SHADE SELECTION (Posto lecture)

To provide the patient with an esthetic restoration, the dentist must consider the esthetic basis of color as well as the artistic aspect of shade selection. color is phenomenon of light (red, green, yellow, brown) or visual perception that permits the differentiation of otherwise identical objects.

The tabs are held on either side of the tooth when making a choice between two closely matching shade tabs. The gingival portion of the shade tab is matched with the gingival segment of the real tooth. The incisal end of the tab is compared with incisal area of the tooth. The operator should be stand between the patient and the light source when matching a shade. Value control during shade matching is made with the patient looking at the mirror and the evaluator, also looking in the mirror, assessing the difference in brightness between the shade tab and the natural tooth. Shade tabs should be placed in disinfecting solution when the shade matching has been completed.

GINGIVAL MANAGEMENT Tissue displacement Tissue displacement is commonly needed to obtain adequate access to the prepared tooth to expose all necessary surface, both prepared and not prepared. This is best achieved through the use of retraction cord and sometimes electro surgery. Displacement/Retraction Cord Enlargement of the gingival tissue can be obtained by placing a non-impregnated cord and leaving it in place for several minutes. The cord is pushed into the gingival sulcus and mechanically stretches the circumferential periodontal fibers. Placement is often easier if a braided or knitted cord is used. Better sulcus enlargement can be achieved with a chemically impregnated cord or by dipping the cord in an astringent.Aluminum Chloride and Iron sulfate, cause minimum tissue damage.

3 Factors upon which Color is Dependent: 1. The observer 2. The Object Modifies the light that falls on it by absorbing, reflecting, transmitting or refracting part or all of the light energy, thereby producing the quality of color. 3. The Light source/s Have a definite effect on the perception of color. 3 Light Source: Natural light- Sunlight Incandescent light- predominantly red yellow and lacking in blue. tends to make reds and yellow stronger and blues weaker Fluorescent- high in blue-green enrgy and low in red, blues are strong and red are weak. 3 Characters Of Color 1. HUE- that quality which distinguishes one color from another Ex. Shades A,B,C,D 2. CHROMA- is the saturation, intensity or strength of a hue. Ex. Hue A- A1,A2,A3 (choma) VALUE/ Brightness- relative amount of brightness/ darkness in a hue, most important color characteristics in shade matching.

A.

3.

General Principles in Shade Selection Use the shade guide that matches the porcelain your technician is using. Shade comparison should be made under the different light conditions, The teeth to be matched.- stain should be removed by prophylaxis Shade comparisons should be made at the start of the patient visit. Bright colored clothing should be draped and lipstick removed. Shade comparisons should be made quickly, with the color samples placed under the lip directly next to the tooth being matched.- to avoid eye fatigue.

Steps in Gingival Retraction 1. Isolate the prepared teeth with cotton rolls, placed saliva ejector and dry the field with air. 2. Cut a length of cord sufficient to encircle the tooth. 3. Dip the cord in an astringent solution and squeeze out the excess with a gauze square. 4. If a nonbraided cord is used, twist it tightly to facilitate placement. 5. The loops cord around the tooth and gently push it into the sulcus with a suitable instrument. 6. Placement of the retraction cord is begun by pushing it into the sulcus on the mesial surface of the tooth. It should be tacked lightly into the distal crevice to hold the cord in position while it is being placed. 7. As the cord is being placed sub-gingivally, the instrument must be pushed slightly toward the area already tucked into place. -if the force of the instrument is directed away from the area previously packed, the cord already packed will be pulled out. -occlusally it is necessary to hold the cord with one instrument while packing with the second. 8. The instrument must be angled slightly toward the root to facilitate the sub-gingival placement of the cord. -If the instrument is held parallel to the long axis of the tooth, the retraction cord will be pushed against the wall of the gingival crevice, and it will rebound.

9.

Excess cord is cut off on the mesial interproximal area. 10. Placement of the distal end of the cord is continued until it overlaps the mesial. The force of the instrument must be directly toward the cord previously packed( to the distal in this case). B. Electrosurgery May be used for minor tissue removal prior to impression making The inner epithelial lining of the gingival sulcus is removed, proving access for a sub-gingival crown margin.

and saliva ejectors are needed for adequate moisture control. All impression materials should be rinsed, dried and disinfected upon removal from the mouth.

Advantage Postsurgical hemorrhage is well controlled Disadvantage Potential for gingival recession after treatment Retraction Procedures for the Anterior Region
Technique Indication Advantages Disadvantages

Most Commonly Used Disinfection Methods For Impression Material Impression Materials Recommended Disinfection Procedure Irreversible Dilluted bleach Hydrocolloid Iodophor spray Reversible Same Hydrocolloid Polysulfide Iodophor 2% glutaraldehyde Addition Silicone 2% glutaraldehyde Condensation Silicone Same Polyether Iodophor spray Chlorine dioxide *** Distortion results from prolonged immersion Available Elastic Impression Materials ADVANTAGES DISADVANTAGES -Rapid set -Poor accuracy and Irreversible -Straightforward surface deatail Hydrocolloid Reversible hydrocolloid
technique -Low cost -Hydrophilic -Longer working time -Expensive -No custom tray required -High tear strength -Easier to pour than other elastomers -Dimensional stability -Pleasant to use -Short setting time -Auto mix available -Pleasant to use -Short setting time -Dimentional stability -Accuracy -Short setting time -Auto mix available -Low tear resistance -Low stability -Equipment needed

Single String

-Healthy tissue

-Simple -Least traumatic -Little potential for gingival recession -Control of bleeding -Good lateral displacement -Control bleeding of

-Impression material may tear if lack of lateral displacement.

Selective double string

Double String

-Healthy tissue with localized initiation -Inflamed tissue

-Additional time placement cord -Time consuming -Potentially traumatic -Least predictable gingival response.

for of

Polysulfide polymer Addition silicone

-Messy -Unpleasant odor -Long setting time -Hydrophobic -Poor wetting Some materials released H2 -Hydrophobic -Poor wetting -Low stability -Set material very stiff -Imbibition -Short working time

Condensation Silicone Polyether

IMPRESSION MAKING Impression An imprint or negative likeness. It is made by placing some soft, semi-fluid material in the mouth and allowing the material to set. From this negative form of the teeth and surrounding structure, a positive reproduction, or cast, is made. An Impression should meet the following requirements: It should be an exact duplication of the prepared tooth/teeth, including all of the preparation and enough uncut tooth surface beyond the preparation to allow the dentist and technician to be certain of the location and configuration of the finish line. Other teeth and tissue adjacent to the prepared tooth must be accurately reproduced to permit proper articulation of the cast and contouring of the restoration. It must be free of bubbles, especially in the area of the finish line and Occlusal surfaces of the other teeth in the arch. Note: the health of soft tissue and the control of saliva flow are critical to a successful impression. Cotton rolls