ESTHETICS

IN
FIXED PARTIAL PROSTHODONTICS
Guided by : Dr. Smita Athavale

Presented by : Hemal Patel

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

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

Why needed in fixed partial prosthodontics? ? ?

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Appearance Zone :

•This is the anterior oral area where esthetics is of prime

concern & which is visible on smiling, from maxillary premolar to
premolar (usually 1st molars also),.

•Depends on the person’s self-image, mouth size, teeth size,

smile width, lip size and tightness.

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 GENERAL PRINCIPLES OF ESTHETICS
1. Composition :

Facial composition Dentofacial composition Dental

composition

2. Unity:

i. Static unity ii. Dynamic unity

The following visual forces play a role in unity.

i. Cohesive forces
5 ii. Segregative forces
 Thus, to achieve unity, the teeth are arranged with tectonic
spacing, that is, an esthetic and functional arrangement.

Centric occlusion Anterior protrusion of the mandible

3. Symmetry: Regularity in the arrangement of forms or

objects.
i. Horizontal symmetry
ii. Radiating symmetry

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4. Color, form and lines:

These provide dominance to a composition.

Color predominates over forms, lines and angles.

According to A. H. Munsell,

HUE Specific color produced by a specific

wavelength acting on the retina.
CHROMA SATURATION : Purity of a color.

VALUE BRILLIANCE : Lightness or darkness o

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MUNSELL’S COLOR WHEEL
Many factors that are part of biologic or structural beauty
depend on the visualization of LINES.

The direction of lines can also create optical illusions.

Vertical lines = longer tooth
Horizontal lines = wide and short tooth

Imaginary anterio-posterior line

of the incisal edges/cusps tips
representing the curve of Spee
Lines & Planes
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 Any FORM can be created from the three basic shapes of a
circle, triangle and square.

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 5. Proportion and Ratios:
Golden Proportion: The Golden Proportion results from the
division of a straight line in such a way that the shorter part is
to the longer part as the longer part is to the whole. Each ratio
equals A0.618. B
C CB/AC = AC/AB = 0.618

Golden Rectangle
A/B = A+B/ C = C/B = B+C/A Golden mean gauge
11 = 1.618 = phi
 FACTORS OF ESTHETIC DENTOFACIAL COMPOSITION

A. FACIAL COMPONENTS
B. DENTAL COMPONENTS
C. GINGIVAL COMPONENTS
D. PHYSICAL COMPONENTS

A.FACIAL COMPONENTS:
1. References:
a. Horizontal references
-Interpupillary line
-Ophriac line
-Commissural line

b. Vertical references:
-Facial midline

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 c. Sagittal references:
Upper and lower lip contours
E-line

d. Phonetic references:
"M" sound: amount of incisal display at rest.
"F" or "V" sounds: lingual tilt of the maxillary central incisor
length.
"S" and "Z" sounds: vertical dimension of speech.

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2. Facial Proportions:

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3. Visibility:

•The amount of tooth exposure when lips part slightly in a

relative rest state governed by muscles.
•Age
•Short upper lips : upper incisors
•Long upper lips: lower incisors
Young Old
4. Components of the Smile:

a. Lip line :
Upper lip line:

• Exposure of teeth at rest/smiling and gingival margins on

smiling.
• Evaluate the need for esthetic gingival contouring/crown
15 lengthening in anterior area.
 Lower lip line helps to evaluate buccolingual position of the
incisal edge of the maxillary incisors and the curvature of the
incisal plane.

b. Incisal plane:
Convex
Gull wing effect

c. Incisal edge position:

INCISAL EDGE POSITION AT REST ON SMILING

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 d. Smile line or incisal curve is composed of the incisal edges
of the maxillary anterior teeth and parallels the inner curvature
of the lower lip.

•Degree of curvature more pronounced

in women than in men.

e. Negative space:

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 f. Smile symmetry:

•Perceived in reference to central midline.

•Horizontal and radiating symmetry.

•In a natural pleasing smile, pleasing tooth symmetry is found

close to the midline and pleasing irregularity away from the
midline, creating a balance between idealism and diversity.

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 B. DENTAL COMPONENTS:

1. Dental midline :

•Anatomical landmarks like the incisive papilla or

the labial frenum..
•Not necessarily should coincide with facial midline.
•Balance and symmetry.

2. Tooth proportion:

•Golden proportion (61.8 %)

•Proportion determined by face form
•Proportion by statistical averages
(75-89%)
“A” 85% ratio, square appearance.
“B” 78% ratio, normal ratio.
19 “C” 65% ratio, teeth appear taller.
3. Axial inclination:

4. Teeth arrangement:

10.2 mm

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 Arch form

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 5. Gradation :

Front-back progression

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 6. Teeth morphology :

a. Contact area:

b. Texture :

• Texture can be noted by the light reflection

pattern.

• The surface texture of a crown should simulate

the reflectance pattern of the adjacent natural teeth.

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 c. Characterization :

According to age, sex and

personality.

Frush and Fisher Rufenacht

d. Embrasure form : facial, lingual, incisal and gingival

embrasures.
•Affects perception : large embrasures make tooth appear
smaller and vice versa.
•Incisal embrasures increase in size from central incisor to
canine.

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 e. Line angles:

•Transition from the labial surface at the

mesial and distal lobes to the interproximal
embrasures.

•Changes in their positions control

the appearance of the width of the tooth
and affect light reflection pattern.

f. Emergence Profile:
A tooth's emergence profile is the angle at which the tooth
emerges from the gums when viewed from the side.

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 7. Symmetry:

Automatically obtained if previous

principles are followed.

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 C. GINGIVAL COMPONENTS:

•Gingival line
•Gingival apex/zenith
•Gingival contour and scalloping
•Gingival embrasure
•Gingival symmetry

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 D. PHYSICAL COMPONENTS:

Perception:
Visual perception is:
•· Increased by increasing contrast
•· Increased by increasing light reflection
•· Increased by decreasing light deflection

Illusion:
•Is the art of changing perception making an object appear
different than it actually is.

•Principle of Illumination
•Principle of Lines

•Solve/hide esthetically difficult situations.

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NARROWING

WIDENING

SHORTENING

LENGTHENING
COLOR:

1. BASE COLOR :
Base color is selected on the basis of hue, chroma and value selection
using shade guides and tabs, comparing with adjacent teeth.

2. INTERPROXIMAL :
Interproximal color provides a silhouette for the tooth.
Dark colors makes teeth look smaller while no change in color will give a
broader appearance.

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3. GINGIVAL THIRD :
•Enamel gets thinner in the gingival third of teeth so darker dentin
shows through and the area looks more yellow.
•Staining .

4. INCISAL EDGE :
The incisal edge is translucent enamel resulting in translucency, a halo
effect, or no change as it is worn away with age.

5. CHARACTERIZATION :
•There are many different colors which can occur within a tooth as
might be seen with craze lines or hypocalcifications.
•Staining.
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 TRANSLUCENCY:

•Degree to which light is transmitted rather than reflected.

OPALESCENCE:

•Important component of the perceived enamel colour

•Subtle bluish gleam characteristic appearance.

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Guidelines for shade selection:

• Stains and deposits must be cleaned off the tooth, and the tooth must
be kept wet throughout shade determination.

•Remove bright make-up like lipstick and use neutral-colored drape to

avoid distraction.

•The teeth should be viewed at eye level so that most color-sensitive

part of the retina will be used.

• The color of the luting agent must also be taken into consideration.

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•· Shade evaluation :

-First visit after cleaning OR Next visit after tooth preparation

or bleaching or a strenuous appointment, but following color
stabilization.
-Under different lighting conditions and wet conditions.

•· Hue, chroma and value should be matched in that order.

•· When in doubt, always select higher value and lower chroma, since
it is easy to lower the value and increase the chroma.

•First impression of the chosen color is best and sometimes, squinting

may help to choose the right value of color.
•Shade tabs :

•Custom shade guides

•Photographs
 ESTHETIC CONSIDERATIONS FOR PONTICS

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 FACTORS AFFECTING PONTIC DESIGN

A. Pontic space
B. Residual ridge contour
C. Occlusal load
A

B B C
 SURGICAL MODIFICATION FOR RIDGE DEFECTS

ROLL FLAP TECHNIQUE

•The Roll Flap Technique to Improve Esthetics in Anterior Ceramic Fixed Partial
Dentures: Perio-Prostho Relationship - A Case Report
Kalpesh Vaishnav, Anita Panchal, Dipti Shah
 Free gingival
graft

INTERPOSITIONAL GRAFT
POUCH TECHNIQUE
 PONTIC DESIGN

A. Inciso-gingival height

B. Mesiodistal width C. Gingival interface

ESTHETIC PONTICS
 Saddle / Ridge lap pontic

•Esthetics : Resembles a tooth &

replaces all the contours of the
missing tooth .

•Concave tissue surface.

•Overlaps the residual ridge

buccolingually.

•Disadvantage : Difficult flossing due

to concave tissue surface.
 Modified ridge lap pontic
• It combines the best features of the hygienic
and saddle pontic designs, combining
esthetics with easy cleaning.

• Overlaps the residual ridge facially only.

• Lingual surface has a slight deflective contour

to prevent food impaction and minimize
plaque accumulation.
.
• “T” shaped tissue contact whose vertical arm
ends at the crest of the ridge.
 Ovate pontic
• First described by DEWEY and
ZUGSMITH in 1933.

•Most esthetically appealing pontic

design and ease of hygiene.

•Convex tissue surface resides in a soft

tissue depression or hollow in the
residual ridge.

•Appears to grow out of ridge.

PONTIC INDICATION ESTHETIC HYGIENE DIAGRAM
CONCERN

Saddle- Difficult
ridge lap
Anterior and Reasonably
Posterior good
teeth esthetics Easier than
Modified above
ridge lap

Anterior and Excellent

Posterior esthetics Easier than
Ovate teeth; & above
emergence
High lip line profile
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 Use of a Modified Ovate Pontic in Areas of Ridge Defects

CHIUN-LIN STEVEN LIU:

J Esthet Restor Dent 16:273-283, 2004

A modified ovate pontic has the following

advantages:

•Excellent esthetics
•Fulfilled functional requirements
•Greater ease of cleaning as compared with the ovate pontic
•An effective air seal, which eliminates air or saliva leakage
•The appearance of a free gingival margin and interdental papilla
•Elimination or minimization of the "black triangle" between the
teeth
•Little or no ridge augmentation required.
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 Available Pontic Systems
Pontic Advantages Disadvantages Indications Contraindications
system
Metal- Esthetics Difficult if an Most situations Long spans with
ceramic Biocompatible abutment is not high stress
metal-ceramic
Weaker than all
metal
All metals Strength Non-esthetic Mandibular Where esthetics
molars is important
especially under
high stress
Fiber- Conservative Long-term Areas of high Long-span FPDs
reinforced when used with success esthetics
all-resin inlay preparations unknown concern
Esthetics Limited to short
Easy to repair spans

Facings Rarely used

 ESTHETIC CONSIDERATIONS FOR CONNECTORS
Connectors are components of FPD that connect the pontic(s) to
retainer(s).
-Rigid
-Non-rigid

A. Connector size

B. Connector shape

C. Connector position
 Fig 1 Fig 2

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 ESTHETIC PERIODONTAL CORRECTIVE PROCEDURES
Inadequate tooth structure for restoration:
1.surgical crown lengthening
2.Forced eruption with fiberotomy.

Recession:
1.Free gingival / lateral pedicle graft
2.Subepithelial connective tissue graft
3.Guided tissue regeneration

Gingival overgrowth:
1.Gingivectomy / Gingivoplasty
2.Apically postioned flap with or without ostectomy

Edentulous ridge defects:

1.Onlay/inlay grafts Electrosurgery/laser for
2.Synthetic bone grafts esthetic contouring
 ESTHETIC NON-SURGICAL CORRECTIONS

•Pontic design:
-Tooth-colored
-Pink ceramic in cervical area

•Gingival mask

•FPDs with pink porcelain flanges

 TYPES OF ESTHETIC RESTORATIVE MATERIALS

1. Ceramic :
- Aluminous
- Feldspathic reinforced with Zirconia
- Feldspathic reinforced with Leucite
- Ceromers

2. Composite :
- Conventional
- Fibre-reinforced (glass, polyethylene, carbon)

3. Gingiva-colored materials:
- Ceramic like d.SIGN
- Acrylic
- Silicone
 ESTHETIC FIXED RESTORATIONS

INDICATIONS
Missing teeth
Crowding/Malaligned anteriors ESTHETIC FIXED RESTORATIONS
Mild rotations Bridges
Stains/Discoloration Onlays
Abrasions/Attrised anteriors Crowns
Erosions/Destructed tooth Veneers/Laminates
Spacing

Full-coverage FPD
Partial-coverage FPD
Resin-retained FPD
Fibre-reinforced composite FPD
Implant-supported FPD
 Metal-ceramic All-ceramic

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 METAL-CERAMIC RESTORATIONS

Facial Tooth Reduction:

•A minimum reduction of 1.5 mm typically is required for optimal

appearance.

Reduction in 2 distinct planes Adequate porcelain thickness

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Incisal Reduction:

•An incisal reduction of 2 mm is recommended for translucency

at the incisal 1/3rd.

•Excessive incisal reduction must be avoided because it reduces

the resistance and retention form of the preparation.

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 Proximal Surface:

The proximal surfaces of these

anterior metal-ceramic crowns are
restored in porcelain, which allows
light to be transmitted for
maximum esthetics.
Margin Placement:
Should follow free gingival contour.

Supragingival margins :
Easy to prepare, finish, maintain hygiene, make impressions
and evaluate on recall visits.
Low lip line.

Subgingival margins:
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Caries/restorations involving root High lip line.
 PARTIAL-COVERAGE RESTORATIONS

Proximal margin:
Mesial margin: just buccal to the proximal contact area, where
metal will be hidden by the distal line angle of the neighboring
tooth.

Facial margin:
•Just beyond the occlusofacial line angle.
•Short bevel (to prevent enamel chipping)
•Chamfer (for more bulk of material in molars, if needed)

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 Fiber-reinforced composite fixed partial restoration

Consists of a fiber-reinforced composite substructure veneered with a

particulate composite material.
 Resin-retained fixed partial restoration

Short span FPDs supported by thin metal retainers bonded lingually

and proximally to the abutment enamel.

Etched resin-retained (Maryland bridge)

Cast perforated resin-retained fixed

IMPLANT-SUPPORTED BRIDGES
 LAMINATES/VENEERS

BEFORE AFTER
PORCELAIN

BEFO
AFTER
RE

62 COMPOSITE
ARTICLES
Collarless metal ceramic fixed partial denture: Clinical
report.
W. Matsumoto et al.
Braz Dent J (2001) 12(1) 215-218.

• Advantages:
- Esthetic
- Excellent biocompatibility of the glazed porcelain
- No special equipment required.
- Less plaque because of smooth glazed porcelain collar.

• Although, it requires skill and there is always the risk of

producing restorations with poorer marginal fit.
•An Alveolar Bone Augmentation Technique to Improve Esthetics
in Anterior Ceramic FPDs: A Clinical Report
Burak Taskonak and Yasar Ozkan
J Prosthodont 2006;15:32-36.

This article describes an alvelolar bone augmentation technique so

as to preserve the edentulous space after extraction which is
nothing but the pontic space.
Tissue sculpturing: An alternative method for improving esthetics of
anterior fixed prosthodontics
Jacques et al.
J Prosthet Dent 1999;81:630-3.

•An unfavorable relationship between residual ridge, pontic, and gingival papilla
commonly compromises the final result.

•This article describes a technique for the improvement of esthetics with

conditioning of the tissue beneath the pontics, by displacing tissue with a treatment
restoration.

•Lateral displacement of tissue under gradual, controlled pressure enhances the

interdental papilla, which improves esthetics.
 References
1. Fundamentals of Fixed Prosthodontics: Shillingburg 3rd
Edition.

2. Contemporary Fixed Prosthodontics : Rosenstiel 3rd Edition.

3. Library dissertation “Esthetics in FPD” by Dr. Guruprasad

Handal ; Dr. DY Patil Dental College.

4. South African Dental Technology Journal : Aesthetic s

Issue,Vol 1 Issue 3.

5. The art of a beautiful smile.

Journal of Cosmetic Dentistry, Fall 2008 Volume 24 Number
3.
7. Use of a Modified Ovate Pontic in Areas of Ridge Defects:
Case reports.
Liu CS.
J Esthet Restor Dent 16:273-283, 2004.

8. Levin El. Dental Esthetics and the Golden Proportion.

J Prosthetic Dentistry 40:244-252 1978.

9. Lombardi RE. The principles of visual perception and their

clinical application to dental esthetics.
J Prost Dent. 1973;29:358-381.

10. McLaren EA and Tran Cao P. Smile Analysis and Esthetic

Design: “In the Zone”. Inside Dentistry- Esthetics,
July/August 2009.
 THANK YOU

Next seminar by Dr. on

 Resin-retained fixed partials:
Short span FPDs supported by thin metal retainers bonded lingually and
proximally to the abutment enamel.

Etched resin-retained (Maryland bridge) Cast perforated resin-retained fixed

Fiber-reinforced fixed partials:

Consists of a fiber-reinforced composite substructure veneered with a
particulate composite material.