Esthetic Restorations

using

Artemis & Tetric Evo ceram

Resin Composite
Restorations

There is an obligation to the

patient to restore not merely
healthy function but the
esthetics that are so
important to healthy
personality.

Introduction to
Light & Color

Understanding of light and color

is the building stone to achieve
esthetics.
Wrong color can destroy a
result of mechanically and
biologically successful
restoration.

Light

 Light

is one form of a class of radiation

called Electromagnetic Radiation.

These

electromagnetic radiant energy

spectra have different wavelengths,
where the wavelength identify the type
of wave energy.

 The

visible spectrum (light) have

wavelengths that range from 350-700
nm.

Wavelength

shorter than visible light

include ultraviolet, x- ray, gamma and
cosmic rays.

Above

the visible spectrum , there are

infrared, microwaves, television, radio
and electric waves.

The spectral Distribution of visible light.

Interaction of Light & Matter

1. Reflection
2. Refraction
3. Scattering
4. Transmission
5. Absorption
6. Dispersion
7. Luminescence [Fluorescence and Phosphorescence]
8. Opalescence.

1.Reflection

Importance in dentistry:
The restoration should have a highly smooth
and polished surface, to simulate the tooth
structure and match the color.

2.Refraction
It

is defined as the change in the direction

of light beams ((bending)) when it passes
through another medium.

Importance of refraction in Dentistry:

The index of refraction is a characteristic property of

the substance and is used extensively for
identification purposes.

It is important to control the refractive index of the

dispersed phase and matrix phase in materials such
as glasses, ceramics or resins manufactured to have
the translucent appearance of tooth tissues.

e.g.: Control of refractive index of the filler and matrix

phases in composite resins and porcelain. A perfect
match results in a transparent solid, while large
differences result in opaque materials.

3. Scattering

If light rays passing through a medium are

obstructed by any different inclusions, it will be
redirected in another direction and is attenuated.
i.e. The original beam is weakened by scattering
in a direction away from the observer eye.
Scattered Light
Opacifier
+
Air bubbles
(Scattering
Center)

Importance:

Rough composite fillings scatter more light, thus

appears dull than smooth polished fillings.

Presence of scattering centers as opacifiers and air

bubbles in a medium causes light to emerge in all
directions. Opacity increases with the increase of the
scattering centers.

e.g.:
a) Opacifiers added to composite resins act as
scattering centers that give rise to opaquer shades of
the materials.
b) Incorporation of air bubbles in the restoration
during mixing acts as scattering centers.

4.Transmission

Light passing through an optical medium

without attenuation, is said to be completely
transmitted. Total transmission occurs in
perfectly transparent materials. If part of the
light is transmitted and part is reflected ((i.e.
diffuse transmission)), the material appears
translucent.

5. Absorption
As light passes through an optical
medium, the electrons in the material
may absorb the electromagnetic energy
of that light and the internal energy of
the material is increased. The intensity
of such light will correspondingly
decrease, and the light will not be
transmitted through the material. The
more absorption of light, the more
opaque is the material.

Properties of materials in relation to

light transmission and absorption:
Transparency
A property of the material, that allows the
passage of light so that an object can be
clearly seen through them. i.e. most of the
light waves are transmitted through the body
and small parts are reflected or absorbed e.g.
glass and acrylic resin.

Translucency

A property of the material, that

allows the passage of some light so
that an object can not be clearly seen
through them. i.e. some of the light
waves are transmitted through the
body and large parts are reflected or
absorbed.

Opacity

The property of the material that prevents the

passage of light. Opaque material absorbs all
of the light. Objects cannot be seen through
them. Black color materials absorb all light
colors. White color materials reflect all light
colors. Blue color materials absorb all light
colors but reflect its own color.
White

Blue

Green

red

Blue

Blue object

6.Dispersion

White light is composed of a mixture of colors, which are

dispersed to its component colors by passing it through a
prism. White light (as sun light) beam is dispersed after it
enters the prism and emerges as fan shaped beam consisting
of different colors, including violet, blue, green, yellow, orange
and red. These colors result from the fact that the wavelengths
corresponding to each color refracted different from the other
as they travel through the glass prism. i.e. White light lies in the
range of wave lengths, 350-700 nm, it gets dispersed by a prism
to give the spectrum starting from the shortest wave length,
violet (350 nm) and ending by the largest wave length, red (700
nm). The series of colored bands that are observed from the
dispersion of light from any particular source of light is called
the spectrum of light source.
White

Red
Yellow
Green
Blue
Violet

A collimated beam of white light passed through a

prism is dispersed into hues from violet to red

Application (some importance):

The spectra of light sources are not identical.

Incandescent light emits light waves different
from neon light. This should be taken into
consideration during color matching.

Color of most materials is due to the selectivity

of that object for light of certain wavelengths.
The object reflects light of a certain wavelength
and the remainder of colors is absorbed by the
object, thus producing a characteristic color.
The phenomenon is known as selective
reflection and absorption.

7.Luminescence [Fluorescence
and Phosphorescence]
Emission

of light without heat.

Immediate

emission is called
fluorescence.
while delayed emission is called
phosphorescence.
The fluorescence contribute to the brightness

and vital appearance of human teeth.

Importance in dentistry:

Sound human teeth emit fluorescent light

when excited by ultraviolet radiation (365
nm). The fluorescence being polychromatic
with the greatest intensity in the blue region
(450 nm) of the spectrum. The
fluorescence contributes to the brightness
and vital appearance of human teeth.
Some anterior restorative materials and
dental porcelains are formulated with
fluorescing agents ((rare earths excluding
uranium)) to reproduce the natural
appearance of the tooth structure.

8.Opalescence

This optical effect is based on the different ways

in which long waves Red and short waves
Blue of light are scattered.
When a tooth or filling material that contain
opalescence substance is examined in
incidental light , a bluish tint can be observed,
while in transmitted light this color changes to
reddish-orange.
A true to nature version of the opalescent effect
is very difficult to reproduce, necessitating far
reaching efforts.
Naturally occurring opalescence is created by
patterns of interference .

Color

Color is the quality of an object, with respect to

light, that reflected or transmitted by it.
Color of most material objects is due to
selectivity of that object for light of certain
wavelength.
According to one of Grossmans laws, the eye
can distinguish differences in only three
parameters of color.
These parameters of color have been described
as three dimensions of colors namely Hue ,
Value and chroma.
These variables can describe accurately the
color of an object.

The Munsell color tree is a 3D representation of

the Munsell system

The Munsell color tree

Munsell system

Hue
is

the name of the color and is related to

the dominant wavelengths. (350 nm ) is
violet in color, and light having long
wavelength of 700nm is red.

Between

these are those corresponding to

blue, green, yellow and orange light.

Chroma
describes the degree of
saturation or strength and
intensity of a particular hue,i.e
weak or strong hue.

Value

describes the amount of grayness in a given

color (lightness or darkness of a color).

Value of a color permits a light diffusing object to

be classified according to the scale ranges from
white (high value) to black (low value).

Between the white and the black scale, we find a

series of grayness of levels.

Black standard has 0 value , whereas a white

standard has 100 value.

Light transmitting objects are classified as black

to perfectly clear.

Bright colors have high value. Dull colors have

low value.

In human teeth, the characteristic of value which

determines the vitality, is determined by:
a)Translucency
b)subtractive color mixing.

Importance of Value in Dentistry:

Value is the most important parameter of color in

Dentistry, because it is intimately related to aspest of
vitality in human teeth.
e.g.
1. Dead tooth have low value ((more gray or dark)),Vital
tooth have higher value ((more vivid and translucent)).
2. When we make a restoration and the hue ((color))
matches the adjacent dentition but its value is too high,
we always have a result of a false look ((too bright)).
Conversely, when hue matches but the value is too low,
we end up with a finished restoration that looks dead
((darker or grayer or dull)).

Factors Affecting Color Appearance

1.

Source
Different light sources have different color content
((different spectral distribution)). i.e. Daylight is
different in its color content from incandescent or
fluorescent lights.

2.

Surroundings
They modify the type of light reaching the
object. A yellow wall, by absorbing some of the
blue light emitted by the source, imparts more
yellow component to the resulting illumination.
Colors of walls, clothing and lips contribute to
the color of light incident on the teeth.

3.

Object:

a) Translucency
b) Surface Texture
c) Presence of
Scattering Centers
d) Fluorescence
e) Thickness
f) Metamerism
g) Opalescence

4. Observer:
a) Color Vision
b) Color response
c) Color Fatigue
d) Sex, Age,
Memory and
Cultural background

Creating Esthetic Restoration

through special effects

Illusion is one of the most important objectives of

esthetic dentistry. The ability to make a tooth look wider
or thinner, small or large, is an available aid when
solving difficult esthetic problems.

Esthetic effects of dental restorations are controlled by

factors such as:
1. Form
2. Size
3. Alignment
4. Contour
5. Surface Texture
6. Color of the original teeth.

Illusions in dentistry are created

using three techniques:
1.
2.
3.

Shaping and Contouring

Arrangement of teeth
Staining

1.Shaping & Contouring

The most frequent illusion is the creation of a

different outline by shaping or carving the tooth.

The basic principles of illusion

concerning shape and outline form
are:
1.
2.

3.
4.
5.

6.

Vertical lines accentuate height and deemphasize

width.
Horizontal lines accentuate width and deemphasize
height.
Shadows add depth.
Angles influence the perception of intersecting lines.
Curved lines and surfaces are softer, more pleaser
and perceived as feminine than sharp angles.
The relationship of objects help determine
appearance.

1. Vertical lines accentuate

height and deemphasize
width.

Although the lines are of

equal length, the vertical
line appears longer
because the brain spend
more time *seeing* the
vertical and interprets
longer time as longer
length (fig. E)
illusion is created by
angled directions of the
arrows.
The outward position of
the arrows in line 1-2
gives the illusion that it is
shorter in length than line
3-4 (fig. F)

2. Horizontal lines accentuate width and

deemphasize height.

Although teeth 1 & 2 are equal in size, the

accent lines make tooth 1 appear longer
while tooth 2 appear wider.

3. Shadows add depth.

Visual interpretation is relatively
simple for a linear drawing with
many edges . ( fig. A)
Form is not so easily understood in
an object with smooth curved
edges . (fig. B)
Adding light and shadow helps to
clarify form interpretation (fig. C)
Like this illusion created in this
drawing, the perception and
manipulation of light is used in
cosmetic dentistry by staining,
shaping and contouring the
dentition. ( fig. D )

The interpretation of whether this folded

paper is outward or inward can be more
accurate when shading is added (fig. G)

Placing the wider tooth in linguoversion masks

its real width by diminishing its prominence
with adjacent teeth and adding shadowing.

NB: Although the eye is more sensitive to outline

than to surface form, it is surface contour , a basic
part of good illusion, that controls light reflection.

Changing the contour of the labial

surface alters the light reflection to make
tooth longer.

2. Arrangement of teeth

Lombardis guide for altering tooth

arrangement illustrate incisal edge
modifications that affects personality, sex and
age characteristic

Alterations of the axial inclination of the labial, lingual,

mesial and distal surfaces can dramatically change
appearance.

Lombardi offers good simple advice for those taking the

first steps in altering tooth arrangement. His one, two,
three guide includes incisal modifications:
ONE refers to the central incisor, which expresses age.
TWO refers to the lateral incisor which expresses sex
characters.
THREE refers to the cuspids which denotes vigor.

This guide shows how to use the negative or dark space

behind the teeth. Alteration of incisor edges helps to
create a nearly limitless variety of illusions.

3. Staining
Staining

is the final opportunity to enhance

the original shade to correct or improve
restorations.
Staining may be used not only to duplicate
the natural variations in a tooth color, but
also to create and enhance illusions
through manipulation of shape and surface
characteristics.

There are two basic aspects of color that you

can use to create and enhance illusion:
1.

Increasing the value of the color

(increasing the whiteness or
translucency) will make the area to which
it is applied appear closer.

2.

Decreasing the value of the color

(increasing grayness) will make the area
to which it is applied appear less
prominent and further away.

Techniques for
solving some
problems

Illusion in Length

For the too long tooth, increase the vertical

contact area (from a to b), keep the
embrasures as narrow as possible , and
linguallly incline the cervical and incisal onefifth areas.

A lateral view
demonstrating the
lingual inclination
of the cervical and
incisal one-fifth
areas which
decrease the
appearance of
length.

The gingival recession evident in this patient was

not masked with the placement of the restorations
, staining and contouring should have been
considered

The faulty and unsightly restorations were

treated and the recessed gingival area was
contoured and stained to make the tooth
appear a more esthetic length.

a. if there are two

adjacent teeth need
to be shorter , reduce
the incisal edge to
converge gingivally at
the proximal common
contact.
b. the length of the
tooth will appear to
decrease by the
notching of the center
of the incisal edge

An illusion of length can be created by

gently sloping the mesial and distal
haves of the incisal edge toward the
gingiva from the midline to the contact
area

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

NB: Although he eye is more sensitive to outline than

to surface form, it is surface contour , a basic part of
good illusion, that controls light reflection.

Changing the contour of the labial

surface alters the light reflection to make
tooth longer.

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)

Illusion in Width

 shaping:
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.

Gentle curving of the misioincisal and

distoincisal edges, as well as a slight
inde ntation at the midincisa edge, alters
visual perception.

A more pronounced curve carved into the

cemento-enamel junction which is a more
incisal or occlusal position is another
technique used to make the tooth appear
thinner.

Horizontal grooves were carved into

the right central to give it a wider
appearance.

 The narrow right central

incisor needs to appear
wide as the left central
incisor.
The line angle X is
extended labially &
incisally , making the
right central appear
wider.

If necessary , the distoincisal angle of the wide

incisor can be reshaped
, making it appear
slightly narrower.

Shallow developmental grooves which break

up the smooth labial reflecting surfaces make
the tooth appear less wide.

A. Too wide cuspid

B. The buccal ridge is carved to the mesial to decrease
the excess width in the cuspid .

The cusp tip should then be moved mesially.

Contact areas should be moved lingually and

cervically.

The loss of the interdental tissue has resulted

in a dark unattractive space between the two
central incisors

Conservative resin composite bonding the lingual,

mesial and labial surfaces of both central incisors
hides the space while not over building the teeth.

This 31 year old patient had an

extreme case of Bruxism
resulting in an old looking smile.

A more youthful look was attained with

cosmetic contouring mainly of reopening the
incisal embrasures and shortening the lateral
incisors.

The replacement of discolored anterior restoration with

resin composite compromise one of the largest
percentages of esthetic restorative dentistry.

The objectives of replacement is to obtain

invisible margins and blending of color to
match existing tooth structure.