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Smile Designing

Nov 13 | 12:30 PM

Smile a lot, it costs nothing, as the adage goes. It is not new to place a high value on a pleasant smile. The smile designing technique comprises of a combination of procedures to improve the appearance. However, as doctors, our ultimate goal is to achieve an attractive smile composition. Learn more about the principles and techniques of smile design by joining us with Dr. Pradeep Shetty.

[Music] good evening everyone i am dr samadhiya and i welcome you all on behalf of team netflix today we have with us dr pradeep shetty former professor dr d by patel dental college pune is also the assistant detective for journal of association of dental research and scientific development he is the director and mentor of center for advanced dentistry pune he has conducted webinar on topic broken tooth spoken and unspoken truth at the world dental association he is also present at papers and national conferences his published papers as author and co-author at national and international conferences welcome sir thank you so much over to you sir thank you so much good afternoon to everyone so i'm dr pradeep shetty i'm uh i'm going to speak about smile stories few cases or a case reports which has happened in my clinic and uh we will discuss about a simple case to a complex case like how many smile designing can be many different aspects like there are so many what happens you know smile designing when we talk about smile designing there are certain specific formula specific principles there are venues and all these things so what we will today this because you must have heard a lot of principles in the sense a classic principle today we will discuss about some principles which is little away from the classic principles which we i have uh done with it with my clinical practice and i have done with my experience okay so we'll discuss all such cases this same i have done this presentation one of uh com conferences or online conferences during which is hosted by cs uh csms is calling and this this same the cases which i have shown to many people in my students or my patients everywhere so this is all the cases which is little different from the uh the normal one so there uh though we will have a nice discussion we will discuss uh in in detail okay so when we talk about the easter tech there is a peter dawson his he is the one who has given definitions for aesthetic makeover he has said that the goal of aesthetic makeover is to develop a peaceful and a stable masticatory system where the teeth tissues muscles skeletal structures and joints all function in harmony see this where is the important aspect in here the teeth tissues muscles skeletal structures and joints all function in harmony means aesthetic is only you should not think only as a aesthetically beautiful we always aesthetic and function wise they should coordinate together if you have if you give a beautiful smile the patient cannot buy properly or a patient is going to develop skeletal muscular problems or any other other joint problems or he he or she cannot chew that is of no use so the the whatever the aesthetic maker you are doing it it has to be in harmony with the function that is very very important you always keep occlusion in keep in your mind whenever you discuss whenever you start with the smile designing so when we talk about the smile designing there are two things that is one is facial composition other one is deadly composition as a facial composition wise as a dentist we don't go much detail into it facial composition is a part of it because sometimes until analysis you are into a plastic surgery or you are a online master facial surgeon orthopedic surgeon ortho orthodontic orthodontist holders or orthognathic surgeries okay until an analysis we don't usually we don't touch to the facial composition we limit ourselves to a dental composition but if at all dental composition for improvement of the dental corporation requires if at all if it requires a facial changing facial composition sharing that you have to do it so in our facial composition there are two things uh one is horizontal dimension and a vertical dimension what do you mean by horizontal dimension say this uh horizontal i mentioned this is always said that the width of the face is should be width of five eyes from one eye from this to this one eye to other eye like if you take an eye at the width of i it has to be five eyes that that considered to be the ideal this is that in picture so it has there are five the eyes has been the horizontal dimensions into okay and vertical dimensions is like the face is equally divided into three equal three parts so upper portion the eyebrow line from the uh from eyebrow line to the base of the nose from the base of the nose to the base of the chin okay head so this is the three and the lower part is again divided into the third one that is from the base of the nose to the chin is divided into two parts that upper lip as one third and a upper lip to the uh chin is two-third so this is how the facial composition is is uh divided so as i said uh the the facial composition we should understand see majorly for to do the truth like you must have we must have heard as a dentist we know that uh for uh in uh complete denture cases and all you must have got the square face all these things so accordingly teeth are arranged or if it is a square phase the two has to be a little overwhelming in nature then it looks nice so it should not mismatch that is the reason the data but sometimes what happens if a face is itself is asymmetrical then how much your smile you have good only that's when you take an entire picture of a person that that doesn't look perfect sometimes so that will be a symmetrical but when you are if you especially if you are in a fashion industry or you are going for any uh any modeling contest or anything else so where you have to this facial composition and a dental composition should uh come hand to hand or it should be in a harmony then it looks the person looks good so the the if you see any beautiful model or anybody who is very uh like who has won many because it is a rule that whenever you go for any fashion composition there are many times a dentist also involved in it so the cosmetic dentist who evaluates the smile evaluates the smile into a facial composition if it is any changes small changes minor changes can be corrected okay that is what in a dental composition what exactly we have to do dental midline it is everyone knows that as a dentist we should know that even if you are in a cluster itself for a second itself you learn that mental midline should coincide with the facial midline so it has to if it is a midline shift a little midline shift also looks drastic okay and the incisor length we all know that the the lower incisor should be upper incisors there is a central inside it should be in a lower level laterally slightly higher and a canine is like when you do the teeth setting you must have heard that you have seen so central a later little up canine is in the touching the glass plate and uh the the premolars buckle cusps and that it has to go like that inside the lengths two dimensions always you remember that central limit is not dominating if the lateral is dominating that that doesn't look good or a canine is nominating okay can i should be there measle partial part of a cannon should dominate not entire can i and the the the curve that's my line it has to coincide with the the lip line and very important point is zenith most of the time what happens you know we give a beautiful crowns or we give a wonderful uh lab work was done very beautifully but this zenith point where the patient has a slightly gummy smile or the the the marginal gingiva is visible that time if the zenith does not coincide coincide because central both the central zenith points should be equal okay you know what is then it is then it is the the apical extension of the uh label portion of a central algorithm or deepest portion of the gingival sulcus in the uh crop that is called as zenith okay so zenith has two coins right central should be up lately slightly down and then it should be in line with the center so i'll show you a cases where we corrected the zenith okay and axial inclination this is very important the tooth has to be inclined in a proper way international contact area and contact point this has to be perfect if it is not proper then it will be a diastema the any space in between it doesn't look nice the patient also doesn't like and especially if they we call it as a black triangle sometimes there is a space aboriginal problems all these things inside the embrasure it is because most of them some some lab works what they do is they give a crowns like absolutely squarish crops so that doesn't look nice so it has to everybody everyone as a dentist we should know that embracious has a lot of usage especially not into posters also portion is very very useful for a chewing purpose it's called also called a spillways the food will pass through that in anteriors it gives a beauty or it looks nice and gives a curved smile and according to the gender of a patient the personality of the patient the age of the patient you have to decide which side type of tooth has to be given if you say old patients if it is a world patients if you give a background it doesn't look nice in cell transplants it does not look good to the old patients because we know that as an aging process as a dentine or an animal innate property of that is like it is not it is not going to be a the same similarity will not be there because in a younger patient incentive translucency should be there it gives a good look but so and this has to be done and ultimately all these things summatively the smile has to be symmetrical in the sense mesial side and a distal side should be symmetrical both should look equal and should be balanced i mean in this sense what one side if it is a central incisor is bigger other center central is not bigger uh smaller or one side lateral is too dominating other side lateral is not dominating it is imbalanced the balance smile is always a pleasant to the eyes because there is a saying uh smile is a lie it goes if your smile smile is like it is not just a tooth it is a mixture of a tooth and a gums it it has to be a very good smell it is it has to be a has a balance between the gums and the smell okay it is not that just a tooth if it is just white white looks it doesn't look like suppose i will give you example of she has a beautiful smile because what when she's much more substitute incisal uh a little portion of the for a slightly minimal amount of the uh marginal gj is visible when the when smile is of extensive smile big smile this all looks looks good so this is how we are we are trying our level best to do a good smile by by compensating with the gums and the keeping of symmetry and a balance between the tooth and the gums we always know that when a patient comes to you okay so suppose a patient comes to you for any uh smile makeover so as a rule we always we speak to the patient we speak to the patient what their what their expectations okay what how their smile how bad they are because initially the dentist dentistry is like it is not it's evolved a lot now initially it was like just a drilling and filling and building and sometimes it was just extraction dentistry now dentistry has been changed and people are coming they are not patients as such they are coming as a customers or consumers like they are coming with the various problems like we don't like our smile are we not confident in their smile if they are not confident with them they are not patients they are they are the one who is like who are consumers or customers for our accidental practice so aesthetic dentistry is is is a part and parcel of especially metals and it is not only a mattress in everywhere you can see the people are very sometimes they are not confident about their smile okay and they are very aware of what hot smile what is maybe thanks to a media thanks to our social media and all these things so so when a patient comes to you talk to the patient and listen carefully what their expectation and you same that you assist so you can see that how when they smile how much these are visible when they uh they when they do a big smile what exactly is happening or when they do when they laugh what how the teeth are so you observe so first few minutes to take observing what their what their expectations how their smile is at present okay then you that is called as so you see the facial aesthetic see lips how there's the moving the soft tissue the chin and everything during the smiling speech and then comes you can slightly close from the face to the gums okay now you start observing when you start seeing them without a mouth mirror or something just see the gj will help shape of the internet laptop from a broader aspect from the face to you're coming to a little a confined area that is called gums you see the gingerbread aesthetics uh any black triangles represent so then you come to a little more closer you start looking about the macro aesthetics in the sense mid line how the midline is how the shape size and shape of the teeth are how the tooth looks okay how the teeth are bigger or smaller how that the how they align all these things you see then finally you come to microaesthetics in the sense you start thinking about the how anatomy how the lobes are made how that the the lines which is seen and translucency is there or not any characterization is there on so you coming to you are coming to a micro you are seeing very very carefully in each truth this is how you have to come to a conclusion from facial to changeable to macro to micro so now we will uh this is how the principles comes okay this is how the case identification or a case uh the the cases are whatever you are understanding the cases or you are started thinking that you are coming to a conclusion okay so first thing is like we have we tried today we'll try to now see down to 6 20. so we'll try to discuss around 10 episodes or a 10 case different different case scenario okay so first one is simple cases like a patient comes to you with the anteriority structure la's class on a classroom fracture which is enough involving the enamel and drinking without involving the pulp tissue okay so whenever the patient comes to a class one class too we always think of doing the composite restrictions okay so composite restorations are are simple actually most of the time what happens you know we sometimes thanks to a dentistry or sometimes thanks to our teaching system uh what happens we are not because we study here that composites since second videos sometimes but the practice was in a dental colleges as i am i had a teaching experience of 18 years i was teaching in a dental college so i it is my i also noticed that so we start learning composites in a second but never learnt in an extensive way it's just you know in internship level every colleges it is all over india it is like that in internship level you start working on a composite you start doing your patients on composite and ultimately what we do is we just typically the composite will just start the composite to the truth we don't understand the principles we even though entire our practice is based on composite restorative industry is now based on composites amalgam is almost outdated okay so ah so but still we don't we struggle we because it's a qualities also we can't help it there are so many students and the materials are shortage and sometimes you don't get the enough shades all these things happens in the deadly colleges but ultimately you start doing a compromising and you start doing the shortcuts so when you come to your private practice in your practice you start understanding ah no that shade is not matching there is a there is a big problem in the anteriorities that is you do a good restoration everything is fine fine but you see when your spine you you yourself can see the demarcation line you can make all patients says no doctor it is slightly line is seen you can make out there is what is the restoration and the door this is a very very clear cut many times demarcation line is very very very reasonable and the major problem what happens you know the the angles measure inside a lot of disturbances the angle it goes like it becomes like a like a potato or a it will go like this it doesn't uh match with the tooth many attacks so we all know that uh and whenever there is a demarcation line the major reason for a demarcation line to occur is the uh you are not giving enough bevel okay if you don't give a enough bevel so what happens there is you can make out which is the composite restriction which is the tooth okay there is a line comes so bevel is very very very important when there are two things one is there are two bevels we have to give primary bevel and a second ribbon i'll just show you so when you give a bevel the first thing is it is it merges with the tooth okay like this when you give a bevel so it it helps for uh to clear the demarcation line second thing is while when you give up bevel what happens so there is a lot of a bonding occurs because more the tooth is uh more to if you have a more tooth more surface area more surface energy more bonding okay bonding will be instead of like if you have a like this say if you bond like this only this posture only this portion so warning will be only this much if it is bonded like this okay like this so what happens the whole area is bounded like this it will it will be covering it so the the bonding area will be better and we always think the body strategy like what which bonding agent you are going to apply whether it is a fifth generation or whether it is a seventh generation or the eighth generation okay then the pulp protection is very very important because it's if it is going very near to the pulp the the even though l is class two even though it is in a dentin but if it is in a deeper layer of identity will have to give a pulp protection may be a like your jc or a the calcium oxide or an empty or a biodental the pulp production has to be given then you have to see the anatomy of it as i told you translucency lobes and everything so see this is how the bevel is some people say that the bevel should be a primary bevel in the sense so the the cutting edge the edge of the tooth suppose this is the edge okay that edge of the tooth will be little uh we can have a uh only the cut where the tooth is cut that there we give the primary value by giving a 45 degree this is the okay this is the two so suppose i'll give you an answer okay so this is the paper okay so if you are giving a bevel this is given this is the tool okay this in this so the primary bevel is given 45 degree like this you can see this 45 degree at the cut okay this here at the cut this is the the blue line you can see in a first picture there is a primary and the secondary bevel is like it is extended you know some people they just extend up to a little bit okay you can see that in the first picture they have extended like a sun burst okay and many people they do extensively secondary bevel is given at the half of the half of the there are two schools of thoughts you can go up to the half of the tooth like a roughening so initially it has to be little deeper as you go at the end of it will be a little uh shallow so that it nicely merges with the second ribbon primary bevel and the the junction at the where the tooth has exactly cut if you give a good bevel so see in this second picture you can see so there's so many so much of area for a bonding purpose so it is nice to have a bonding surface like that okay so bevel is very very important for a bonding purpose as well as for the demarcation line to remove the demarcation line so there are so many uh researchers they have said that uh that how much level should be given to mm or 2m but there are so many schools of thought how much bevel should has to be given to a member well or bigger than the value like that okay so bevel has to be uh nicely done so this is one of my case where see this is the cut tools can you see that class two uh lease class two fracture we usually don't say that uh class four fraction because class four is a carries yeah gb black zebra glove back class four it is like uh carries involving the incisor like this we usually it's a better term is like l is class one class two plus three or l is okay so it is a class to lease cluster fracture can you see that okay and here what i do is in my practice we have i have a digital uh density treatment simulation software sometimes we show the patient that if you do the uh treatment so this will be the final outcome so the patient uh will have a nice the mentally they will be prepared okay but it is up to you also you show nicely digitally but if you're not able to give back if your the the results weren't as good as original then patient will catch a lot of you you're shown like this and you did like this okay it is up to you you have to show if you've shown like that digitally you have to do it nicely with the digital as good as digital so this is the teeth okay we have given the bevel you can see that i have given a bevel till the half of the tooth so say now you cannot see a demarcation line it is nicely matched and the line is also very important that is as i told you there is a the easier measure inside the line the where the light transmits that is very important there is a key to success in the anterior illustrations where you are demarcated where you have to decide that the light where exactly it is going to get transmitted this is another case where you see that there are nicely merge you can see the light where it exactly it is transmitting and it's that it's very nicely transmitting or it is reflecting out say like see this it's reflecting out so in this case also you can see this light is nicely reflecting here okay so this is another case this is also this light is say this is another case of ellis cluster i'll zoom out and show you say this see the see this is a tooth see the where exactly the angle escape the light getting transmitted so this is the patient suppose a patient comes to you uh sometimes very worried patient whatever parent comes to you that my daughter or my son has fallen down and they have a they lost a uh tooth okay suppose or they the tooth got broken okay so then what you do they came to you uh with a broken piece of a tooth okay so then that is the what you do you they you checked it exactly it is getting matched okay so that is called as re-attachment okay what you do there are in 1964 this technique has been developed re-attached of a broken uh tooth okay natural crop that can be reattached there are so many methods of reattaching okay so that so the the reattachment that the broken piece is bonded back to the original okay so what we do is we give a v-shaped notch sometimes we give up the valve sometimes we give a uh over control okay sometimes internal groups all these things so there are the the the it is always it is better to it's ultra conservative preparation the booth matches superb the shade match will be perfect because it's a natural good same tool there's a matching and it is a protection factor some sense okay so this is how the certificate the patient came come to come to me my clinic my private practice with so i have checked it it was it was whitely the pulp was not involved okay the tooth was the broken piece okay so i have checked it whether it is perfectly matching or not it is matching perfectly what i did is i did a beverly both side the the broken portion as well as on the tooth then bonded with the bonding agent and the flowable composite and bonded nicely give a bevel like a primary bevel and a secondary bubble on the tooth as well as on the fractured portion okay so like this say this is gonna see this nicely it is merged you can see this it is nicely merged the whole area okay then we i took an x-ray to check whether how it is is there any uh deformity and you can see this after two years follow-up now it is it's been two-year follow-up in the sense it is uh it's been in 2020 19 or 20 i have now it must be a three or four year follow-up now if i come back patient comes back to me so i'll have to call the patient certainly perfectly done okay so consider that after the two years also there was not a because the slight amount of the training was there i cleared it and it was perfect okay so now you can see i feel there is another case the two cases we discussed one is a simple fracture where patient does not have a tooth to reattach and the second case patient come with a fracture but with the fracture tooth intact so we reattached okay this two two simple cases now comes a little complicated one where the teeth are there is some hyperplasia or hyper manipulation is there okay so whenever there is a hyperplasia or a hyper mineralization there will be a like there is two terms there are hyper uh hypo mineralization and hypoplasia there are two hypovaleration is a qualitative defect hypo mineralization meaning the mineral content of the tooth is less it is a qualitative with the reduced mineralization resulting in a discolored enamel in a tooth of a normal shape and a side say that that is everything is fine tooth have a good side but only thing is that some white spots are too they are they're weaker okay it cannot can undergo posture up to be breakdown but enamel hyperplasia is a quantitative enamel itself is less that so because of the enamel is not formed enough okay it is a quantity quantity of the enamel is less so that is the reason what happens there is a break or there is a grooves there is a pit okay missing enamel or a smaller t because its a quantity quantity of the enamel is less you understand this two terms hypo mineralization and hypoplasia okay so in a hyperplasia there is a pitted enamel there is a hard enough but it is enamel is hard but it is not soft okay that is reduced redundant but in the hyperventilation there is a white or yellow obviously or a softer a porous enamel it's a poor quality okay or a bonding vision because it's the quality of the animal is ready so bonding might be affected okay so what is the treatment for a mineralization for a hypoglycemia it's the hypermedulation we do a micro abrasion resin infiltration vital base bleaching if it is not happening then we will go for a composite restoration okay so in a hypo glacier or a hypoplasia cases we have to go for because it's a the the the quantity of the anomaly itself is less so we'll have to add okay quantity is less than you can't do anything just conservatively so you will have to add the quantity so to make it into a perfect shape so we'll have to do a restoration or a direct venue or a direct venue or a crop so this is how the treatment goes okay so then so this is how okay this is how the the differences are okay the pigmentation say this patient comes to me this young girl around the 16 year old 15 16 year old girl very mild she doesn't she never used to smile also like she was not happy with her especially and when she smiles the incision edges used to be used to get visible and that white patches used to be the same so she said i know i don't like my smile i am just worried about that the question is if you have done you must have done some cases of like this cases the question is very difficult to manage these cases hypoplastic cases or hyperventilation is hyperventilation what happens when you manage the cases so when you remove the so what happens you have to try to remove because to add material okay so you'll have to slightly remove the hypoplastic area that white the portion so when you remove it so the question comes is like if you apply a light color enamel or a light color composition restorations that inside becomes visible if you apply a dark color composite that the composite becomes dark shade matching is very very tough okay so she came like this so you can see that it's a prop burn hypoplastia okay white patches from canine to connect so she was smiling like this okay so i have i've used a new spectra st okay so that is a dense fly so they have a compulse ok so this is very good material they have a cloud shape in the a1 they its shades are a1b1c1 that is cloud sheet technology there is a sphere tech technology we use so i i've reduced the areas slightly abraded or roughened the surfaces where there was a only the area where the hypoplastic patches were seen then bonded and the say this okay it was nicely the upper upper answer lower has to be done okay upper is say this see the the lower picture can you say every hyperplasia is gone and you can see the the the angle which i gave in the composite restoration okay so the light reflections everything is perfect the key is like how you polish it how you do the uh how to how do you achieve a final success okay this was her smile okay after the uh the restoration and then comes fluorescence portion okay so this patient so this is fluorescence properly where the hypo mineralized hypoplastic hypo mineralization are hypoplastic okay so in this case we had thought of going for a variance so i had given iodine our linear case so upper ah six variation in direct veneers lower six values okay there are 12 indirect values and premolars also darker you can see that premolar also darker so eight i upper do upper four and lower premium four or eight i've done a direct so there are twenty veneers has been given to this patient so 12 were uh indirect and a to a direct composite venues this was the smell i'm not going to in detail with the veneer itself is a one hour topic so you can talk only about the veneers for a longer longer period of time okay then comes a spacing so this is all we usually come across the anterior teeth spacing diastemas okay so say this so a patient comes to you with the bla sometimes patient comes with the black triangle sometimes patient comes with the like this uh smile okay there is a proper uh midland dystrophy in between i am i love to treat them with ms i have treated in my clinical practice of 18 years more than 100 patients i've done diastomas okay i have a records of 100 patients more than that so the hd mass is like my areas of interest i do close rise tomorrow uh even though ortho is preferable because you all know that diastema is notorious for relapsing okay so sometimes off the cases also post also we do closes the spaces which is remained in orthodontic treatment okay so this was the patient came with this space and then space was the same patient didn't want it because if they want most of the time what happens they are in hurry all these things these all these spaces the crooked teeth all seen just before marriage or when you start searching for a groom or a bride or a then you said oh my teeth are not good my teeth are not looking good i have to go for but then it will be a quick fix so you don't have a time for one and a half two years for the parents are not ready to wait that till that time so two years braces no no no no not at all it's not possible do something very quick it has to be done within a week or so or 15 days or a month so in such cases it has to be done fast okay so diastemas can be closed it's like a simple daycare procedure it can be done within a uh one or two hour hours so ideally as a technically speaking so the the the the contact point and the rest of the bone has to be minimum 5 mm should be there so what i did is i placed a composite a little composite uncured composite and took an x-ray to see the distance between the the future contact point or the tip of the papilla to the uh crystal bone okay so it was tip of the papilla to the threshold bone it was four point five so the target at all have said that the contact point and the uh the crest of the one between that there has to be a phi m so then that the 5 mm has to be filled with the uh internet so then it will stay otherwise you you may if you are lesser than that you may implement the space or a biological width okay so that is so i have uh checked it with the mathematically so it was in the actually it was 4.5 okay so i wanted a 5. so because why i have taken an x-ray because in the cash you can't see a crystal ball in x-ray you can see a pressure point so then that is that is trans uh transported into a cache so then we have measured it at the 5 mm so it came here i am so this will be the my future contact point of closure okay then i did it with the i've just checked it with the with mock-up okay then what i did is the papilla is like compressed okay gingival re-contouring or a non-surgical drug re-controlling what i did is i placed the uh the retraction cord okay and the once it is the retraction chord which retraction is over i play attack the little bit of a cotton inside so that the jinjeva gets contoured or it becomes like a triangle otherwise what happens there is a black triangle okay when the gingiva is contoured from that contoured area i have started adding the matrix so whole gingiva becomes like a triangle otherwise what happens you should not place the composite on the papilla if you place it place on the or if you increase the papilla with the composite registration there will be popular loss this is disaster i have seen patients who lost the tooth just because of the composite was impinging the biological width or impinging the midline papilla so you should never ever place the composite on the papilla you can re-contour the papilla and and make a sulcus you can place it on the surface and make it reconfirm it so it will it'll nicely otherwise what happen if you don't re-contour or if you just place like metadata then there will be an unpleasant black triangle okay so this is see this in this the x-ray you can see this so in a second x-ray i have added the composite so this was the the first x-ray in a second x-ray i have added the composite side can you see that the triangle k so nicely composite of the the distance between the composite and the pressure of the moon is 5m see this is genius recon okay this can be done this is another patient okay same way we what we did is we did a uh because it's a premium was the culprit we did the free anactomy we did the flame activity [Music] okay so then same same procedure and never ever join two incisors i have seen so many practitioners in the in the attempt of closure of the diastema they join like they bond the incisor together should not because the almighty or bhagavan had given the teeth separately we should not join it okay that then it will be a problematic or as a paradigm will help so i say i should told you so this is how it has to be nicely placed okay see ah this this is the tooth so you should not place it on the tooth we should not place it in the gums okay so the whenever you have a closure okay uh it is very very important that the the i'll show you some cases where i have managed around the uh four five mm midland stream also by managing with the angles okay the tooth looks broader and narrower with the angles when you give a uh libya into the land okay so this is one case so this is the case uh so you can say it's a huge rise it was like uh nice the tooth also slightly tilted see i have just tried with the there is something called as a gc has a they have a reverted lc there is a temporary temporalization material so i've just tried with the temperature it's a template it is not a see i've just tried it roughly i made it on the booth and without doing any preparation it's just to check whether it can be closed or not say then the using a composite i have closed it say this this is a direct compositor it is nothing it is just the illusion it is otherwise the previous case if you see it's like this such a huge this is the post off say from pre to post the differences this entire giga is recorded okay without doing anything this patient is again uh one of a very trusted patient he came back every year he comes back to show this is all simple cases this is just say that this musical musical sites are absolutely uh like a straight line so we'll have to just have to counter it the diastema is closed very simple this mesial sides are straight if you give a contour it becomes the rationalized used all these cases this is another huge case again this is all direct venues directories direct composites this see i as i showed you somebody has joined two insider chemists two insiders that were joined and she was not happy with the smell see the smile was negative so then lower also she was had so had a diastema so i closed entire diastema so see this this is all simple this is this is one of a good case okay this is here the size and shape discrepancy most of the time diastema occurs because of the size and centralizes are bigger laterals are smaller so what happens so because of the lateral smaller central moves away from the that is the reason middle we last this and the lower instructions okay and this is a post ortho okay uh post or to the results uh midlander there is a black black triangle was seen okay because he had a uh museu dance this this gentleman had a music dance we he was not uh liking those musicians we had to extract the music once they extracted after the extraction of the visual ends what we did is we uh did the ortho close the space when you close the since there was a measure tense so a packet portion was not matching so then i did ah the the contouring and we had given inside we got a permanent retention so this is another case this is this for this case report i won the best case award on uh ies on this ip account conference and gonna one of the urges i've got a first place for this case okay this was the one okay so yes the patient came to me so she was uh one she was a girl who is again age of getting married and she was not liking this especially the central insistence the space she has her complaint is only the simple i don't like the space in between okay so this was the case so i had take a took a picture and i seen that see that huge trailer okay that the zlatan was lateral scissor was inside it was locked okay this one so her smile was like this i told her so see it's first best option is the see again it's a disclaimer or to is always the first option okay never ever these all are cosmetic areas that are cosmetic it's a secondary ortho is the first preference it should be given as a treatment of choice for the patients okay so first author it's it's a mandatory because the tooth moves physiologically truth moves uh in a natural way so it is always the the the the first preference is to be given for ortho if the patient is have a time consuming constraint a patient is not ready for ortho or a patient wants a urgency for it is happening and because of the social pressure or they are there because of this uh they are not getting married or they have less confidence all these things then comes for equipment others ortho is always a better option as we said ethically the ethical practice i do ethical practice i always give a right right advice to the patients so then what it is i told her we will have we can go but major problem is with your labial free numb which is very thick and fibrous and second is your lateral she said that no no i don't want to touch the say lateral i just have to i have to place the space has to be closed okay so then what we did we started doing that we have uh my friend so he's a consultant so he did a uh okay remove see this this is for stop it is 24 hours later uh again first off after one week and after healing one month what he did is as i said i do i did a template and show the patient so how it looks if it is done properly and that was that time what happens the whenever you close this essence lateral was looking very obvious because it's a natural uh human mentality when you see a bigger space that looks uh bad but once you start if you close that space then the latter looks very or it started looking obvious because other thing has become almost perfect so the imperfection is in a lateral i told her we'll have to do it together it looked nice so she agreed i uh succeeded to convince her so what i did is because the latter was the the you can see the zenith so see the zenith here it was here okay so what i did is we did a slightly crown length clp procedure for the latter so to match the zenit line with the centrals okay because with the other center other left we did a zenith line matched then i cut the tooth in saturday which is locked so that the locking has to be done properly it has to be removed properly then place the post and change the angle of the tooth ideally the angle change is better done with the cast post or a custom press but sometimes if it is if you are not if you are able to get the angle change with the fiber force you can do it but ideally is the cast post angle change so data cast change the task force then in this case we thought of going for a crowns because all are situated and we will have to close the smile so my lab gave a nice grounds with the ceramic because there was a huge area where it was seen uh otherwise what happens if you just give a crown there will be black triangles see the black triangle is nicely matched with the pink ceramic and this is her post okay see the tree and the post so the ceramic also we took a lot of time to match the pink ceramic with her shape shape or a shade of ginger okay this was the this is this is a one of a very good case we got a wonderful result we think another case that there was a crocodile so here the antidotes was blocked so the patient came again ortho is the first choice okay so what happens there is there are so many people there are so many schools of thought if you close with the with the angle change with the cast coast and whether it is going to happen with any biomechanical is going to be doing any there are there are two schools and people say that if you change in a proper way corrected is not going to much hamper with the long axis there are literature or literature support for this change angle change okay this patient came to come came to me see the block line accuracy so she was not at all happy that the two things were okay so in such cases it is always first is ortho second is you have to take a priority consideration periodical uh health assessment okay if it is any parallel health assessment is done it is because of the pathological migration or and change the angle okay and gave a graph with four graphs here we gave a joint ground because there was so it was actually splint okay there was a slide because of the pathological periodontal problem was there so since it is a joint clone that that otherwise what happens after some time there are chances that individual grounds again space can have come up since it acts as a splinting okay so let's see the change of the angle you can see nicely curved okay this is post off see the the the lip line see the lower incisor has come inside the lower lip inside the edge of the hole this is what the angle change see the so much of angle is changed okay and this is a tree and a post okay so the patient was of course she was very happy and we have she got many more patients also to me after that say from this to this from this to this okay this is nicely the angle has been changed and another patient again with same see the see the differences okay again change with the say the angle change okay again the total angle is changed and this is another case one of a wonderful case we took a a long long period to complete so this patient is very complex there are so many problems with this and plus the patient is perfectionist he wants like this he used to come with me pictures from the google so my see this is the teacher teeth my tooth should look like this this was a main model uh he was he's a one of our executive from a company he was supposed to uh present himself for various occasions and he has to be with limelight so he was like he did he was not very not at all happy with the smile okay he came like this see this was first thing he came like this central then says it was crooked in the sense they have incessant is not gone lateral in caesar was special plus when he bite sedus though the up lower canine was touching the upper side upper gums see it was absolutely going in between the space between the lateral and uh okay it is like this say this when you smile it was like this everything was good so i did a digitally modified image showed the patient so and we did a template about a calc template we did it and showed the patient that is this may look like this before we do anything otherwise he will outright reject the treatments okay he said i am trusting you he is my good old patient he has a lot of trust in me i'm trusting you otherwise i wouldn't have gone to anybody else since you i am coming and i'll since i what i did is i showed him first if it is it will look like this it will look better but a rough surface will be like this okay so what i did is i central scissor i did the compositions this is both both central and dresser the crookedness or the that everything is changed composite direct composition and latin will say that i have not done anything just to do the crown cutting i am not done a root canal with anything just do the cutting and change the uh change the shape for to facilitate the crowns then lower canine what i did is i had to do a root canal because it was impinging the space between the upper canine and the lateral lateral so i had to do the root canal so that to intrude okay to cut the the the can i incisal edges of the canal so i did that and this four lateral incisors both lateral this was the uh this was the case it's not a trial we have taken a trial then this is the final let me see that see the lateral see the candidate perfectly went inside say this central's both composite laterals were crowned okay and the smile okay this see the smile line that is perfectly matched say this from here to here see the occlusion i was telling you now so see the occlusion it is completely gone okay so you have a video for this i think that is 120. foreign [Music] we have done template was made using dc reverted lc udma based temporary crop material for our guidance and to show to the patients to give an idea about future outcome of the treatment middle and asthma was closed inside the edges were corrected using direct composite saturations vertical treatment was performed on both lower canines where maximum cutting [Music] here you can see the coping trials of both upper laterals and both lower canals bit was chipped and corrections required were communicated to the lab technicians and here this is the final outcome where you can see ah improves my remaining space between the lateral incisors and the canine were closed using the complete direct copper generation you can see here and all the spaces were closed and the shades were matched you can see the lower canine is uh absolutely without fusion one of the most important steps in comfortable illustrations is finishing and polishing here we achieved that quite successfully by following proper polishing protocols here you can see the patient's smile you can see a happy patient and a confident smile the smile line follows the lip line and you can see a sample inside there and a battle inside and can i also evaluated after 24 hours [Music] please [Music] [Music] [Music] [Music] fiber reinforced composite okay so what happens uh sometimes uh there is something called as frc fiber reinforced composite we call it as a the conservative bridges okay so it's all there are so many fibers are available like glass fibers e-class uh s-class or uh kevlar fibers or a carbon fibers or a uhm wp fiber fibers that is we heard of this ever stick and a reborn the commonly used is like everest cnb interleague from angelus and ribbond these three are the commonest common fibers we use for cases like this okay there is ever six cnb is one of the fibers which is very popular okay uh very popular uh its name itself cnb cnb is nothing but crown and bridge from gc company okay so what we do is so this uh visually what we do is for a suppose our tooth is missing okay a patient comes to you young patients who is of uh 18 year old or a 20 year old who is lateral and says that is messy patient is when the lateral insulin we have option of uscis implant okay implant is the best option it is first first treatment of choice but implant is expensive suppose if the poor patient cannot afford the implants the second is bridge for a bridge you'll have to cut the central and the connect say it's a cutting a central and a canine sometimes it looks like a crime okay and canine is like it should be if you cut the current because entire occlusion is depending on the canine guided or a group group function so the lab has to do a good uh connect if you don't lab does not do a good can end then it will it will be a disaster for the occlusion and the 100 60 to 70 percent of the lab cannot do a la canine which is like god god given can i okay so they do something else so that doesn't look nice so you know in such cases if it is in an economic way and if you do not want to touch the canine and a centralizer for a bridge then the third option comes is rpd rpd it's again the patient does not have to because you have to they have to remove it during the night so the patient never be comfortable so the third or fourth option comes is this fiber reinforced composite bridges so so for that reason we have a this fibers or as a support and the pontic and the tooth can be made with the either can be made with natural tooth if a patient comes with a tooth which is extracted or which is come out or we can do it with the composite resin entire quantity can be made with the composition or you can do a acrylic resin teeth but the best is natural truth okay if the natural tooth is not available then comes with the resin if it is if you are not confident with the composition making the the tooth look like a tooth then you have can go for an acrylic resin okay this patient came so this is one of them uh she was the mother of a dentist itself so she was not happy with the so she was used to wear a uh rpd for a lower concentration actually it was a pathological migration there are four incisors are present but there is a huge uh diastema so an upper also so she said my mother is not happy with the denture do something for her so i said that we will do uh see the upper diastema i'll close with the direct composite but lower diastema is huge it cannot be close with the direct composites i can make a extra tooth maybe see there will be five teeth when if you make a extra tooth it is five so in a lower incisor there is if it is one tooth extra or one tooth less it is not going to be visible whereas in the upper if it is a one tooth little bit extra also it looks very bad okay because automatically you must have seen people extract central incisors or lateral sometimes in size or lower incisor for ortho purposes but still it looks fine patient uh the first third person won't come to know so same way if it is one two text also nothing will happen so it looks nice the space is the back not the tooth so say this upper this was the estima and i closed it with the direct composite see the angles this is what i was telling you the the trick of the trick of the trade is give a angle properly if you give an angle the light reflects in at the angle the tooth does not look wider or it does not look like a elongated or a stretch top okay so it was a huge estima still i could able to close it with by giving the angle and a lower what i did is like this you have to roughen the surface okay so that you bond both the areas [Music] nicely attached to the purpose and all attached to the tool [Music] and just like this and go to cure [Music] shhh [Music] nicely [Music] [Music] thank you [Music] [Music] [Music] [Music] so [Music] see this is the case see the final outcome so this is the lower inside okay which was made from the composite restriction and which is bonded okay with the fiber [Music] that was a tooth which is broken and it which was actually it was a post treated so the post was removed very difficult so what we did is we did the fiber the keep the tooth intact the root was intact so we placed the uh we treated this tooth as a abutment or a pontic and this composite was built on the truth okay this is another case one more tooth which is again a video is there for this that is kiran 146. uh can you play the video yes yes foreign another case where the natural tooth uh contact the in this in this case there are two teeth uh give me a second i'll show the case first the reinforced composite that is about studies that frc processes have a good longevity because people are scared that longevity longevity of the restoration is good has a good longevity okay then last is my presentation is like natural truth context okay because natural truth the tooth itself it acts as a pontic and it's a good because it has a benefits of right shape and the size and one tooth giving a hope to the hopeless tool and it's a conservative cosmetic and possibility okay so this patient came like his both the teeth were mobile okay this was the video which was showing both sent lower central it says there was mobile so can you show the video okay we have removed that two teeth which is mobile grossly which is very mobile video please what we did is we did a root canal outside okay and this teeth were mobile can you see that we i'm showing say this both the deeper mobile so we removed the teeth both centralized which was very very mobile okay we cut the apache portion okay of the teeth and we did we did a retrograde observation okay [Music] and just kept a this plumber tape so that nothing should go inside the socket which is recently just extracted and check whether the keeping the tool which is uh extracted keeping the truth back on the socket and to check whether it is perfectly matching or is there any changes are required let's check which was our observation was done immediately and then the the apache portion is blocked with the gac so that any microbial growth in growth will be reduced [Music] [Music] [Music] [Music] yes so this is can you see that it is nicely matched okay yes okay this is natural truth so we keep the same yeah continue so for this splinting we you can use ribbond or you can use interleague okay say this is we use the interleave from so the truth entirely from canine to canine it was printed fiber splitted using the interlink from angelus so that this has a this is like a two uh two it is one is splinting also done plus uh the tooth also got a support yeah come back this is another case where we have done anterior teeth it was mobile so data see this so this is how can you see this uh the the gac and x-ray you can see that restoration truth was cut and kept and the uh it is joined this x-ray also you can see that a petal portion which is cut which is gac is placed and the observation and it is placed like this like this okay so i would like to conclude by saying that we always uh we do good work okay so but thing is like our we have to manage work carry our business and with the life and the health and the family okay so that makes the uh we always remember our teachers who have given us uh many things because of whom we are today so whatever dentistry it is taught to me by my teachers and my friends and my students always i'm ever grateful to my students who is always a driving force for me okay thank you so much for uh entire netflix stream for giving me an opportunity to speak on this uh forum uh thank you doctor thank you so uh sir can we take one two questions sir yeah yeah yes sir um so we have a question from dr shadab khan for such splinting do we prepare adjacent we usually what we do is so what we do is we always do a roughening we don't prepare much see when you do a lateral suppose if you're doing uh any uh mid-light diastema closure or any any what we do is we uh prepare the tooth very like uh c shape like this is the truth imagine okay this is this is two incisors okay we prepare like this here and here okay from labial half mesial side and a palatal side that is for a when you close the midline but when you do a splinting we do the uh lingual side and a mesial side and a lingual side we just rough on it we don't make a absolute groove okay that even though there are some textbooks and the the literature says that we'll have to make a groove okay but you need not make a group you can make like a roughening where exactly your whole the fibers because the fibers are very thin it is not like very thick in nature so you can just make a roughening surface and do the uh you can do a splinting okay we need not do much of preparations actually as such so we have questions from dr jodesna suja how to decide whether to go for composite for diastoma closure or crown okay see crowns is if you talk from talk from the conservative point of view always composite is preferable so crowns are uh also okay but crowns you require a toothpick pressure and that root preparation okay so there are middle diastema closure is always his first proponents will be the direct composite if not indirect composites if not when here okay then comes the crown okay this is how the the the uh sequence goes first try for that it composites then go for indirect composites then go for indirect veneer from the ceramic windows because this all indirect things are more aesthetic they give a better aesthetic uh more than a direct parity is entirely up to your skill ceramics are their glass made up of glass they have a better aesthetics than the composites okay ceramic is a if a patient is able to spend because when it is expensive everybody knows that patients should spend that much so if it is a three four four spaces means they have to spend a thousand thousand thousand more than a lot of money so so direct composites becomes economical and conservative okay so it is that is the reason we prefer when it's very conservative you need not do a much of a tooth preparation when he requires a tooth preparation but here uh it's just you have to rough on the surface but thing is you need to have a skill for that uh so doctor swami saying you did bring in a lot of smiles now looking at all the magical transformations um so there's one more question of which brand do you use for composites so i i do use uh a lot of uh then spline because i have a uh presentation person who's asking what is omnichrome up uh composition only chroma is like even though uh is a good one but they have uh it's a recent one so what i prefer is uh i always use uh which is cloud shade my i'm ceramics from dance fly okay i do well i do a lot of mix and match from i'm a big fan of ceramics which is spare tech technology cloud shade less super composites more of a shades less number of composites required than the multi shade where you required enamel dentine body and uh enamel so that requires it has also a good technique where uh style italiano have said so this is this i simplicity wise cloud shade i prefer but it is not like it is case to case suppose mono shade even simple compositions also work it is not uh brand waste but it's a personal preference case to case but most of the cases which i have shown here today managed by uh ceramics from the dense supply okay i use even io i use from gce okay i use uh from 3m also okay so there are so many compositions but this many cases i have done with the dense place right i think we've covered almost all the questions so thank you so much for the wonderful session and hope to see you back soon on netflix thank you so much

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Dr. Anuja Mahajan & 1294 others

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dr. Pradeep Shetty

Dr. Pradeep Shetty

Professor, Dr. D.Y. Patil Dental College and Hospital, Pune

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dr. Pradeep Shetty

Dr. Pradeep Shetty

Professor, Dr. D.Y. Patil Dental College and ...

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