with the lips.

Figure 4.25 Digital planning for the restorative procedures. Analyzing the relation between the length of the anteriors and the lips. The first guess about how much one can lengthen the anteriors (curved dotted line).

Figure 4.26

(A)

Digital Mock‐Up, giving an idea about ideal tooth design. One can visualize the relation between ideal design, actual tooth position, and soft tissues.

Figure 4.26

(B)

Again, utilizing the Digital Ruler after calibration measurements are made that will be transferred to the diagnostic wax‐up. For example, the amount of lengthening: 1.7 mm on right cuspid, 1 mm on left central, and 1.5 mm on left cuspid.

Figure 4.27 One of the main steps of the DSD technique, transferring the cross from the computer to the model to allow for a diagnostic wax‐up that is integrated with the patient’s face. The horizontal dotted line is placed above the teeth and the distances from the line to the cervical of the centrals and cuspids are measured.

Figure 4.28 Transferring the cross to the model. The measurements made on the computer from the horizontal line to the cervical of the teeth are marked on the model by using a caliper. Then the four marks are connected creating the horizontal reference on the model.

Figure 4.29 The vertical line can also be transferred from digital to the model. Now the model has the references for the wax‐up to be developed without missing the midline and the occlusal plane.

Figure 4.30 Guided diagnostic wax‐up, guided by the digital planning and in harmony with the facial cross.

Figure 4.31 The wax‐up is transferred to the mouth to create a mock‐up by utilizing a silicone index (Matrix Form 60‐Anaxdent).

Figure 4.32 The mock‐up made with a bis‐acryl type of material.

Figure 4.33 If the mock‐up seems a little long, a permanent black marker can be used to create the illusion of shorter teeth before actually shortening them.

Figure 4.34 The smile with the simulation of shorter teeth on the left side.

Figure 4.35 Shortening the mock‐up with a sand disk.

Figure 4.36 Photographic analysis of the mock‐up. These photos will be nicely displayed on the slides and presented to the patient.

Figure 4.37 The smile design should always be presented to the patient by images and videos rather than by the mirror.

Figure 4.38 Before and after the mock‐up.

Figure 4.39 These casual photos of the mock‐up help stimulate, motivate, and engage the patient.

Figure 4.40 Presenting the smile design with just the mirror is not effective in presenting all the possibilities to the patient.

Figure 4.41 The photos and videos allow the patient to see the changed smile from all angles in order to fully understand the integration of the smile design to their face.

Figure 4.42 After the smile design project is approved by the team and the patient, the clinical procedures can be planned as tooth preparation. The tooth preparation will be as minimally invasive as possible if one knows exactly the final ideal forms.

Figure 4.43 Finishing the tooth preparation. One can notice an almost prepless situation.

Figure 4.44 A very important analysis is done when comparing the preps with the silicone index that shows the ideal buccal position according to the mock‐up.

Figure 4.45 Impression.

Figure 4.46 Impression.

Figure 4.47 Monolithic ceramic veneers (Emax LT BL4).

Figure 4.48 The veneers in position with try‐in paste (Variolink Try‐in paste).

Figure 4.49 Variolink Try‐in paste and shade guide.

Figure 4.50 A video of the try‐in allows the dentist and the patient to evaluate in all the details the integration between the veneers, the smile, and the face, allowing for final adjustments before final cementation.

Figure 4.51 Bonding procedures.

Figure 4.52 Bonding procedures.

Figure 4.53 Immediately after cementation showing a very good soft tissue condition.

Figure 4.54 Smile integration.

Figure 4.55 Final face photos.

Figure 4.56 It is important to present the patient with a before and after comparison slide to demonstrate the overall value and improvement to his or her smile.

Figure 4.57 Post‐op after 1 year.

Chapter 05

Figure 5.1

(A and B)

Esthetically pleasing décor enhances the patient’s perception of the dentist’s esthetic taste. The presence of colorful flowers and other art décor around the office may also help to enhance your patient’s confidence in your esthetic judgment.

Figure 5.1

(C)

For your reception area, in addition to news or entertainment videos, consider more personal educational programs with you as the teacher.

Figure 5.1

(D)

Whenever possible, the entrance to patient treatment rooms should also be an attractive, pleasing, and comforting experience.

Figure 5.1

(E)

This dental office uses art glass so patients can relate to the doctors’ esthetic taste.

Figure 5.1

(F)

Custom art glass flowers were designed so patients sitting in the dental chair can see the different colored petals.

Figure 5.1

(G)

This unique Lalique crystal bowl has a double meaning. In addition to its beauty, the fluorescence in this bowl can help patients visualize the artistry and fluorescence that will be used in creating their ceramic restorations.

Figure 5.2

(A and B)

The color and style of doctor and staff uniforms is another aspect of the total office image. (A and B) Two examples of physician’s uniforms and staff uniforms

Figure 5.3

(A)

In addition to other amenities, patients have the luxury of watching their favorite program on the ceiling HD television, both while waiting and during treatment.

Figure 5.3

(B)

This office has a comfort room for patients who have extended treatment visits. While waiting for the laboratory to complete her restorations, this patient is being served lunch by one of the office’s most valuable team members.

Figure 5.4

(A)

A chairside computer monitor is one of the easiest ways to consistently keep your patients informed. It is also helpful for demonstrating both intra‐ and extra‐oral pictures to your patients throughout their treatment.

Figure 5.4

(B)

A tablet computer is an example of how new technology can be used to easily educate your patients while in the chair. This patient is viewing a video of a proposed laser‐assisted new attachment procedure (LANAP) to help better understand the treatment.

Figure 5.5

(A)

Although in most instances a treatment coordinator or other team member can present the treatment plan, at times the doctor may be called upon for more detailed explanation.

Figure 5.5

(B)

Internal marketing should always be considered when planning for office décor. These colorful photographs from a renowned Brazilian photographer and artist help to show the ingredients of a beautiful smile.

Figure 5.6

(A)

The ultimate success of any marketing program is satisfied patients who are willing to refer their family and friends. This cake presented to the dental team is evidence of that satisfaction.

Figure 5.6

(B)

The design of the cake was the creation of the patient.

Figure 5.7

(A)

A good example of external and internal marketing is seen in this blog which was a website posting of a news clip of the practice’s work with StemSave.

Figure 5.7

(B)

The website should be easy to navigate and have a section for new patients and what they can expect on their first visit.

Figure 5.8 Local magazine ads can target marketing to specific geographic areas close to your practice location.

Figure 5.9 This office newsletter demonstrates that this practice is involved with local charity in the community.

Chapter 06

Figure 6.1

(A)

This 29‐year‐old man wanted esthetic treatment to lighten his natural tooth structure to match the two previously crowned left central and lateral incisors.

Figure 6.1

(B)

After several more conservative consultations, including bonding, bleaching, and periodontal therapy, he chose a dentist who elected to crown all of his teeth. Note the extensive presence of periodontal disease.

Figure 6.1

(C)

Unesthetic crowning. Note open margin.

Figure 6.2

(A)

This 19‒year‒old accident victim presented with emergency splinting material previously applied by her attending oral surgeon.

Figure 6.2

(B)

Displaced teeth and incisal fractures are seen after splinting material was removed.

Figure 6.2

(C)

A recent photograph was used as a model to mold and carve the patient’s teeth when rebuilding her teeth during first direct bonding stage.

Figure 6.2

(D)

Result following the first stage of direct bonding.

Figure 6.2

(E)

Patient’s orthodontist provided a photograph of the patient following his successful orthodontic treatment only 10 months prior to the accident.

Figure 6.2

(F)

Final picture of the patient’s smile following second‐stage treatment with porcelain laminate veneers.

Figure 6.3

(A)

Crowns prior to periodontal surgery.

Figure 6.3

(B)

Postperiodontal surgery. Note grossly open margins.

Figure 6.3

(C)

Proper contours of crowns.

Figure 6.3

(D)

Overcontouring of crowns.

Figure 6.4

(A and B)

Cotton displacement cord packed into the gingival sulcus to illustrate defective margins.

Figure 6.5 Postbleaching external root resorption.

Figure 6.6

(A)

Normal biological width.

Figure 6.6

(B)

Gingival inflammation of biologic width invasion resulting from failure to wait for laser sculpting to heal before veneer preparations.

Chapter 07

Figure 7.1

(A and B)

Notice the different fields of view of the same teeth when viewed through a wand‐like camera (A) versus a single‐lens reflex (SLR) camera. Wand‐like cameras, though simple to use, may detract from a patient’s ability to understand how one tooth fits into the bigger picture.

Figure 7.2 Well‐composed clinical images allow exceptional communication between all members of the team. Nuances including tooth shape, form, translucency, color, and texture can be well represented in a properly composed image.

Figure 7.3 This image was captured by itself, filling the entire frame, rather than capturing it as part of a full arch and “zooming in.” Notice the detail in terms of sharpness and color as compared to Figure 7.4.

Figure 7.4 This tooth was cropped from an image of the full arch. Aside from loss of detail, capturing a full arch from roughly 60 cm away often makes it difficult to see issues such as saliva, which can block vital components of the image.

Figure 7.5 Examples of standard “point‐and‐shoot”

(A)

and single‐lens reflex (SLR)

(B)

cameras. It can often be difficult to differentiate between the two; however, almost all point‐and‐shoot cameras do not allow for lenses to be removed and exchanged for other ones.

Figure 7.6

(A and B)

Examples of two similar lenses made by different manufacturers. In this case, they are both 105 mm macro lenses.

Figure 7.7 One can differentiate lenses by looking on the body of the lens for a proper marking. In this case, three different lenses (A, 60 mm, B, 85 mm, and C, 105 mm) are shown in a close‐up view with their markings highlighted in yellow. Note that lenses with a range (i.e., 18–200 mm) are not appropriate for dental use.

Figure 7.8

(A–E)

Starting with a well‐composed image, consecutive images demonstrate how pixels can become more apparent as one repeatedly zooms in. In the final image, particularly in the light areas, one can see the individual pixels very clearly.

Figure 7.9 When one crops an image too much and then expands it to fit a larger area, the amount of pixels in the image may be less than the display requires. In cases such as this, the image is said to be “pixelized.”

Figure 7.10 An example of different monitor resolution options offered in Microsoft Windows.

Figure 7.11 Example of the same monitor set to two different resolutions.

(A)

It is set to 1024 × 768 and

(B)

it is set to 1440 × 990. Notice how some icons become smaller (B) because their set number of pixels making up the icons take up less space on the screen with more pixels.

Figure 7.12

(A)

Example of a single‐point flash with a ring flash.

Figure 7.12

(B)

Example of a double‐point flash.

Figure 7.12

(C)

Example of a ring flash alone. Many dentists confuse their double‐point flashes with ring flashes. To be a true “ring” flash, it must be an uninterrupted circle of flash.

Figure 7.13 An example of a camera attachment which allows multiple positions for the macro flash. Moving the flash away from the lens makes it more difficult to control lighting, but it rewards the photographer with better shadows and highlights for diagnostic purposes.

Figure 7.14 An example of a histogram showing what the information means.

Figure 7.15

(A–C)

Examples of different images and their corresponding histograms. Examine the images and note what colors within the images create each of the peaks. Every single pixel is properly represented by its histogram.

Figure 7.16

(A and B)

This image of the tooth takes up most of the field of view. The tooth is not pure white, but rather an “off white.” Notice how the largest and broadest peak in the histogram is found in an area that is representative of this tonal makeup. The skinny peak on the right side of the histogram represents the light reflecting off of the tooth.

Figure 7.17 Examples of histograms with the largest and broadest peak centered

(A)

and to the left (darker side) of midline

(B)

.

Figure 7.18 Examples of how f‐stop relates to depth of field. Notice the difference of focus as one moves away from the camera. Images were captured with a very low f‐stop

(A)

and with a very high f‐stop

(B)

, allowing a much greater depth of field in the latter where many more keys are in focus.

Figure 7.19 Keep a quick‐reference checklist of correct camera settings to control lighting. It is important to note that different camera and flash combinations can cause many of the settings to differ from the ones in this example; however, once determined, the settings themselves will differ very little from patient to patient.

Figure 7.20 A common mistake for the clinician is to choose too small a mirror, thinking that it will be more comfortable for the patient. Notice the difference between

(A)

and

(B)

, based solely on the use of a larger mirror in the second image.

Figure 7.21 Warm running water is a great way not only to clean a mirror but also to keep it from fogging during use.

Figure 7.22 The basic types of retractors used for most images.

Figure 7.23

(A–K)

The 11 basic images in composite.

Figure 7.24 Notice how the face is not centered in the frame. The ears are an excellent way of judging how the patient should be positioned. This patient is also turned slightly to her left and this is also demonstrated very nicely by looking at the ear display. It is important to look at the patient, not through the camera, after capturing the image to determine whether the image accurately represents the patient or if there is some sort of misrepresentation caused by poor positioning.

Figure 7.25

(A)

Image of a laugh.

Figure 7.25

(B)

Image of a smile.

Figure 7.25

(C)

Smile held for too long with same patient.

Figure 7.26 Images of a cant as found naturally

(A)

and an artificially corrected through camera rotation or software manipulation

(B)

.

Figure 7.27 Image of a patient too far reclined in the chair and the resultant image. Notice how it looks as if one is looking up at the patient rather than straight on.

Figure 7.28

(A)

Examples of a visible incisal edge at repose.

Figure 7.28

(B)

The need to use a periodontal probe to demonstrate an incisal edge that is superior to the lip, and therefore not visible. Without a probe, one cannot determine whether the incisal edge is 1, 3, or even 8 mm above the lip at repose.

Figure 7.29 An image taken using TTL. Notice how the camera has arbitrarily chosen an f‐stop that doesn’t allow all of the teeth to remain in focus.

Figure 7.30

(A and B)

It is vital to capture a retracted “open” image after the “closed” image. Often, vital information is not visible if only a closed image is captured.

Figure 7.31

(A)

Closed bite image.

Figure 7.31

(B)

Image with patient opening too wide and distorting image.

Figure 7.31

(C)

Image captures important information below the lower central incisors missed in previous image.

Figure 7.32 To properly capture a lateral arch image, one must not pull the contralateral retractor very far back. Ideally, one wants to move it as close to the midline as possible to reduce “pull” on the working side lips through tension. In this case, the height of concavity for the mirror is between the lateral and cuspid.

Figure 7.33 In contrast to Figure 7.32, notice how much more the contralateral retractor is being pulled, not allowing the mirror to be rotated and how misrepresented the angles classification has become.

Figure 7.34 Although this image looks “clean,” the clinician has captured the second molars at the expense of a misrepresented angles classification.

Figure 7.35 In contrast to Figure 7.34, this clinician has chosen to omit the second molar to properly position the mirror for an accurate representation of the angles relationship.

Figure 7.36 Notice the different positions of the clinician attempting to capture a proper maxillary occlusal image.

(A)

Demonstrates proper positioning where the patient’s head is tilted back and the doctor’s nose is directly over the patient’s nose.

(B)

Very common example of improper patient positioning where the clinician’s nose is behind the patient’s head. It is nearly impossible to capture a proper occlusal image from this position. Most clinicians who are in this position generally feel that they cannot get the patient to open wide enough.

Figure 7.37

(A)

The differences in using split retractors and full retractors for occlusal images are considerable.

Figure 7.37

(B)

Note the way the full‐arch retractors get in the way of the mirror and stretch the lips in places not necessary to capture the image, thereby reducing opening.

Figure 7.38 One can upload information either directly from the camera using a cable

(A)

or from the memory card using a reader

(B)

.

Figure 7.39 Notice the differences in the original

(A)

and edited

(B)

images. It’s important to note that only “global” changes have been made (histogram adjustment, sharpening the entire image, rotating and flipping the arch) and not “regional” changes such as whitening a specific tooth or “morphing” proposed changes.

Figure 7.40 One example of database management using Windows Explorer.

Chapter 08

Figure 8.1

(A and B)

Correction of negative smile line with porcelain veneers.

Figure 8.2

(A)

Visual interpretation is relatively simple for a linear drawing with many edges.

Figure 8.2

(B and C) (B)

Form is not so easily understood in an object with smooth curved edges.

(C)

Added light and shadow help to clarify form interpretation.

Figure 8.2

(D)

Like the illusion created in this drawing, the perception and manipulation of light are used in cosmetic dentistry by staining, shaping, and contouring the dentition.

Figure 8.2

(E)

Although the lines are of equal length, the vertical line appears longer because the brain spends more time “seeing” the vertical and interprets longer time as longer length.

Figure 8.2

(F)

Illusion is created by the angled direction of the arrows. The outward position of the arrows of line 1–2 gives the illusion that it is shorter in length than is line 2–3.

Figure 8.2

(G)

The interpretation of whether this folded paper is outward or inward can be more accurate when shading is added.

Figure 8.2

(H)

Although teeth 1 and 2 are equal in size, the accent lines make tooth 1 appear longer and tooth 2 appear wider.

Figure 8.3

(A and B)

A study cast in yellow or green stone is sprayed with model spray

(A)

or gold powder

(B)

to show texture and highlights.

Figure 8.4

(A and B)

Narrow, thinner look created with distal rotation of teeth.

Figure 8.4

(C and D)

Broad, wider look created with mesial rotation of teeth.

Figure 8.5 Lombardi’s guide for altering tooth arrangement illustrates incisal edge modifications that affect personality, sex, and age characteristics.

Figure 8.6

(A)

A smoother surface results in greater light transmission through the tooth, which results in increased translucency and lower value.

Figure 8.6

(B)

Incorporating greater texture into the restoration will reflect more light, so the tooth can be designed with a slightly higher value while maintaining a natural appearance.

Figure 8.6

(C)

Note the difference in light interaction of restorations depending on substructure. Top row: reflected light; bottom row: transmitted light.

Figure 8.6

(D)

Split view of the same restoration with different stump preparation color. Notice the value decrease with darker preparation.

Figure 8.6

(E)

Influence of stump preparation on final color is evident with all restorations except those with a metal substructure. Top row, light stump; bottom row: dark stump.

Figure 8.7

(A)

This patient required anterior splinting to correct the effects of mandibular periodontal disease and therapy which left her with large interdental spaces.

Figure 8.7

(B)

A combination of staining, contouring, and effective arrangement of the mandibular anterior crowns gave this patient a natural‐appearing result.

Figure 8.8

(A)

A crown with a zirconia core and a layered ceramic buildup.

Figure 8.8

(B)

The completed crown after firing, glazing and polishing. Note how the deep orange‐brown modifier provides a more realistic crown.

Figure 8.9

(A and B)

This is a good example of internal characterization to mimic the natural effects sometimes seen in the naturally aged dentition.

Figure 8.10

(A)

A combined glaze and stain technique is shown here at the try‐in appointment. The restoration has been checked for fit, shape, and occlusion.

Figure 8.10

(B)

The appropriate shade of stain is mixed to a thick, creamy consistency.

Figure 8.10

(C)

The stain and glaze mixture is applied to the restoration.

Figure 8.10

(D)

The final result after firing. Note how the contrast between orange, brown, and blue can help create a more natural look.

Figure 8.11

(A)

The final close‐up smile shows the two new ceramometal crowns combined with porcelain veneers.

Figure 8.11

(B)

This photograph of two central incisor crowns taken under black light demonstrates that they did not fluoresce like the adjacent natural enamel, causing the crowns to appear different under various light conditions.

Figure 8.11

(C)

Black light helps to show how naturally the new crowns and porcelain veneers fluoresce.

Figure 8.12

(A)

A “natural‐looking” microcrack is added by first applying a broad band of the selected shade of stain.

Figure 8.12

(B)

The flat edge of the brush is used to achieve the desired thinness.

Figure 8.12

(C)

The final result including additional “characterizations” after firing gives the appearance of realism.

Figure 8.12

(D)

These white “microcracks” may be more esthetically pleasing, especially for a younger patient.

Figure 8.13

(A)

The Chairside Shade Guide ceramic shade tabs are divided into different categories, with 20 tabs in each grouping.

Figure 8.13

(B)

Early Age (14 colors). Shade tabs range from bright to warm colors with different degrees of translucency.

Figure 8.13

(C)

Middle Years (20 colors) include variation of color in enamel in ratios of 50% enamel and 50% translucency with three white calcification possibilities.

Figure 8.13

(D)

Later Years (20 colors) include intensive color saturation with deep dentin, translucency, and transparency, as well as a variety of enamel translucencies.

Figure 8.13

(E)

Pre‐molar (five), Molar (10), and Canine (five) selections show a variety of occlusal stains as well as canine enamel incisal variance.

Figure 8.13

(F)

After Preparation Color (10)—shows a variety of colors of prepared teeth. Surface texture (four) is also seen as well as a variety of pinks with enamel overlay.

Figure 8.13

(G and H)

Shade tabs position in photograph is critical for communicating color property. Shade tabs should be placed below and in the same plane as teeth.

Figure 8.14 Tooth “a” is made to appear thinner than it actually is by carving the mesial and distal line angles to the lingual, thus presenting less labial surface.

Figure 8.15 Gentle curving of the mesioincisal and distoincisal edges, as well as a slight indentation at the midincisal edge, alters visual perception.

Figure 8.16 This figure illustrates a too‐wide cuspid. The buccal ridge is carved to the mesial to disguise the excess width in the cuspid.

Figure 8.17 Shallow developmental grooves which break up the smooth labial reflecting surface make the tooth appear less wide.

Figure 8.18 A more pronounced curve carved into the cementoenamel junction which is in a more incisal or occlusal position is another technique used to make the tooth appear thinner.

Figure 8.19 All three shaping special effects are combined on this restoration to produce the illusion of a thinner tooth.

Figure 8.20

(A)

These two central incisors appear too wide with respect to the other teeth in the patient’s dentition.

Figure 8.20

(B)

To accomplish thinner looking central incisors the ceramic restorations were made slightly longer and more translucent stains were used in both mesial and distal proximal areas to give the appearance of thinner‐looking teeth.

Figure 8.21 Placing the wider tooth in linguoversion masks its real width by diminishing its prominence with the adjacent teeth and adding shadowing.

Figure 8.22

(A and B)

Although the right central appears wider than the left central, the left central is actually rotated distally, which causes it to look thinner.

Figure 8.22

(C)

When the patient is viewed from a different angle (halfway between the rotated and non‐rotated teeth) the teeth look proportional.

Figure 8.23 The distal aspects of both the replaced central incisors are rotated, which narrows the light‐reflecting surface and decreases width perception.

Figure 8.24 When a space is too wide (X) a distal diastema is preferable to making the replacement tooth too wide (Y).

Figure 8.25 The narrow right central incisor needs to appear as wide as the left central incisor. The line angle “X” is extended labially and incisally, making the right central appear wider. If necessary, the distoincisal angle of the wide incisor can be reshaped, making it appear slightly narrower (Y).

Figure 8.26 When the crown of the cuspid is too narrow, move the visual center of the labial surface distally by carving the buccal ridge distal to the usual position if this remains compatible with functional requirements.

Figure 8.27

(A)

Horizontal grooves were carved into the right central (1) to give it a wider appearance.

Figure 8.27

(B)

Light, thin, orange and yellow opaque lines were placed on the surface to further enhance the carved horizontal lines.

Figure 8.27

(C)

White calcification spots running horizontally across the middle third of the tooth further accentuate width.

Figure 8.27

(D)

Staining used to create the illusion of incisal erosion to match adjacent teeth also emphasizes width if the crown is horizontal and flat.

Figure 8.27

(E)

This photo of a ceramometal splint shows the ability to modify shades to the patient’s natural looking teeth.

Figure 8.28 For an inadequate space involving central incisors, the teeth can be slightly rotated labially and lapped rather than reducing their ideal width, making them appear wider and more prominent.

Figure 8.29

(A)

For a female, the mesial aspect of the lateral incisor is rotated labially and lapped in front of the centrals to increase a soft, feminine appearance without increasing the space needed for the replacement teeth.

(B)

The mesial aspect of the lateral incisor of this male patient is rotated and lapped lingually behind the central to project width and boldness without requiring additional space.

Figure 8.30 Narrowing a too‐short tooth mesiodistally at the gingival one‐third creates the illusion of length

(A)

. To further this illusion, vertically flatten the labial middle third (B, C).

Figure 8.31

(A)

An illusion of length can be created by gently sloping the mesial and distal halves of the incisal edge toward the gingiva from the midline to the contact areas.

(B)

If two adjacent anterior teeth need to appear longer, each incisal edge should be made to slope gingivally away from the approximating common incisal angles, lending the illusion of length.

Figure 8.32

(A)

Microcracks, decalcification, and interproximal restoration staining has produced the illusion of length.

Figure 8.32

(B)

This 49‐year‐old patient had an extreme case of bruxism resulting in an older‐looking smile.

Figure 8.32

(C)

A more youthful look was attained with all ceramic restorations consisting of slightly altering vertical dimension to be able to lengthen teeth. Interincisal distance was re‐established and incisal embrasures restored.

Figure 8.33 For the too‐long tooth, increase the vertical contact area (“a” to a wider contact “b”), keep the embrasures as narrow as possible, and lingually incline the cervical and incisal one‐fifth areas.

Figure 8.34 A lateral view demonstrating the lingual inclination of the cervical and incisal one‐fifth areas which decreases the appearance of length.

Figure 8.35 When two teeth are involved, reduce the incisal edges to converge gingivally at the proximal common contact

(A)

. The length of the tooth will appear to decrease by the notching of the center of the incisal edge

(B)

.

Figure 8.36

(A–C)

Modifications of form and color can create illusion of better proportion of teeth.

Figure 8.36

(D–F)

Darker gingival color and root formations create shorter tooth appearance.

Figure 8.36

(G–I)

Pink gingival ceramics used to re‐establish correct proportions of teeth and gingival levels.

Figure 8.36