Dental Anatomy

see the video: http://www.learnerstv.com/video/Free-video-Lecture-4716-Dental.htm

In this presentation we will discuss the anatomy of the primary teeth. Our objectives in today’s presentation are to identify these teeth by name and location and the positions of them, to discuss a little bit about occlusion and to discuss rather extensively the differences between the primary teeth and the permanent teeth, to discuss the morphology on some of these primary teeth as well as the differences and terminology, and to get some identifying characteristics of some of these teeth. If we look to our skull here of a youngster of approximately 4 or 5 years of age, we can start to identify our primary teeth. We have 20 in number and if we divide these down into quadrants of 5 here, we’ll identify them individually. We have a maxillary right primary central incisor, our lateral incisor and our cuspid.

The interiors are essentially the same. If we look to our posteriors now we have a first molar and a second molar. This means that we have no premolars or bicuspids in our primary teeth and we have no third molars. This just leaves 5 in quadrant. With four quadrants it will give us our 20 teeth. Now in the permanent teeth we identified these teeth by number, for record purposes, and we had 1 through 32, starting with the maxillary right posterior tooth. In our just primary dentition we’re discussing these teeth by letters and we’ll start with a maxillary right posterior and this will be number A and then we’ll go, as we did with the permanent ones, around to the maxillary left posterior, which should be 10 letters around to the letter J and we’ll drop directly below to a mandibular second primary molar K. And continue on around until we come to the 20th letter in our mandibular right molar which would be T. I called these teeth primary teeth. You may well recognize that there are other terms for them. Deciduous teeth has been a technical term for these teeth for a long time and it is in a lot of the literature. Primary teeth has been more recently accepted official name for these teeth so we’ll try to refer to them as primary although still [Roll?] refer to them as deciduous I’m sure because of a habit. Also these are called baby teeth. Of course parents most commonly know these as baby teeth and not by other terms although they are continuing to be educated here on this.

Frequently they can be called milk teeth. Some of these have gotten stained from the glue and dirt, what have you, but these teeth frequently are very white and oftentimes much wider than the permanent test. So they’re called milk teeth as a slang term. If we look to the occlusion on these teeth we’ll find essentially the occlusion is basically the same as the permanent teeth. Our mandibular teeth are smaller in the anterior and they’re…develop an arc which is inside of the maxillary arc and they’re biding to the lingual of our maxillary teeth. And this occurs all the way around. We have the same type of an overbite and an overjet situation in the anterior and in the posterior. We’ve got the buccal cusp of our mandibular posterior teeth occluding into the central fossas and grooves of our maxillary teeth. One thing in relation to the occlusion is a little bit different and that is if we look all the way back to our posterior teeth, frequently we’ll have in this area what is called a flush terminal plane. Our anterior teeth in the mandible are much smaller but our mandibular teeth on the molars become much wider and they help to make up for this difference and often times will end up with the same plane at the posterior here. This makes quite the significance in the eruption of the permanent teeth here. We might look to the eruption here a little bit. We’ve got a cutaway section and if you take the labial plate or cortical plate of bone I should say off of these skulls we’ll find that underneath we have a tremendous number of teeth developing. Got a central and the lateral and a cuspid, our two premolars. And all of these teeth are basically called succedaneous teeth, which is a term which we should identify. To define, a succedaneous tooth is a tooth which replaces one of the primary teeth. One the reasons we can call this a 4 to 5 year old is because these first permanent molars which erupt at 6 years of age are not quite coming through the bone yet. They are still down underneath the cortical plate of the bone in some of the areas. Maxillary one started through, a mandibular one is completely under the cortical plate of bone. Some people ask why we don’t study the primary teeth first, particularly since they are the first in the mouth, as in this 18 month old child. But there are many reasons. First of all our primary teeth do not have well-defined landmarks or grooves, fossas, ridges, depressions.

They are just not as distinct as they are in the permanent teeth. These teeth are generally smaller and harder to study from size standpoint. And availability of them is not very good. The good fairy has a way of getting most of these teeth and we have a hard time getting a selection to study. Our text book lists the primary teeth after the permanent teeth but they do have a rather large number of good diagrams and photographs which you may have to use to supplement your study on these teeth. We also have a fairly decent collection of these primary teeth in the [Kaiden?] Center which can be checked out for studying and looking at in the [Kaiden?] Center. Let’s look at the differences that exist between these permit and primary teeth. We have 8 general differences. The first one is size. We’ve got some permanent teeth and some primary tooth next to each other and just overall general size is very significant. This is obvious. We’ve also got a size variation in relation to the crown height. The crown height on these deciduous or primary teeth are very short and squatty. The distance from the cervical to the occlusal is considerably shorter in proportion to the permanent teeth. We can go back to the slides here, we can see that there is a number two difference, is a significance color variation. We can see some permanent teeth coming in down here and they’re often times yellower. Our primary teeth are whiter and this is where they pick up the term milk teeth. This is a big problem with parents when these permanent teeth usually start coming in on their first children, I bet you I’ve seen a hundred of them or more in more practice, they come running in and say “Something’s wrong with my child’s permanent teeth. They are all yellow.” And there’s supposed to be that difference and you have to point out to them the difference and why. This also points out, I think rather significantly, the size variation. For instance on our central incisor of the primary tooth we’re wider from the mesial to the distal than we are from the incisor to the cervical. This is one of the reasons why they’re getting a short squatty type of terminology to the crown. Third major difference is basically number. Again, easy one. We got 20 primary teeth. We have no premolars. We have the same 6 anterior, 4 mandibulars and the 4 maxillaries…6 of maxillaries. Mandibulars. And then we have 2 molars.

So the ones we’re missing are basically third molars and our premolars and these are simply termed first primary molar and second primary molar. You can see the first permanent molars starting to come in here in this section. This is not a deciduous tooth here and very important that we learn eruption of these because parents don’t recognize that these are not, as they would term them, baby teeth and they’re very frequently likely to get into a great amount of disease and trouble before they know that they are permanent. One of the things that’s number four main difference is that our primary teeth have no mammelons. You can see permanent teeth here. Very strong mammelons when they first come in. Primary teeth have no mammelons, even when they’re present to begin with. 5th major general difference is in pulp chamber size. Pulp chambers in the primary teeth are proportionally larger than they are in permanent teeth. And this is significant. Number 5… number 6 main difference would be that the enamel is thinner on the primary teeth. We can see how the enamel is thinner and rather even in comparison to the enamel on the permanent tooth. This is the first permanent molar here. This is your second primary molar. The large size of these primary pulps becomes very important when removing decay and in preparing these teeth for restorative fillings. We’ve got a major root difference on these teeth and actually we divided this into three differences. So I’ve listed number 7 as root differences on the molars, molar root differences, in three basic areas. One is that the roots are widely spread and you can see the succedaneous tooth developing right here, which would be your second permanent mandibular premolar, a number 20 developing right in between the roots of the primary teeth. So these roots are spread wide. They are often times said to be bold or flared in this area.  Number two, the roots are frequently thin from mesial to distal. Quite broad as we’ll study…find  as we study the individual teeth. Quite broad from the buccal to the lingual but quite narrow mesially distally. Gives them a ribbon shaped appearance, particularly on these mandibular molars. Third major difference is this root trunk. They are trifurcating or bifurcating. In this instance it would be trifurcating. Here it would be bifurcating. Very close to the cervical of the tooth and in some instances there is no root trunk whatsoever left. We’ve got a very short, very small root trunk on these. Number 8 major difference is the cervical ridge. A cervical ridge is very prominent on primary teeth.

Whether you want to call this buccal deflecting ridge or the deflecting ridge of the teeth or the buccal ridge. Here it would be labial ridge. Or whether we want to say that the cervicals constrict. Sometimes they’ll say cervical constricts but nevertheless you get a large cervical roll on the primary teeth in comparison to the permanent. Our maxillary permanent teeth have a heavier cervical roll or cervical ridge than what the mandibulars do. But this is even much more prominent in the deciduous teeth. And this becomes very important from many operative and restorative standpoints. Again, here is a cuspid. Just a general outlined form. You can see a very much more prominent roll on the cervical. We back and look at these teeth on the individual basis. We’ll go through each one of them fairly promptly. We’ll find that the differences aren’t real tremendous. For instance if we were to take a primary central incisor. Aside from the general differences that I’ve been pointing out to you, um, we find that the ridges on here are not nearly as prominent. For instance we haven’t got these labial ridges that develop from these 3 mammelons or depressions I should say. Labial depressions that develop from the mammelons because we basically don’t have the mammelons present on the primary teeth. On the lingual surface our marginal ridges are just not real prominent. Our mesial distal marginal ridges are indistinct. The cingulum looks proportionally larger on it. But again this is prominently due to the fact that this shortness of the crown from incisor to the cervical and often times our lingual cingulum will be kind of prominent but it’s, as I say, short and squatty. Other than this we haven’t got a large number of differences. Our main roll at the cervical is very important difference. Our cervical line is not nearly as prominent in its curvatures. It still has the same basic curvature as a tooth has all the same basic anatomy as the permanent ones but it’s just not real prominent or characteristic.

Masters of Masters in Esthetic Dentistry P2

Now you have the smile line, you have the position of the teeth, lengths. You have everything and there is practically no wax on this model. Because I was working from the strategic point of the shape . And you know when you retouch a mock up, sometimes you retouch, you retouch and nothing happens.  Little bit more, a little bit more. And after that dentist goes “Oh, I reduced too much now I…can we redo a mock up?” There is strategic point. Somewhere you can touch a lot and nothing happens. Somewhere you touch a little bit of transition crest and it has changed completely the expression of the smile, the form of the teeth, etc. This you have to know. [inaudible] Please, monochromatic. Monochromatic wax. I like to have the same as the model. Are you agree with Francesca that you can do first in grey or something like that to have the where is the junction of wax and the natural teeth but you have seen some [inaudible] as yellow model, yellow stone and green wax. How you want to make a form with that? You have pain in the brain already. [inaudible] have to be…to play with light and shadow. And white…I like white because it’s a lot of…I would not recommend to start like that. I would light grey. But after that when you have a little bit [inaudible] you pass in the white because you are enough sensible. You don’t need that much light. It’s important to have a light 40-50 centimeter on your table. Direction light. A tubed direction light. You are playing with the light to make the shade do everything and you don’t need this powder, argentic powder or something like that.

 

There is a lot of things. And when it is in the wax, after that I duplicate in stone and I finish my surface texture in stone because wax is not precise enough, you touch with your fingers and everything is coming wrong etc. And after that we transform in acryl. In acryl here is different kind of work we do in acryl. There is the shell provisional, there is the mock up, there is the adapted provisional, provisional on implants.  We can characterize. I use my own material for them I developed 20 years ago. It’s very powerful material. You remember this patient that in the same appointment the dentist wanted to remove the crown and to place something. That the reason we make a shell for this one. I just take a [inaudible]. I pour dentin and I make a cut back. This one is a nasa silicone matrix to see how much I’ll reduce for the cut back. And after that I replace the provisional with enamel and it makes a bi-layer provisional, like a sandwich. I check a little bit the shade and after that I could just around here and remove the inside and dentist can reline in the mouth. I deliver a key he can place and verify if everything is going on the right place. The day we remove the crown he can reline the provisional and it’s very easy, this day and place. You see everything is correct, you reline and after that it looks something very enough for the patient to live until we fabricate the final work. And this one is very important to know. This kind of provision cannot condition the tissue. This one is just a shell. If I have to condition the tissue I will make an indirect adapted provisional. You have seen this patient here. A mock up. A mock up was made by the student. We have the wax up. Then we see the clearance. It was an additive wax up only, only additive. And after that the student make the mock up. I can go fast because everybody knows this kind of thing a little bit staying on the surface. Not very nice but okay to verify the length.

 

Too long? Not enough? What do you think? You cannot see! You don’t have the face. I agree with the photo. If you see only teeth we cannot say nothing. If you see that you can’t see nothing too. The patient is a person. It is a face, expression. With the same face you will not do the same teeth if they are twins. Because maybe one, she’s an artist and she’s very fantasy and she will never accept the  orthodontic treatment. And the other one, I don’t know, she’s a CEO of a company, a big company. Now we can see. Yes, it was too long. Means we’ll reduce by the…you know this kind of stuff…the marker etc. And finally we agree on the lengths and we can go for the final work. And the final work you see when it’s adjusted, polished etc. The enamel of the natural tooth needs to look exactly the same. The veneer. the same kind of surface, the same kind satin. These are not all the time hyper polished. [inaudible] The gloss is very important. The gloss is not the same as the surface texture. It’s something different. And she was okay. She was happy. In the case we do adapted provisional, it’s which one we verify the form, the length, the position, the composition and condition the tissue. Here are case we made with Pasqual. Long story with this patient because is Asian she’s absolutely…she’s frustrated to have big teeth and small arch and she wanted to go out of her nature. And she was asking me all the time “I want more narrow teeth, more narrow teeth.”  And now I listen why the work before was made with narrow teeth and not the right form, the right size. Because she don’t want to have the natural. We made this one. There is [inaudible] the provisional is too transparent but it’s most of all to see how it’s in accord with the lower lip and most of all in the face. And for me, it’s too flat.

 

She needs longer central. It’s too flat. Take a look at her lower lip. The lower lip requests length and she don’t want. It’s too flat and she said it looks artificial. Cause nature would give her much longer teeth. I’m sure. All this kind of provisional are important because it’s the which one we will calibrate for the definitive work. Means that the reason I attach a lot of importance here .A patient from Los Angeles. She has a old work, not difficult to make a little bit better but she lost a tooth, we put an implant, made the wax etc. What’s that? I have to come back. What’s that? Veneer on the refractory, crown on the refractory. And this one? Provisional. When we have combined case like that, crown and veneers, we bond the veneers, we wait 3 weeks until rehydration, to be sure it is re-hydrated. And after that we take the shade to make the final work. If not, you do everything together. How you do? Too much everything. Because you are depending on the color of the teeth, of the prep. And now she is with the veneer bonded and the provisional in the mouth. Before. Now she started to take a little bit of self-confidence. I never ask to the patient come nice with their hair cut and this woman the first picture you do a horrible picture and the last picture you don’t recognize the patient because she was to the hair stylist etc, the face stylist etc. No. I let the patient doing and feeling and I can see if he take confidence to himself or not. Again, the provisional .I have to go faster on this one. We will see much more cases after that but just to…the diagnostic is very important. We use all the time this envelope technique. You can see that we can really go very into details even with the acryl [inaudible] All the details are like in the natural teeth. It’s a good [inaudible]. Acrylic can be adjusted as you want in the [inaudible] in the surface texture is the[inaudible], is the natural tooth. And you see is the same kind of texture, of surface etc. And it is the best way if you have an apprentice working with you. He can do all this work. He can do very good provisional. He can change the material and would do exactly the same in ceramics. It’s the knowledge, not the material that makes the difference. And here this patient received two implants on the lateral.

 

What it is? Provisional. We want to condition the tissue. And you will see here…and very nice illumination, for sure with the flash but you see the difference even with the healing cup. I think I will show you later with the healing cup the difference when you have something white or with the healing cup grey how much the soft tissue can be difference. The product is the New Outline. I can tell you it’s a very powerful PMMA – polymethyl methacrylate – and is very, very good optically. The gingiva loved this material, I can tell you, even more this material than the ceramic. Because ceramic tends [inaudible] too shiny. The gingiva doesn’t like very, very polished [inaudible]. We need a certain [inaudible] that is the tissue go better. And now we evaluate the case. Here we have a case I made with Lucca [inaudible] in Milan. And for sure. It is what I call a Hollywood smile because you don’t know if it’s full central or full lateral. It’s all the same and it doesn’t go well. These clips request more. I don’t even want to speak about the story. She make a some surgery, she lost roots here, the canine and the lateral etc .Just to see… I make longer, much longer but I make embrasure. Means it’s longer but it’s less heavy because I make embrasure like if I put up all these things and now it’s in harmony with her face, the white is pretty corresponding. It’s like for sure…maybe it’s too clean, too clear, too nice. We have to make a little notch in the incisor border. That is going with her face, it’s more narrow than before because she has narrow nose, long nose etc. You need to fit with the rest. Another patient with Dr [inaudible], Brazil Sao Paolo. He made the mock up reproducing my wax up. He lost a little bit here, he make the embrasure a little bit too large, too width. And what he made after the mock up? He just [inaudible]. I don’t want to take too long because we don’t have too much time but it’s a complimentary of pictures. In this moment when the patient agree, what you do? Please don’t forget to take an impression of the new situation and pictures. Model without pictures, no value. Pictures without model, no value. Both together the most best thing you can give to your technician. I’m sorry I just have to change my file. To take the second. We jump on this one without stop. Black. And final restoration. Final restoration. I will go pretty fast like a movie, like I said. Model. Model. We published this one. I will give you the file if you’re interested. I do have model again inspired by nature. I want to have a crown, a root and it’s powerful because you can use for veneers, for crown, for everything but what I want to show is the gingiva. The perfect gingiva design. And it’s a not precise model because [inaudible] on impression. Means the interproximal contact and occlusion is never [inaudible] The reason why at all the time have one not fragmented model, one solid model. You make this kind of model by pouring a first [inaudible].

 

You visualize the root and you generate this first dye we call alpha dye. We cut 6 degree conical [inaudible] and after that we have one dye we will duplicate the first time and in this one we will pour a first dye, a second or third. The first is to put the spacer, to duplicate, to get our refractory. But now we have 3 dyes. No model, only dyes. And I would pour a second one in order to create the…to reposition the impression and to create the [inaudible]. I have a third one you will see this one many time. I will pour in PMMA to reproduce the color of the prep. I use all these kinds of silicone. It is a One One silicone, faster setting. I don’t know [inaudible]…power of this model is that you can in the same alveoli put the original dye, the master dye. You can put the refractory and here you can put repoured wax up. I repour the wax up on one virgin dye like that and I reduplicate it. I have this one now installed. [inaudible] Oh my gosh it’s complicated. But imagine the full mouth reconstruction when you will have all the teeth installed replica exactly your wax up. You can go one by one. You don’t need the articulator during the [inaudible] to make final contact and adjustment. It’s very powerful and most of all you have all the adjecentees as a wax up. Means you copy your wax up hundred percent. And you can get what you promised to your patient. And you can see on the refractory …and here is the wax up because it would be two zirconia crowns and here two zirconia crowns. And we already made the anteriors to this patient and now completed with the zirconia crown. And the refractory only. And for the implant I do the same. With the analog I cut apart, I block the undercut and like that I can have a removable dye. How we fabricate the ceramic? I use most of time for the anterior on the refractory because it is really powerful two layer from the first layer you apply on the refractory. IMAX is good for some case, for  some case it is contraindicated. I hate when you want to do everything with the same system. That doesn’t function. I want the best system for this patient.

Masters of Masters in Esthetic Dentistry

See the video: http://vimeo.com/37367270

Today I use the same tool than the past. I just add on movies and I just want to show you how we communicate. You are seen with the patient. One hour I explain sometimes the patient request the second hour to understand better and I love when you say “Oh, but you are the professional. You decide.” And I say “No, you are the patient. You decide for your smile but I want you…you decide for me is kind of respect.” He decide with all the parameters her need to decide. Means he can make an objective choice. And the communication. The most important thing I think is photography. [inaudible] we recommend to buy to our students is a photo camera.  What is photography? It’s modeling with light. Means you have to understand light. You have to understand there is different kind of photography. There is not really wrong or right photography. There is different photography, express different things, show different things. And photography for portraits. I have no time to speak about that. Photography about teeth. You can read what kind of lighting is here by reading the light on the teeth and you know there is two light point because the two transition crest angle are highlight by these flash. The body camera is not very important. We need a good definition for sure. The lens, if you want to have the simple [inaudible] I would recommend systematically the 105 because you can use for everything, for posteriors, for anterior, for everything. And if you want to go a little bit more far for anterior I would recommend you to a 60 because it give more depths of feel, more three dimensional et cetera. But the importance is the two light point for your flash. For sure now the tendency is to defuse or reflect light. It means to get a different photography. But you have to know what you want to show. You want to show surface texture. You want to show depths of transparency, translucency of the teeth et cetera. Means I work systematically in manual. Manual because I want to have the same light all the time. The same quantity of light. And like that my brain can calibrate, my eyes and my brain calibrate by themself because I take the same distance and the same quantity of light. Means it doesn’t depend anymore if it’s a person with dark skin or darker tissue, dark gum or something like that.

 

We just have to really to do the photo we want. And it’s like the third eye. It’s like you show us through your photo camera what you want to tell to your technician. Means it’s important to take the shade guide. I love to take the shade with the photo camera. I still to do some map when I do that because I think for me it is pretty important. And as I’ve mentioned we have different light available and you can have a photography correctly exposed, overexposed or underexposed. What’s the consequence of that? Just have a look. If for example this one is a correctly exposed or control photography, if I overexpose, what happens? What do you see here? I lost some information.  It’s not anymore the same. I lost a lot. In opposite now, if I underexpose. Oh my gosh, it’s something much more. Means I do all the time correct exposition and under exposition to understand better. And you know you go with the little [inaudible]. And you reach the under exposition. What we really don’t want is to have some picture that is not focused or is not…yeah, like that. It just gives you pain in the eyes and on the brain. What is important is to have different black background with slips, there different kind of degree of smile. Rest position, in the rest position we need to see the two central, two lateral, no canine. And after that we have a E smile where the patient say E and the maximum like a grimace where you see how much he can go up with the upper lip. And we use shade guide. Important to a this one. When you have photography like this one. If you have enough definition you can magnify and because you have this one your brain calculates everything by itself. We have a phenomenal computer in ourselves. It’s our brain and you don’t need to have a photo spectrometer to measure the color or something like that. Just take the two closest shade guide and one more to calibrate everything and it’s look like it’s three dimensional color. It’s really easy to do. It’s photo your technician wants to have in the front of the teeth or reference teeth. It’s important to put on the same plain because if you put more in the front or more in the back it doesn’t receive the same light and it’s like making fake the real color of teeth, the real value. Shade selection. What do you think about the light? What kind of light you use to take the shade? Natural light is the best. Everybody agree? It is the worst. Not the worst but practically. I want to have a constant light. It’s which one allow to me to take the shape, to build up the crown, the veneer or the crown or I don’t know what, to trying and to deliver all the time the same light.

 

If I change all the time what parameter is light and I change this parameter all the time, how I can follow something? I’m all the time lost, every step. Means if I do constant light, the same, I close the window, everything. Light, artificial light. 5500 kelvin is excellent. And after that like I said if you calibrate your flash and everything all the time the same. It’s coming like a constant light. Means it’s coming good tool. But after that natural light is changing all the time and if it’s not the same weather when you take the shade and you make the try in, you are lost. It’s very important this kind of thing to respect the chronology, give the most importance to the 5500 kelvin. And the comprehensive analysis is what you do with this picture. This picture we took with the patient et cetera. First of all we want to see all the mouth. We want to see  the [inaudible] but we want to see the palatal, the occlusal and everything. And you get this kind of picture. This kind of picture is nice because I can see a lot of things but is a lot of things missing too. Have a look. What I do now is systematically I will do polarize picture. I polarize, I put a filter in front of the lens in front of the flashes and now I have no reflection and I can try to read inside the teeth. And because I have enough definition with my recording photography I can magnify. And I open my picture on my computer and what I do? I have a [inaudible] scanner. Wow, now I can see inside. And this scanner is just your augment to the contrast. Every time you open your picture you can augment the contrast. It is powerful. Because now I read every detail. I can feel, see this fluorescence, I can smell everything. It’s very easy. It costs nothing. Just a little bit art but practically no time. It’s very small amount. And after that I can make my personal map if I want with dentin. After that [inaudible]. We want to go pretty fast on this one. And I do three different maps. One for the dentin [inaudible]. I like to have the first bake all the time a little bit brighter and after that I will put the characterization. The characterization will shoot down a little bit the light and it’s absorb light most of time. Means the restoration will be a little bit more with the less value and after that I choose the enamel. For the enamel I need the flash reflection because to feel what kind of enamel it’s really. And if you really want to copy I said earlier, it’s a lot of powder. You can’t make with two powders.

 

It means I have these 3 maps. Dentin, [inaudible] and enamel. And for sure now we can…it was my first video. I let it because I want to show even if it’s a bad video, it’s powerful. And for that sometime I ask my wife to participate and she’s very kindly okay to do that. And she liked to play a little bit. But you see its dynamic, makes you see things that you will not see in the picture. How she moved her lips, how she’s really. And it’s important to have face like that to…I like to see the complimentary of pictures. with this video. I don’t know if you feel something different than other picture but we can see how she wear, how the lips behave. It’s really powerful and now I work with some dentist over the country and they give me a little video when they make the mock up. And I love that because I can really see my [inaudible] transforming mock up in the mouth in the dynamic way. And what we really see is how [inaudible]. I can tell you a million things about integration and things like…it’s very important you know in the smile, the central of the personality. The lateral are the [inaudible] of the smile and the canine are the masculinity. [inaudible] for women. And no if you take the…you see the close up, you see this transparence you don’t feel the same on the pictures. Because it is natural light, it’s room light but can…the light is higher…the behavior of light is different. Means when I say about the personality of the central lateral fantasy, canine is the masculinity. Now if you want to make central and anteriors more soft, we have to make more round, more [inaudible], more kitsch. I don’t know if you say that. What do you do? You don’t want to make this too round to make softer. No! You make canine a little bit stronger. And by contrast the anterior will look softer. The same with luminosity. You don’t want to go down with the luminosity. You want to augment the transparent in incisor border. What are you doing? You don’t go transparent. You just surround the transparent by something a little bit more opaque, more translucent, less transparent. And by contrast the transparent will look more transparent but we didn’t add transparency. It means the value will stay the same even brighter. There is a lot. It’s concept of art. If you paint it with watercolor you will know everything like that. Means that there is a lot of things like that you can use, balance the smile, use color value, surrounding, contrast. Eaton wrote a book about contrast. It is fantastic. We need to know these kind of things. And after that technical diagnostic. I will go fast because I’m very, very, very late.  Stone. Stone. The model. When you make a stony model, it is the base work of all your work. Means it is an extremely important model. Don’t say to your assistant “Oh, just make [inaudible] for this one.” I have nothing against assistant doing that but you have to teach her. And take a silicone. Because I want to have something very precise and after that I can start to put my first drop of wax because I know, I’ve hold the permit as the patient agreed about what I want to do. I [inaudible] this one, I want to make big [inaudible] and maybe a diastema between the central et cetera. Because now it will coming back, I can tell you this diastema. But in this case, the patient you remember which one it was, we will make big teeth without diastema. But what I start. You remember the shape, the green and the red? I start by the [inaudible]. Have a look at the amount of wax I put on this model. It’s practically nothing and you have all the design of the smile already done. Mesial crest, distal crest. Now in every teeth I do mesial and distal crest.



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