Smile Design & Occlusion - Full Course  

Function, esthetics and balance

1 hour 20 minutes

This session lays the foundation of holistic treatment offering to patients. An understanding of the interrelation between occlusion, patients’ symptoms and disease status is critical for deriving the correct treatment plan for a clinical situation.

An introduction to the temporomandibular joint, its muscle attachments and its movement because it is critical that a clinician identifies the cause of the imbalance in the rhythmic movement of maxilla and mandible that is resulting in different symptoms.

Introduction to the concept of Esthetic Oral Rehabilitation and why the correct position of the central incisor is the primary objective.

Esthetic Diagnosis with ARTISTIC PRINCIPLES

1 hour 23 minutes

How does a clinician understand the esthetic issues of a patient even before clinical examination? It requires the clinician to learn the “Esthetic Language”

Knowledge of the “principles of esthetics” related to the artistic aspect of Smile Analysis and relating it to clinical situations has been covered. This video trains your eye to understand ‘contrast’ and through cases, guides you on how to identify problems in ‘contrast’ of a specific dentofacial composition.

Every composition should look uniform. Similarly, the dentofacial composition may show a lack of uniformity and those very elements when treated, create a beautiful smile. The principle of ‘unity’, ‘dominance’ and ‘proportion’ has been explained as the next important aspect of artistic diagnosis.

Visual balance, symmetry, cohesive and segregative forces are the last 3 artistic principles explained in the last part. Since this is a recorded session of a live course, the participant’s doubt solving interaction with the mentor has also been included in this part.

SCIENTIFIC PRINCIPLES to establish a diagnosis

1 hour 19 minutes

Scientific principles allow you to make a quantitative analysis of the case.

Diagnosis is based on observations of the patient’s face, the face and dentition and the dentition independently. Knowledge of facial esthetics that could be related to dental issues can be observed by correlating facial reference planes to dental planes.

Preliminary observations of the eight macro aspects of the dental composition, (the teeth and the gingiva ) their individual characteristics and their interrelationship as visible when the patient smiles is of great importance. Also, six ‘smile elements’ of the smile that are peripheral factors to the beauty of a smile need to be recognized. All these have been covered with clinical correlation for better understanding and better diagnosis.

The golden proportion as applied in smile design- the advantage when applied discretely and the damage it can cause when trying to be ideal have been explained. A detailed discussion on the position of the incisal edge of the maxillary central incisors, its role in esthetics and significance in occlusion has been done.

Actual v/s Perception – Magic of Illusion

1 hour 25 minutes

Knowledge of standard principles of tooth form and application of illusions is important to tackle clinical situations of space discrepancy and arch form variation. Ground principles of illumination, outlines of the tooth, tooth planes and color gradation have been laid.

Actual principles of how the art of illusion is explained. How to make a tooth appear longer, wider, shorter, etc. than what it actually is required for various clinical situations when one needs to manage space discrepancies in the arch. An elaborate list of these clinical situations, well classified is put forth.

How does one put this knowledge and information regarding ‘illusion’ to visualize the end result even before beginning the actual treatment? Diagnostic wax-up and its use, its practical methodology as part of treatment planning and patient conversion are the keys.

Dentin and Enamel bonding concepts

1 hour 35 minutes

For successful adhesion, an understanding of the substrate and the substance helps for appropriate use of materials for application. The substrate-ENAMEL and DENTIN -its cross sectional and optic properties that need to be mimicked are highlighted. The substance- RESIN -is studied via available forms and generations.

Addressing Class III and Class V cavities

1 hour 34 minutes

After enlisting the important aspects for a successful composite restoration, a detailed discussion on the etiology and management of class III and Class V restorations has been carried out. For acquiring an invisible tooth and restorative interface/margin, knowledge of the various facial planes of the anterior teeth comes in handy. The approach to Class III cavity excavation -palatal/labial, placement of finish lines, consideration to remanent thin enamel shell, bonding protocols, and layering have been discussed. When it comes to Class V restorations, identification of the root cause of these cavities (caries/ abrasion/ abfraction) helps decide whether only a restoration will suffice or occlusal adjustments and a more intense treatment plan are indicated. The available options for types of composites and curing lights have also been explored in this session.

Class IV cavities and shade matching with composit

1 hour 25 minutes

Shade selection and shade matching are most important. Understanding their difference while using a variety of dental materials to build the lost portion of the tooth helps achieve desired results. Science and attributes of color play a vital role- and so does material optical properties. How should the clinician use the composite layering technique to obtain the final desired tooth color is explained, especially when class IV cavities are restored.

Other aspects of Class IV restorations like finish line extensions, bevels, actual step-by-step layering for shade matching are taught with clinical examples.

Diastema closure and composite polishing

1 hour 32 minutes

The plethora of finishing and polishing tools available in the market is extensive. The speaker here describes how the shape of the tool has an area-specific application. Also, the tip design and angulation of hand sculpting instruments for placement and manipulation of composites to achieve the desired shape and tooth form is important. The correct tools help the clinician get desired results in the shortest time. The later part of the presentation covers how diastemas between teeth can be restored. The preparation design and the use of a matrix band for achieving anatomical contacts while closing diastemas are the key.

Veneer prep designs, Bulk fill composites

1 hour 23 minutes

For restorations of Class I and II, to save time, bulk-fill composites are advised. The usage methodology helps us use these materials to our advantage. The second part of the video lecture describes in detail various modifications/ designs of veneer preparation and their clinical indications. Lastly, step-by-step treatment of one of the most challenging cases-direct veneer for a single discolored anterior tooth has been showcased.

Class III and Class IV cavity prep- Model demo

8 minutes

The video is a demonstration of tooth preparation in Class III and Class IV situations where direct composite as a final restorative material is planned. Learning from the video: Introduction to the burs used, details of finish line placement, and rationale for margin design.

Standard and modified veneer preps- Model demo

21 minutes

Direct veneer preparation designs need alteration as per clinical situations. Two such situations have been demonstrated in the video on a model- when a full labial veneer is required to close a diastema for achieving proximal contact and when a full labial veneer is required to increase the length of an anterior tooth.

 Learning from the video: Introduction to the burs used, details of finish line placement, and rationale for margin design.

Tooth prep for diastema closure - Model demo

13 minutes

Preparation of teeth for diastema closure may/may not be required and that depends on the amount of diastema space. For a small diastema space, the use of an intraoral mockup as a guide for tooth preparation has been demonstrated.

 Learning from the video: Introduction to the burs used, details of finish line placement and rationale for margin design.

Model demo: Resin restorations Class III, IV, V

1 hour 36 minutes

Step by step demonstration on models for the creation of different shades for resin restoration -Class III, IV and V. Use of minimal shade tubes to achieve these results.

Resin restorations Class II & diastema

1 hour 46 minutes

A unique technique for obtaining a tight contact with the help of a sectional matrix system in Class II restorations has been shown on a model. Step by step demonstration of how to obtain a flossable contact area in a midline diastema situation where post-restoration the papilla remains healthy.

Model Demo- composite veneer layering technique

1 hour 10 minutes

Patented layering technique with specialized composite instruments to create High-Definition composite veneers has been demonstrated on a model. The philosophy of the technique equips a clinician to tackle successfully any shade match that is required for patients. Finishing and polishing with minimal tools are recommended and taught.

Design principles and materials for ceramic crowns

1 hour 12 minutes

More than just listing bookish ground rules of preparation design for crowns, the lecture content is directed to a thought process of preparation design aspects-margin, taper, etc. related to clinical situations. Example: Preparation design when old metal-ceramic crowns need to be replaced with all-ceramic crowns, margins for a discolored tooth for receiving all-ceramic restorations. The rationale for material selection has been taken up, again, with clinical situation examples.

All-Ceramic Veneers

1 hour 21 minutes

All-Ceramic materials have an interesting history. Evolvement relevant to Dentistry, its benefits and limitations has been explained. This session mainly focuses on its use as a “Dental Veneer/ Laminate”. Clinical examples of its indications, contraindications, preparation designs, especially modifications in designs for various situations and a detailed explanation on its bonding protocols has been taught through a clinical case. This case also helps apply learnings of Smile Design Concepts in a practical fashion.

Partial veneer, thineer, onlay, vonlay, endo-crown

1 hour 19 minutes

With a bonding protocol that ensures a strong chemical bond to the tooth, and with simultaneous betterment in optics and strength of All-ceramic materials, the approach to restorative treatment has changed for the better. More conservative preparation designs and conservation of natural tooth structure is the mantra. With clinical cases, concepts of All-Ceramic partial veneers, thinners, onlays, vonlays and endo-crowns have been explained with a display of step-by-step execution.

Endocrown preparation design

7 minutes

A practical method to restore an endodontically treated tooth with a large access cavity is the placement of an endo crown. The ground rules for the preparation of such a tooth that has all the peripheral walls intact, has been demonstrated on an extracted tooth.

Endocrown in a grossly decayed tooth

10 minutes

Tooth preparation of a grossly decayed, endodontically treated tooth (where the remaining tooth structure is not much,)for All ceramic bonded restoration has been demonstrated. The rationale for an onlay inlay type of an endocrown and placement of margins in grossly decayed teeth has been demonstrated on an extracted tooth.

Model Demo: endo-crown impression, bonding thineer

1 hour 26 minutes

Capturing prepared and unprepared surface topography of the tooth for fabrication of an endo-crown can be done by 2 methods- By a regular A-silicon impression technique or by a customized pattern resin technique. Undercuts need to be identified and eliminated. This has been demonstrated on models. Apart from the same, step-by-step conditioning of the ceramic surface and the tooth surface for the use of resin luting cement to bond a ceramic thineer has also been shown.

Perio-esthetics: Biologic width and CLP

1 hour 20 minutes

Healthy gingiva is a basic necessity for any restorative procedure. Gingival biotype is a precursor for final esthetic results. Crown lengthening procedures are done with/without osseous reduction are aimed to obtain esthetic gingival architecture. Prosthetic restoration margins can adversely affect gingival health if biologic width is violated. Principles of Perio-esthetics related to the above are taught with clinical case displays.

Perio-esthetics: continued

1 hour 13 minutes

Connective tissue graft, depigmentation, frenectomy – The session focuses on various aspects of these procedures to manage gingival recessions, dark, pigmented gums and aberrant frenal attachments. Multiple cases pictures including videos following different techniques have been shown.

The Temporomandibular Joint- function and stress

1 hour 17 minutes

How are occlusion and temporomandibular joint related? What are the normal functions of the joint, how does it get affected by discrepancies in occlusion? How does one identify symptoms of Temporomandibular joint pain disfunction syndrome? What is myofacial pain? What is the differential diagnosis? How do we deprogram a stressed joint? What should be the right approach to treat such patients? The session answers all these questions and gives an introduction to the concept and apparatus of facebow.

The dynamic nature of OCCLUSION

1 hour 3 minutes

This session begins with the bookish definition of occlusion to further relating this definition to its dynamic form. It describes the mundane task of chewing - understanding what happens in a chewing cycle, how teeth arrangements influence static and dynamic movements and what are the factors influencing occlusion. Occlusion during function, the role of TMJ and muscles of mastication, centric relation, centric occlusion and the 5 most acceptable theories of occlusion have been covered.

OCCLUSION - clinical examination and diagnosis

38 minutes

The nuances related to clinical diagnosis- patient examination process, understanding function, parafunction, identifying dysfunction, etc. have been described in the earlier section of this presentation. The latter half takes you through the movements of jaws as simulated on a semi-adjustable articulator.

Twin stage concept for FMR

1 hour 18 minutes

Not only occlusion, but the amount of disclusion is equally important to maintain stability in the joint and for effective function. This is explained by Prof. Hobo in his twin stage technique. This session takes you on a journey of full mouth rehabilitation with a detailed case study. A session where all the theory learned so far is made clinically relevant at each step of the case explanation.

Determine and record correct Vertical Dimension

1 hour 41 minutes

Factors that determine the appropriate vertical dimension, clinical assessment of the same, recording it and restoring it are critical for the health of the stomatognathic system. Nuances of all these have been described. One interdisciplinary case has been shown from start to finish-smile analysis, treatment plan and rationale, tooth prep, gingival procedure, lab communication, final cementation and occlusal adjustments. The session ends with a demonstration of the clinical steps of this case on a model.