Esthetics, Light and Colour in Dentistry

Esthetics, Light & Colour
with its significance in Prosthodontics

Dr. Deepa M.K.
Principles of Esthetics
• Esthetics is the theory of
experience based
judgement by which an
optical stimulus is not
simply perceived as an
object of consciousness,
but evaluated as
pleasant and unpleasant,
beautiful or ugly.
Esthetics vs Cosmetic Dentistry
• Esthetic dentistry is the art
and science of dentistry applied
to create or enhance beauty of
an individual within functional
and physiological limits
• Cosmetic dentistry is
application of principles of
esthetics and certain illusionary
principles performed to signify or
enhance beauty of an individual
to suit the role he has to play in
his day to day
Esthetics, Light and Colour
• Objects cannot be
distinguished without light
and their form cannot be
appreciated without
shadow.
• Colour helps us differentiate
between two similar looking
objects
• And esthetics categorises
the appearance of the
object
Smile Designing
Complete oral hard and soft
tissue are studied and evaluated
and certain change are brought
about which will have positive
influence on the overall
esthetics of the face.
Good smile design should

naturally and effortlessly blend
with the rest of the face
Artistic Creativity
Esthetic dentistry imposes
severe demands on the
artistic abilities of the dentist
and technician and the
knowledge of the underlying
scientific principles of colour
is essential
Role of Dental Prostheses
Three tasks of dental prostheses according to Wild are
restoration of
• Mastication
• Phonetics
• AESTHETICS
Dentofacial Esthetics
• Main frame of reference is
the face. Features within
this frame can further be
analysed by means of inner
frame which constitute the
nose, eyes lips, forehead
chin etc
• Relating face to innermost
frames consisting of teeth
and gums help evaluation of
dentofacial esthetics
Physical Attributes of the Elements of the
Dentofacial Composition
• Contrast
• Unity and oneness
• Cohesive and Segregative forces
• Symmetry
• Proportion
• Dominance
• Balance
Contrast
It makes the various
elements of the
composition visible.
Contrast can be among
colour, lines, patterns and
texture
Unity and oneness
It gives different parts of the
composition the effect of a
whole. It can be static
(inanimate) or dynamic
(living)
Cohesive and segregative
forces
Elements that unify exhibit
cohesive force and that
which breaks the monotony
exhibit segregative forces
Symmetry
Regularity of arrangement of form. It can be analysed horizontally or
radially
Proportion
• Mathematical
representation of beauty
• Establish relationship
between various units
Golden Proportion
Golden proportion
exists between
maxillary central and
mandibular central
incisor and also in
progression of the
maxillary teeth antero-
posteriorly
Dominance
Strong centralized structure is surrounded by well demarcated,
characterized structure. Colour, shape and size control dominance
Balance
Establish equilibrium among
elements on either side of the
midline. Elements far away from
midline is just as important
Visual Tension
Tension created by imbalance.
Closer to the fulcrum, more is the
visual tension
Factors of Esthetic Dento-Facial
Composition and their Clinical Significance
• Esthetic orientation of the dental composition with the entire
facial composition can be achieved by taking into
consideration
• References – Horizontal, Vertical, Axial, Sagittal
• Smile elements
• Proportions
• Symmetry
Reference
They are guidelines to demarcate the various facial zones
Provides a sense or orientation
Smile window- exposed oral structures in smile
Anatomical, functional and phonetic elements help in such
orientation
Reference
• Horizontal reference
• Interpupillary line
• Ophraic
• Commisural line
Reference
• Vertical refence
• Facial midline
• Axial inclination- the direction of
anterior teeth in relation to the
central midline
• Becomes more pronounced from
central incisor to canine
Reference
• Sagittal reference
Soft tissue analysis at standardized
position to help study the profile of
the individual
Lip protrusion, prominence of chin,
recession or prominence of nose and
its degree
Reference
• E-Line (Esthetic Line)
Imaginary line connecting the
tip of the nose to the most
prominent part of the chin on
the profile.
Upper lip is 1-2mm behind and
Lower lip is 2-3mm behind the
E-line
Smile Elements
Main goal is to achieve pleasing
composition in smile
• Passive
• Active (moderate)
• Laugh
Smile Elements
• Lip and lip lines- length, curvature and
shape of lips, influence on tooth exposure
• Ideal location of upper lip height relative
to central incisor is at the gingival margin
or 1mm above it
• Smile line is an imaginary line passing
through the incisal edge of the upper
anterior teeth
• Negative space
• Progressive abating in dental
composition -Depth
Proportion
The position of the tooth in the arch, the
relationship between the width, length and
the face of the tooth numerically established
in relation with certain anatomic landmark.
Golden proportion- central incisor is 62%

wider than lateral incisor and lateral incisor is
62% wider than visible portion of the canine
Symmetry
Identical recurring ratios with
reference to size, shape and
position exist on either side of a
dividing line
Art of Illusion
• Illusion is a figment of
imagination where a perception
of an object is created
• Fundamentals and principles to
create illusion and their
application
• Cosmetic contouring as a
treatment modality
The Principles of Form
• Perception • Illusion
• Cultural bias
• Horizontal lines create
• Masculine illusion of width and vertical
feminine lines create illusion of length
• Golden proportion
• Artistic bias
Controlling Illusion
• The Law of Face
• Canines and Law of Face
• Principle of Line
• Age
• Gender
Law of the face
Transitional line angles of the face of the tooth. Help create shadows
which delineate the boundaries of the tooth
Law of the face
• Altering perception of maxillary incisor without reducing the
form
• Altering perception of tooth by making changes in adjacent
tooth/teeth
Canines and the law of face
• Only a potion of the tooth is visible from the frontal view
• Importance of mid labial ridge
Principle of line
• Horizontal lines- cervical staining, texturing, white hypoplastic

line, long/straight incisal edge
• Vertical lines – accentuated developmental grooves,
hypoplastic lines, vertical texturing, accentuated height
Age
• Older teeth are smoother, darker • Younger teeth are more
higher saturation/chroma, textured, lighter/higher value,
shorter incisally, longer lower chroma, gingival margin at
gingivally, wider embrasures and cemento-enamel junction, more
are more characterized incisal embrasure and smaller
gingival embrasure. Less
characterization
Gender
• Feminine teeth are more • Masculine teeth are more

rounded, both on incisal edge angular and rugged. Chroma is
and at the transitional line usually greater and body colour
angles. Incisal embrasures are extends to incisal edge, incisal
more pronounced, incisal edges edges are more squared.
are more translucent and white Charecterization is stronger
hypoplastic striations can be
given to give illusion of delicacy.
Gender
Controlling apparent tooth size when adding proximal dimension. A, Teeth
before treatment. B, By maintaining original positions of the facial line angles
(see areas of light reflection), increased widths of teeth after composite
augmentations are less noticeable
Esthetic Diagnosis and Treatment Planning
• Observe the violation of principle of esthetics

• Identify cause for visual tension
• Prepare problem list-deficiencies in dentofacial complex
• Smile analysis
• Prioritize the problem to decrease visual tension (all problem may not
need correction)
• Other elements treated as secondaries
• Make a comprehensive list of problems to be addressed and the possible
solutions for each (alteration of healthy natural teeth included-justify)
Esthetic Diagnosis and Treatment Planning
• Compromise between function and esthetics

• Patient’s expectation and his understanding of the outcome
• Treatment planning sequence – phase wise distribution depending on
healing, patient convenience, interdisciplinary treatment modalities
• Initial phase- basic periodontal, pulpal and TMJ problems addressed.
• Mock up – reference, better planning, cosmetic preview with
composites
Total Smile Analysis
Cumulative interference analysis
• Interpreting and integrating various analysis like
• Space Analysis
• Profile Analysis
• Computer Analysis
Space Analysis
• Gauge the amount of

space available at
treatment planning
phase
• With of the teeth and
the available dental arch
space
Profile Analysis
• Identify underlying skeletal dental and soft tissue defects

Computer Analysis
Intra oral camera with digital

support
Radio-visuograph
Multiple magnification at
various angles
Facial and profile analysis
Explaining treatment modalities

and visualising the anticipated
end result becomes easy
Esthetics and PFM Crowns
• Tooth reduction- adequate to place
opaquer and not make tooth look bulky
• Finish lines
• Full shoulder- ideal is with bevel90-120
degrees, 45 degree facial bevel,
proximally and lingually 80 degrees
• Pontic design
• Modified ridge lap
• Selection of tooth form
Esthetics and Porcelain Crowns
• Light absorption and refraction
• Unorganised, random crystalline
form of fledspathic porcelain
refracts approximately 25% of
incident light
• Cast glass (Dicor) and pressed
glass (empress) refract as much as
75% of entering light as it has
more organised crystalline
structure making refractive index
similar to enamel.
• Placement of gingival margin and
marginal fit of the restoration
• Luting cement also affects the
colour of the final prosthesis
Partial Coverage restorations
• Shade selection
• Shape
• Texture
• Characterization and
polychromaticity of
porcelain laminate veneers
(gingival, body and incisal
shading)
Resin Bonded Cast Restoration
• A very translucent composite
resin allows the darkened
etched metal to cause graying
or dark shadowing in the incisal
area of the anterior teeth
• Commonly used bis-GMA
composite resins now contain
opaquers to mask the colour
change
• Use translucent resin in
interproximal areas
• Simulated bonding
Acrylic and Resin Provisionals
• Use surface colourants
on acrylic restorations
• Taub minute stain kit

• Lang jet adjuster kit
• Prevent staining
Acrylic Removable
• Evaluate the existing
denture esthetics
• Tooth selection
• Shade selection
• Mould selection
• Limitation of denture
esthetics-long flaccid upper
lip
Esthetics and Implants
• Stage 1- Implant placement

• submerged-immediate
replacement
• Stage 2- implant exposed,
soft tissue healing and
fabrication of prosthesis
• Placement of healing
abutment and temporary
crowns
Esthetic management in transitional phase
Stage 1
Immediate prosthesis with adequate relief advantageous-surgical
compression stent-stabilize flap and control bleeding
Stage 2
Provisional fixed bridgework
After Stage 2
Determination of abutment size and type finalised
Tissue recontouring, evaluation od VD , tissue maturation done
Esthetic management in transitional phase
• Soft tissue management

• Healthy attached gingiva necessary to maintain the level of
marginal tissue around the final restoration
• Gingival grafting for tissue augmentation
• Provide vestibular extension
• Creating papilla surgically
• In severely resorbed ridge, emergence angle of the implant
will be compromised. hybrid type restoration is warranted
replacing teeth and lost alveolus to restore lip support,
esthetics and speech management
• Soft tissue emergence profile
• Soft tissue reacts best to smooth contours. Depends on
dimension of the supporting implant. Diameter similar to
tooth being replaced
Introduction to Colour and light
Colour is a psychophysical sensation that results when the
human visual system responds to the light reflected from the
objects on the scene.
Light
• Electromagnetic radiation
that can be detected by the
human eye
• 400nm(violet) to
700nm(dark red)
• Sir Isaac Newton
discovered the spectrum of
light
• Colour as perceived is result
of absorption or reflection
of light
Esthetics and Light
• Dentist manipulate light, colour,
illusion, shape and form to create
esthetic outcome
• Objects cannot be distinguished
without light
• Natural light is multidirectional and
hence promotes a feeling of depth
• Dental restorations can mimic the
shadows of adjacent teeth to create
a shape that blends with
surrounding tooth form (Shadow
manipulation)
Eye
• Rods and cones – photoreceptors in the retina
• Energy is converted through photochemical reaction into nerve
impulse
• Rods interpret brightness difference and value
• Cones interpret hue and chroma
Puce
puce- a dark red that is
• yellower and less strong than cranberry,

• paler and slightly yellower than average
garnet,
• bluer, less strong and slightly lighter than
pomegranate and
• bluer and paler than average wine
Munsell Colour Code
Alfred Henry Munsell created a colour system where colour is
divided into three parameters –hue, chroma and value.
Hue
Hue is the name of the
colour. In younger
permanent dentition, hue
tends to be similar
throughout the mouth.
With aging, variation in
hue often occurs because
of intrinsic and extrinsic
staining from restorative
materials, food, smoking
etc.
Primary Hues Secondary Hues Tertiary Colours
• Red yellow blue form • Mixture of any two • Red-orange,
the basis of dental primary hues form yellow orange,
colour system secondary hue yellow green, blue
green, blue violet
• Violet, green and and red violet
orange
Complementary Hues
• Colours directly opposite each
other on the colour wheel
• When primary hue is mixed
with complementary secondary
hue, the resultant colour is
gray. This is the most important
relationship in dental colour
manipulation
• Intensification- placing
complementary hues next to
each other so that they
intensify one another and
appear to have higher chroma
Hue Sensitivity
• After 5 seconds of staring at the shade guide, the eye becomes
biased
• Stare at a blue surface after 5 seconds to get back to orange-
yellow spectrum which is most prominent in colour matching
Chroma
Chroma is saturation or intensity of hue. For example, to increase

the chroma of a porcelain restoration, more of that hue is added.
• It varies radially
• Chroma is the quality of hue that is most prone to decrease by
bleaching.
• In general, chroma of teeth increases with age
Value
Value is the relative lightness or darkness of colour.
• A light tooth has a high value and a dark tooth has
a low value.
• It is the quality of brightness on a gray scale (light
and bright, dark and dim)
• Value is most important factor in shade matching.
If the value blends, small variation in hue or
chroma will not be noticeable.
Factors Affecting Colour of an Object
Metamerism
Metamerism is the phenomenon that can cause two colour
samples to appear as the same hue under one light source and
as unmatched hues under different light source.
Metamerism
Three Light Source
• Metamerism can complicate colour matching of restorations.
Hence it is best to use three light sources for colour matching.
The three sources available in a dental operatory are
• Outside daylight through a window
• Incandescent light from dental operatory lamp
• Cool white fluorescent lighting from overhead fixtures
Opacity
• An opaque material does not permit any light to pass through
• PFM Crowns have a opaquer applied over the metal to prevent
the metal from shining through the restoration
Translucency
• Translucent material allow some light to pass through. It
provides realism to an artificial dental restoration
Depth
• Depth is spatial concept of colour blending combining the
concept of opacity and translucency
Fluorescence
• Natural tooth structure
absorbs light at wavelength
too short to be visible to
human eye (near ultraviolet
radiation -300-400nm)
• The energy the tooth absorbs
is converted to light in long
wavelength in which case the
tooth becomes light source.
• This phenomenon is called
fluorescence
Gloss
• An optical property
associated with a
smooth surface that
produces a lustrous
surface appearance
thus reduces the
effect of colour
difference
• Tints – intense colours used to impart character
• Shades – colours with quantum of black added to a base
colour
• Saturation – intensity of the colour
Colour and Appearance
• Teeth are small, curved, translucent,
opalescent and fluorescent and have
colour transition throughout the
surface and cross section.
• According to Bergen, “Colour is
unimportant to the physiological
success of dental restoration, yet it
could be the controlling factor in overall
acceptance by the patient.”
Colour Matching Conditions
The light source and

environment influence the
quality and intensity of the light
reaching the place where
matching of colour and
appearance occurs. Although
daylight was initially thought to
be the ideal light source for
colour matching, its use is not
recommended given its
inconstant colour
characteristics.
Light Source
A light source at dental office should be diffuse and comfortable
to the eyes allowing observers to perceive colour accurately and
comfortably. The light source at dental operatory should be
compatible with or similar to the light source in dental
laboratory.
Quality of Light Source
The qualitative descriptor of the light source, such as correlated
colour temperature (CCT), colour-rendering index (CRI) and SPD
must be considered for the objective of improving visual colour
matching
Colour Matching Environment
• Recommendation
• The colours of the dental • It is recommended that the
operatory, clothing of the walls, staff and patient
dentist and dental assistants, clothing and the colour
the patient’s clothing and the matching environment have
dental drape may influence a Munsell chroma value of 4
perceived colour of the or less which corresponds to
pastel or neutral gray tones.
patient’s teeth and shade guide.
• Ceiling should have a Munsell
value of 9.
• All other major reflective
surface should have a
Munsell value of 7 and
chroma no more than 4.
Colour Matching Procedure
• Preliminary procedures
• Dentist position
• Tab placement
• Time and length pause
• Three step shade matching method
• Tab modification
• Matching of other appearance attributes
Preliminary procedures
• Remove all distractions- lipstick, glasses, jewellery
• Teeth to be matched should be clean
• Matching done at the beginning of appointment
• No rubber dam
Dentist position
• Tooth viewed along normal axis under different light at
multiple angles.
• Patient’s profession and ambient light in which he spends
most time
• Dentist’s eye should be in level with patient’s tooth with
viewing distance of 25-33cm.
Tab placement
• Rearrange shade tabs from lightest to darkest and divide them
into groups
• Parallel to the tooth with same relative edge position and if
possible in the same plane as tooth being treated
Time and length pause
• Trials ro be limited to 5 seconds to prevent eye fatigue.
• Relax eye by viewing neutral or gray cards between two shade
matching trials- increase sensitivity to yello
Three step shade matching method
• proper tab arrangement (both as a whole and within group) is
necessary
• the number of potentially adequate tabs be reduced to
between 2 and 4 as quickly as possible by choosing tabs from
same or different groups
Tab modification
• The colour of the tabs can be extrinsically modified to achieve
a better match
• Some authors recommend grinding off the cervical part of
shade tabs because they are more chromatic and could have
negative influence on shade matching quality
Matching of other appearance attributes
• Surface roughness and gloss of the tooth and the tabs should be
compared
• If the surfaces of tab and tooth are dissimilar, both should be
wetted with water to eliminate this difference
• Visualize translucency, surface roughness, gloss and local colour
characteristics
• It is best to compare tooth and shade tab in both relatively wet and
dry conditions
Instruments for Colour Matching in
Dentistry
• Colorimeters
• Spectrophotometers
• Digital Imaging and
Shade Analysis
• Hybrid Systems
a)Vita EasyShade b)Shade Eye NCC c)Shade Scan

d)ShadeRight Dental Vision System e)Spectroshade
Dentistry
Colorimeters
Chromascan
• the first instrument designed in 1980s. met with minimal
success because of difficult user interface and somewhat
limited accuracy
ShadeEye NCC Chroma Meter
• second generation of modern dental tristimulus colorimeter
Dentistry
Spectrophotometers
Vita Easyshade
consists of a handpiece and a base unit which are connected by
a monocoil fiberoptic cable assembly
Dentistry
Digital Imaging and Shade Analysis
ShadeScan
digital colour image technology with colorimetric analysis
The multiple colour calibration ensures that the colour reproduction is
consistent over time. The illuminance level is high enough to overwhelm
any stray ambient light and hence can be used under any lighting
condition.
Shadevision
combines digital colour image technology with colorimetric filtering
technology
Dentistry
Hybrid Systems
SpectroShade
• combines digital imaging with spectrophotometric analysis
• the most flexible in application when compared to all instruments.
ClearMatch
• hardware independent system that can be used on any Windows
personal computer and hence is relatively inexpensive
Colour Formulation in Dentistry
Kulbelka Munk Theory
• used in dentistry to achieve good
colour matching and prediction
among natural teeth and variety of
esthetic dental materials.
• applied to various dental materials
for calculation of the scattering and
absorbing coefficients and to
predict the stratiform layered
colour defined as turbid media
Shade Selection
Shade Guide
• Tooth colour standards, colour standards
for oral soft tissue and colour standards for
facial prostheses are commonly known as-
dental, gingival, and facial shade guides
respectively
• Shade guide of all dental restorative
material are based on long established
porcelain shade guides
• A value based shade guide is more
accurate since our eyes are more sensitive
to changes in brightness/darkness and
chroma than to the subtle changes in hue.
Communication of Colour and Appearance
Verbal and Written Instructions
• Because natural teeth are
polychromatic, having
multiplicity of anatomic
characterization, a valuable tool
for communicating colour and
appearance to the dental
laboratory is a detailed diagram
or chart of the tooth
Shade Selection
The range of colour in human teeth has

Y
been measured with a spectrophotometer
by Dr. Robert C. Sproull and others.
Range
Hue- 7.5YR to 2.7Y
Value- 5.8-8.5
Chroma- 1.5-5.6
No shade guide available covers the entire

range
All present data is based on extracted
teeth
Shade Selection
• Custom made or Modified Shade
Tabs
• . After choosing the basic shade, the
upper glaze can be removed and the
shade tab is modified with extrinsic
stains
• different levels in gloss, surface
texture and translucency can be
communicated with the use of custom
made guides
Shade Selection
Traditional Film Photography
• photograph of natural tooth taken
together with the tab
• view taken perpendicular to the tooth
• A second photograph can be taken from 15
to 20 degree angle to the tooth reflecting
the light away from camera
• dental camera-equipped with high
resolution (100-120 mm range) macro lens,
providing a minimum range of
magnification from 1:10 to 1:1 views
Shade Selection
Slide Films
• spectral sensitivity of the film and spectral distribution of the
light source
• two types of slide films, K-14 and E-6
Shade Selection
Digital Images
• an instant image which can be

shared instantly with the laboratory
• other aspects must be considered in
digital imaging in order to obtain
accurate colour
• spectral sensitivities of the sensor,
imaging geometry, illumination
aspects light uniformity, flare
reduction etc.
CONCLUSION
The art of colour will rely on individual observation and

interpretation, and it must be expressed through the intelligent
use of scientifically sound principles. The science of colour must
underlie the art, yet the ability to employ art makes the science
useful. Separately art and science cannot produce the product
required. Together they make dentistry not only more
productive but eminently more satisfying.
REFERENCE
• Phillips’ Science of Dental Material – Kenneth Anusavice
• Fundamentals of Esthetics- Claude R. Rufenacht
• Esthetics and Prosthetics- Jens Fischer
• Colour Science And Dental Art – Jack D. Preston, Stephen F. Bergen
• Esthetic Colour Training in Dentistry – Rade D. Paravina, John M. Powers
• Esthetic Dentistry – Aschheim, Dale
• Esthetic Dentistry- Ratnadeep Patil
• Colour in Esthetics – Bergen SF
• Current Status of Shade Selection and Colour Matching – Preston JD

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Esthetics, Light & Colour

with its significance in Prosthodontics

Good smile design should

Golden proportion- central incisor is 62%

• Horizontal lines- cervical staining, texturing, white hypoplastic

• Feminine teeth are more • Masculine teeth are more

• Observe the violation of principle of esthetics

• Compromise between function and esthetics

• Gauge the amount of

• Identify underlying skeletal dental and soft tissue defects

Intra oral camera with digital

Explaining treatment modalities

• Taub minute stain kit

• Stage 1- Implant placement

• Soft tissue management

• yellower and less strong than cranberry,

Chroma is saturation or intensity of hue. For example, to increase

The light source and

a)Vita EasyShade b)Shade Eye NCC c)Shade Scan

The range of colour in human teeth has

No shade guide available covers the entire

• an instant image which can be

The art of colour will rely on individual observation and

• Phillips’ Science of Dental Material – Kenneth Anusavice

• Fundamentals of Esthetics- Claude R. Rufenacht

• Esthetics and Prosthetics- Jens Fischer

• Colour Science And Dental Art – Jack D. Preston, Stephen F. Bergen

• Esthetic Colour Training in Dentistry – Rade D. Paravina, John M. Powers

• Esthetic Dentistry – Aschheim, Dale

• Esthetic Dentistry- Ratnadeep Patil

• Colour in Esthetics – Bergen SF

• Current Status of Shade Selection and Colour Matching – Preston JD

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