The “S” in Esthetics - Dental Academy of Continuing Education

Earn
2 CE credits
This course was
written for dentists,
dental hygienists,
and assistants.
The “S” in Esthetics
A Peer-Reviewed Publication
Written by Bill Connell, CDT, CDL
Abstract
This course will discuss the “Line of Beauty” and its
application to clinical dentistry. The Line of Beauty is
an “S” shaped curve which typically goes unnoticed
until it is pointed out. It is not just an illusion, but
a major detail that is extremely obvious after it is
recognized. The “Line of Beauty” is not only distinctly
found in nature but is also very apparent with teeth
and their surrounding environment. It is significant
from an esthetic viewpoint and a functional and oral
health perspective. It is important that these concepts
are understood and applied, so that we may capture
the natural nuances of true beauty in our restorations.
Educational Objectives:
At the end of this self-instructional
educational activity, the participant
will be able to:
1. Describe the “Line of Beauty”
2. Describe how the “Line of Beauty”
applies to clinical dentistry
3. Describe the parameters of an
inadequate crown preparation
4. Describe and execute a crown
preparation providing adequate
reduction to achieve excellent
esthetic results
Author Profile
Bill Connell, CDT, CDL, completed his A.S. Degree in 1986. Bill’s
foundation for complex dentistry began at the Pankey Institute
in 1989. Bill has spent time learning from many of the most
respected dental professionals including; Dr. Peter Dawson, Dr.
Frank Spear, Willi Geller, Dr. Robert Winter, Don Cornell, Michel
Magne, and Gerald Ubassy. Bill’s focus is to stay abreast of the
rapidly advancing technology, and continue his daily pursuit
of excellence in work, family and life. He can be reached at
[email protected] .
Author Disclosure
Bill Connell, CDT, CDL, is currently a Pankey Institute advisor
and guest presenter.
Go Green, Go Online to take your course
Publication date: Oct. 2013
Expiration date: Sept. 2016
Supplement to PennWell Publications
PennWell designates this activity for 2 Continuing Educational Credits
Dental Board of California: Provider 4527, course registration number CA# 02-4527-13087
“This course meets the Dental Board of California’s requirements for 2 units of continuing education.”
The PennWell Corporation is designated as an Approved PACE Program Provider by the
Academy of General Dentistry. The formal continuing dental education programs of this
program provider are accepted by the AGD for Fellowship, Mastership and membership
maintenance credit. Approval does not imply acceptance by a state or provincial board of
dentistry or AGD endorsement. The current term of approval extends from (11/1/2011) to
(10/31/2015) Provider ID# 320452.
This educational activity has been made possible through an unrestricted grant from Pankey.
This course was written for dentists, dental hygienists and assistants, from novice to skilled.
Educational Methods: This course is a self-instructional journal and web activity.
Provider Disclosure: PennWell does not have a leadership position or a commercial interest in any products or
services discussed or shared in this educational activity nor with the commercial supporter. No manufacturer or
third party has had any input into the development of course content.
Requirements for Successful Completion: To obtain 2 CE credits for this educational activity you must pay the
required fee, review the material, complete the course evaluation and obtain a score of at least 70%.
CE Planner Disclosure: Heather Hodges, CE Coordinator does not have a leadership or commercial interest with
products or services discussed in this educational activity. Heather can be reached at [email protected]
Educational Disclaimer: Completing a single continuing education course does not provide enough information
to result in the participant being an expert in the field related to the course topic. It is a combination of many
educational courses and clinical experience that allows the participant to develop skills and expertise.
Image Authenticity Statement: The images in this educational activity have not been altered.
Scientific Integrity Statement: Information shared in this CE course is developed from clinical research and
represents the most current information available from evidence based dentistry.
Known Benefits and Limitations of the Data: The information presented in this educational activity is derived
from the data and information contained in reference section. The research data is extensive and provides direct benefit
to the patient and improvements in oral health.
Registration: The cost of this CE course is $49.00 for 2 CE credits.
Cancellation/Refund Policy: Any participant who is not 100% satisfied with this course can request a full
refund by contacting PennWell in writing.
Educational Objectives
At the end of this self-instructional educational activity, the
participant will be able to:
1. Describe the “Line of Beauty”
2. Describe how the “Line of Beauty” applies to clinical
dentistry
3. Describe the parameters of an inadequate crown
preparation
4. Describe and execute a crown preparation providing
adequate reduction to achieve excellent esthetic results
Abstract
This course will discuss the “Line of Beauty” and its application to clinical dentistry. The Line of Beauty is an
“S” shaped curve which typically goes unnoticed until it
is pointed out. It is not just an illusion, but a major detail
that is extremely obvious after it is recognized. The “Line of
Beauty” is not only distinctly found in nature but is also very
apparent with teeth and their surrounding environment. It
is significant from an esthetic viewpoint and a functional and
oral health perspective. It is important that these concepts
are understood and applied, so that we may capture the
natural nuances of true beauty in our restorations.
In 1764 at the age of 67 a man named William Hogarth passed away. He was recognized as an 18th century
English painter, satirist and writer. Most notably in the
art world he was known for his theory of “The Line of
Beauty”. To put this into a time perspective, the Renaissance era was from the 14th century to the 17th century.
Leonardo da Vinci died in 1519 which put da Vinci in the
middle of the Renaissance era. The Renaissance was a
time of intense study and discovery of art and many other
developments that we enjoy today. For the art world it
was an eye opening development of linear perspective
and other techniques which rendered a more natural reality of painting. It was an awakening of the human brain
and its ability to “observe” and create within the world of
science and technology. Hogarth does reference Leonardo
da Vinci and Michelangelo with respect to their abilities
and insights and what made them as good as they were.
Hogarth explains that Leonardo did in fact understand
the “line of beauty” in nature and utilized it throughout
all of his work. He utilized it because it was a natural occurrence in his observations; he just didn’t define “the
line of beauty” and pinpoint its significance in nature.
In 1753 William Hogarth published a book called The
Analysis of Beauty ( Figure 1) . Prominent among his
ideas of beauty was the theory of the The Line of Beauty;
an S shaped curved line. He makes many references to
Leonardo da Vinci paintings and sculptures and his ability to bring his masterpieces to life. He explains in detail
that the reason Leonardo da Vinci’s work was so amazing
is because he captured the true essence of beauty, and
the “S” curve was ever present throughout all his work.
Hogarth explains how da Vinci had a passion to study the
human body and the intricate details of anatomy that are
hidden beneath the skin. In reality our anatomy is not
completely hidden beneath our skin, but more of the substrate that supports and forms our outward appearance.
Like da Vinci, Hogarth illustrates in his book the many
muscles and tendons of the human body and how it all
forms a twisting and serpentine effect on the surface of
the skin.
Hogarth goes on to explain that this “Line of Beauty”
is found throughout nature. He explains how the thickness or thinness of lines can most often determine the
reality or sense of the actual purpose and function of the
object of study. He uses a race horse and a work horse
among his many examples. He illustrates a race horse and
points out the muscles and tendons that are visually apparent on the body of this animal. He explains how the
muscles and tendons give definition and create the lines
in the skin of the horse. These lines are thinner, sharply
defined, and in many cases longer. He shows that all these
lines have this “S” line, and their existence is very obvious
after he points them out. Hogarth explains how his observations of the race horse and many other creatures that
possess speed and agility have similar definition and lines
on their bodies. He points out that these features exist in
creatures of the land, sea and sky.
On the other hand he illustrates the work horse and
explains and shows the thickness of the “S” lines on the
outer body of the horse. Again in contrast to the race
horse he points out the bulgy definition of the work horse
and how the lines are thicker and shorter in appearance.
These thicker lines on the work horse exhibit strength
and give us the feeling of such.
Hogarth developed and theorized 6 principles of beauty; Fitness, Variety, Uniformity, Simplicity, Intricacy, and
Quantity. Each of these principles can be observed and
applied to the anatomy of the oral cavity.
Hogarth defines FITNESS as the bulk and proportion of objects which are governed by their particular
function and specific utility. This would apply to the
different teeth in the mouth and their specific function.
For instance; incisors are narrower and designed for incising food and the bicuspids and molars are more bulky /
sturdy in appearance and are designed for crushing and
chewing food.
VARIETY can pertain to most of our senses. If all
things smelled, looked, tasted and felt the same we would
be displeased and frankly bored. Our brains thrive on
variety. It is difficult to imagine a mouth full of teeth all
looking like incisors and all being the same shape and
size. To us that would seem alien-like. It would possess
neither good form or function in our opinion.
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Hogarth states “We in deed in our nature a love of imitation from our infancy, and the eye is often entertained
as well as surprised, with UNIFORMITY, and delighted
with exactness of counterparts. But this always gives way
to its superior love of variety and soon becomes tiresome”.
In our profession we strive for uniformity/symmetry in
much of what we do. We look for good symmetrical arch
forms. An orthodontist’s goal is to straighten teeth and
make them symmetrical from one side of the arch to the
other. We also like the central incisors on an individual to
look exact but at the same time we like to rotate one lateral
compared to the other. We also like to ever so slightly create differences in one tooth of the same type compared to
the other. This follows the exact mindset that Hogarth is
conveying in his words above. Uniformity is good but it
must have variety as well.
Hogarth said “SIMPLICITY without variety is
wholly insipid and at best does only not displease”.
“There is no object composed of straight lines that has
such variety, with so few parts, as the great pyramids: and
it is its constant varying from its base gradually upward
in every situation of the eye without giving the idea of
sameness, as the eye moves around it”. Like the great
pyramids, teeth may seem simple to people outside of the
profession of dentistry. Teeth and pyramids appear to be
simple shapes, but the key is the incorporation of fitness,
variety and uniformity, while maintaining the sense of
simplicity.
INTRICACY. Hogarth states “The active mind is
ever bent to be employed. Pursuing is the business of our
lives; and even abstracted from any other view gives pleasure”. He further states; “Intricacy in form, therefore, I
shall define to be that small peculiarity in the lines, which
compose it, that leads the eye a wanton kind of chaser
and from the pleasure that gives the mind, initiates it to
the name of beautiful”. It is obvious that Hogarth had a
true love for the nature in art or the art in nature. It is
the intricacy in what we do and having the knowledge
to apply it in a natural way. That is the key to creating
“masterpieces”.
Regarding QUANTITY Hogarth states; “The wide
ocean awes us with its vast contents, but when forms of
beauty are presented to the eye in large quantities, the
pleasure increases on the mind, and the horror is softened
into reverence”. There are a multitude of details and nuances in the process of fabricating successful restorations.
The quantity of a complex restorative situation can be intimidating if there isn’t a well thought out map. “Beginning with the End in Mind” is essential. It is the quantity
of all these details; Fitness, Variety, Uniformity, Simplicity, and Intricacy, that makes the Quantity of something
massive or intricately pleasing to the senses.
Hogarth artistically and intelligently explains that
these principles comprise the fact that it is “Lines” and
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a certain arrangement of “Lines” that surround shape/
matter. It is these lines on the outer surface that gives us
the visual pleasure or an unpleasing response. In most
cases the notion and determination of the subject’s function is apparent.
Hogarth was a supporter of the philosophy; “form follows function”. It is the function that precedes form and in
turn renders form.
Figure 1.
Hogarth consistently utilized his “Line of
Beauty”theory in his paintings (Figure 2). He found it
to be a prominent and almost subconscious visual effect.
The “S” curve creates flow and a natural movement for
our eyes and brain to follow.
Figure 2.
*Painting by William Hogarth
The blue line was later placed by Hogarth to illustrate his theory
of the “Line of Beauty”
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Figure 3.
The technician cannot achieve a masterpiece without
the proper ground work to build his restorations upon
and the dentist cannot accomplish his preparation work
without understanding these nuances of nature and the
materials that will be replacing what is taken away. Stephen
R. Covey, inspirational speaker, businessman and author,
coined the saying; “Beginning With the End in Mind”.
This saying is extremely appropriate with many things we
do in life but it should also certainly apply to our daily lives
in dentistry. The biggest disconnect and reason for mediocre results is this lack of planning, communication, and
understanding between the technician and dentist.
The best interdisciplinary success stories are those of
a technician and a dentist who have taken the time to understand the nuances of art and precision of each other’s
particular jobs, and to communicate exactly what one or
the other needs to achieve success in their role as a player
in the masterpiece. This is a small investment in time that
reaps great rewards of team success.
Figure 4.
These well known companies are familiar and their logos are
distinct and pleasing to the eye. Based on their success, it is safe
to conclude that they have also appealed to our brains. They all
clearly possess the “S” curve.
Knowledge through observation is what makes this
world a more interesting place. The information that Hogarth shares in his book Analysis of Beauty and his theory
of the “line of beauty” does enable one to understand
exactly why something catches the eye and/or appeals to
the senses. This course is intended to point out this detail
found in nature and to illustrate how it translates into dentistry and the “oral structures” of the human mouth.
Dentistry involves recreating and restoring something
that has been lost. Incorporating these details into your
work as a dentist or dental technician through a deeper
understanding of what makes something more beautiful
enhances one’s ability to create masterpieces. These small
details and nuances are intricate but entail little to no additional effort.
“Why is it so difficult to Create Masterpieces?”
The major underlying problem to creating a masterpiece
is having everybody who is involved in creating it to be on
board the same boat. Most masterpieces are a collaborative
effort of likeminded people with a common goal. Likeminded does not necessarily mean that each member of
the team has to be exactly alike, but they must bring to the
table the qualities that are in demand and possess the mindset of accomplishing a successful masterpiece. Actually,
people’s natural uniqueness is what inspires innovations and
progress. This can all happen within the boundaries of the
common goal. When this occurs it is actually easy to create
masterpieces of all sorts.
This is a famous drawing by M.C. Escher. Note the “S” curve that starts
at the corner of the bookshelf above his head, follows the bookshelf
down the left side of the head, down his left arm and finishing at the
end of his knee. It gives the picture flow and movement.
With teeth we have a root that is typically unseen and
a clinical aspect that is visible. The reality of this situation
with teeth in our mouth is that these roots underneath
the soft tissue are what create the beautiful shapes of the
papillae. To an untrained eye these papillae just look like
points of pink tissue. When you observe a healthy mouth
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with full papillae, you will notice the nuances of tissue
and how it follows and flows with the contour of the teeth
and invisible root. There are depressions and concavities
on the mesial and distal aspects of teeth. These depressions are generally from the bifurcations on posterior
teeth and the natural concavities in the roots of anterior
teeth. Subsequently the bifurcation or concavity is deeper
at the apex of the root and softens as it nears the cementoenamel junction and flows into the coronal portion of
teeth. It is these little nuances in the art of making teeth
that many technicians and dentists fail to mimic. These
nuances, if not understood and followed, will negate the
ability to make restorations look natural. The papillae will
not have the “S line” / “Line of Beauty” making the teeth
look bulky or simply incorrect to the human eye. “Fake”.
It is simply a “flow” in the lines and they all possess
this “S” curve. This anatomical beauty is found in the
entire tooth, root and mouth. (Figure 5).
The lower jaw has left and right excursive movement ability. This alone changes the entire design of the
anatomy of the orofacial structures. Everything from the
condyles to the teeth is uniquely and distinctly different.
It would be easy to elaborate on the temporomandibular joint and the role it plays in form and function. The
design of each tooth is precise in its form. Maintaining
this form is vital for the longevity of the teeth, tissues and
temporomandibular joints.
Figure 5.
Figure 6.
This “S” shaped contour is also visible on posterior
teeth. It is solely dictated by the anatomical shape of the
teeth and one of the reasons we find them so uniquely
beautiful. (Figure 6)
Figure 7
Figure 8
The contours of posterior teeth have an appearance
similar to a champagne glass (Figure 7) . There are many
different areas in which the “S” curve plays a part. Teeth
were created to function in speech and masticate food,
but their beauty is visually stimulating to the observer.
(Figure.8)
It is these things that define a pleasant smile from an
unpleasant smile. These nuances of nature can be negatively affected by a variety of factors. These factors can
be habitual, environmental, physiological, dietary and
iatrogenic, among others.
“What makes an ugly crown ugly”?
The “S” curve /“Line of Beauty” is very prevalent in teeth and
tissue. An “S” curve is present from the tip of the papilla to
the apical point of the gingival margin. This is created by the
emergence profile/entrant line angle of each individual tooth.
The emergence profile is created by the anatomical contour of
the tooth and how it transitions from the cylindrical/oval shaped
root to the anatomical shape of the clinical crown. In this area in
which the “S” line is present, there is a negative contour to the
tooth which the gingival tissue flows into. This is why it is critical
to observe and incorporate adequate reduction to allow the
ceramist to recreate this natural and beautiful nuance. It is also
critical to observe this when making provisionals so the tissue is
not violated and permanantly altered.
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If crowns are bulky and present unusual contours at the
tissue line, it will affect the overall health of the gingiva.
If a crown presents an occlusal table that is too wide for
the overall anatomy of the surrounding environment then
it may not masticate food efficiently and it will produce
more force upon that tooth, thus impacting the surrounding tissues and joint. And if a crown has the above mentioned irregularities it will not display as beautiful.
The clinical application of tooth preparation and the
errors that occur with a lack of reduction and improper
design are illustrated in Figures 9-13. The finished crown
exhibits the esthetic results of these deficiencies in tooth
preparation, which are potentially accompanied by functional issues as well.
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Figure 9. Under-reduced preparation
Figure10. Under-reduced central fossa
Figure 11. Computer generated coping.
Figure 12. Facial view of final restoration
Figure 13. Occlusal view of “ugly” restoration
The laboratory can create masterpieces with dentists
who provide the skill of hand and knowledge of concept
for successful preparations.
The author requested that one of his dentist accounts
put as little effort into his preparation of a tooth as possible
(Figures 9- 13). A crown would then be fabricated on the
poorly designed preparation to the best of the technician’s
ability. Subsequently the dentist would re-prepare the
same tooth to ideal contours thus enabling the technician
to fabricate an ideal restoration (Figures 14-21)
Figure 9 illustrates a lack of axial wall reduction. Basically it is too square, bulky and lacking any anticipation of
the restorative materials that are going to be applied and
the minimal thicknesses required to obtain proper color,
vitality, strength, and contours. The results will be unsatisfactory for a number of reasons, and at the expense of the
patient, dentist and technician. The crown will not look
good from day one and the longevity may be compromised.
The central fossa area is most commonly underprepared. Adequate reduction is critical from a strength perspective, Figure 10. The inclines of the adjacent teeth are
fairly steep, and the inclines on the occlusal of the prepared
tooth are nearly flat. In this case, the buccal and lingual
cusps were reduced adequately but the central fossa is
under-reduced. This inadequate reduction will result in a
restoration that will not render good color, will be subject to
fracture and the contours resulting from this type of design
will hinder the function and esthetics of the restoration.
A computer generated image for a zirconia coping
was created, keeping the coping as thin as possible in an
attempt to maintain adequate room for layering materials
(Figure 11). Many areas on this restoration were less than
1mm. Even a monolithic full contour zirconia crown is
not advisable at that thickness because studies show that
exposed (unglazed) zirconia will weaken by approximately
50% over a 6 year span. Sufficient strength of restorative
crown and bridge materials is provided with 1.5mm tooth
reduction. Materials with a thickness of 1mm do not have
the strength of the same materials that are 1.5mm thick.
Even with nanotechnology and super fine grain materials
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that exhibit beautiful tooth-like qualities in thin quantity,
it is still a suggested protocol by porcelain companies to
have minimal thicknesses of material of 1.5mm to 2mm.
The minimum amount of reduction on teeth that are being prepared for a crown or bridge is 1.5mm. The other
significant factor is the wear compatibility of restorative
materials with opposing dentition. Gold is a very compatible restorative material but it is still important to provide
enough reduction so that there is sufficient room for material to attain proper contour.
From a clinical standpoint the best result obtainable
with the under-prepared tooth was a bulky crown that
did not exhibit proper color, contour, function or beauty
(Figure 13) It was necessary to put a zirconia contact area
on the occlusal surface to avoid the need for a reduction
coping, or reduction of the opposing teeth or completely
prepare the tooth again.
Figure 15. Preparation that provides the ability to design a
properly supported coping , but with sufficient space for ceramic
and contouring.
Figure 16. Notice how the depth of the central fossa allows the
technician to incorporate ideal fossa depth and inclines.
“What makes a beautiful crown beautiful”?
The highly respected technician Lee Culp said “[A technician usually has complete control as to how he or she can
make the occlusal or incisal two thirds of a crown look,
BUT it is the dentist who controls the result of the gingival
1/3 of the crown]”. The choices between a feather, chamfer, bevel and/or shoulder preparation will determine to a
great degree, how close to ideal the technician can fabricate
the crown restoration. If the gingival 1/3 is not correct then
the entire crown will appear incorrect.
Modern day protocol for all ceramics is a semi-deep
chamfer with a minimum of 1.00mm depth at the margin
without creating a trough.
The All-Ceramic Chairside Preparation Guide for IPS
e.max® restorations states: “When layered or pressed
ceramic margins are preferred in conjunction with zirconia
framework, enhanced gingival esthetics can be achieved
with a definite 90 degree shoulder preparation”.
Too often there is inadequate chamfer at the margin
and or the margin does not have a harmonic flow with the
crest of the tissue. This is where the true art of preparing
teeth comes into play. It is these little nuances that can
make big differences in the end results.
Figure 17. Note “S” curve in the emergence
Figure 18. This “S” curve coincides with the soft tissue.
Figure 14. When the preparation provides adequate reduction,
the crown can be made to proper proportions.
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Figure 19. Note that the occlusal table is in agreement with the
adjacent teeth
Figure 22. Drawings by Hogarth, illustrating his “Line of Beauty”.
Figure 20. Ideal preparation which provides the ability to fabricate a natural restoration that mimics the adjacent natural teeth.
Figure 21. A less than ideal preparation makes it difficult, if not impossible, to create restorations that harmonize with adjacent natural teeth.
Even though restorative materials and techniques are
forever changing and in many cases advancing it does
not alter the principles of natural esthetics and the function that nature provides. This is where we must adhere
to nature’s principles as we evolve as an industry of fixing, repairing, and maintaining the anatomy of orofacial
structures.
So when you think about the “S” in Esthetics or the
“Line of Beauty” you might want to visualize it when you
look at teeth. It is the little nuances in nature that make a
HUGE difference. It is the “FLOW” in nature that attracts
our attention, and makes the brain say “I Like That”.
Author Profile
Bill Connell, CDT, CDL, completed his A.S. Degree in
1986. Bill’s foundation for complex dentistry began at the
Pankey Institute in 1989. Bill has spent time learning from
many of the most respected dental professionals including;
Dr. Peter Dawson, Dr. Frank Spear, Willi Geller, Dr.Robert
Winter, Don Cornell, Michel Magne, and Gerald Ubassy.
Bill’s focus is to stay abreast of the rapidly advancing technology, and continue his daily pursuit of excellence in work,
family and life.
Author Disclosure
Bill Connell, CDT, CDL, is currently a Pankey Institute
advisor and guest presenter.
Notes
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Notes
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Questions
1.According to Hogarth, which of the
following gives definition and creates
lines in the skin of a horse?
a.
b.
c.
d.
Uniformity and simplicity
Strength and agility
Muscles and tendons
Speed and agility
2. William Hogarth was most recognized as:
a.
b.
c.
d.
An engineer
A sculptor
A philosopher, lawyer and humanitarian
A painter, satirist and writer
3. One of Hogarth’s greatest inspirational
characters from the Renaissance era was:
a. Leonardo da Vinci
b. Filippo Lippi
c.Bronzino
d. Andrea del Sarto
4. In William Hogarths book “ Analysis of
Beauty” what is his greatest theory based
upon, and what did he call it?
a.
b.
c.
d.
Curvature / “The Flow of Nature”
Light / “The Diversion of shadow’s”
The S curve / “The Line of Beauty”
Sight / “Parallelism of refraction”
5. Which of the following was a supporter
of the philosophy, “Form Follows
Function”?
a.Michelangelo
b. Lee Culp
c. William Hogarth
d. Leonardo da Vinci
6. In the book “Analysis” Hogarth intelligently
explains how the principles of beauty comprise the fact that it is “Lines” and a certain
arrangement of “Lines” that surround:
a. Muscles and tendons
b. Form and function
c. Hair and skin
d.Shape/matter
7.How many principles of beauty did
William Hogarth theorize?
a.4
b.10
c.7
d.6
8.How did William Hogarth represent his
theory in his paintings?
a.
b.
c.
d.
With swirling strokes
With dark objects contrasting with light objects
With an S curve flow or subtle S line.
With thick and thin lines that run straight
horizonatlly.
9. Which principle of beauty did William
Hogarth theorize to have the quality of
“small peculiarity in lines”?
a.
b.
c.
d.
Fitness
Intricacy
Variety
Uniformity
10. Which principle of beauty did William
Hogarth theorize to have the quality of
“bulk and proportion”
a. Intricacy
b.Quantity
c.Simplicity
d.Fitness
11. Which principle of beauty did William
Hogarth theorize to have the quality of
“exactness of counterparts”?
a.Uniformity
b.Fitness
c.Variety
d.Simplicity
12. William Hogarth’s reference to the great
pyramids illustrates the principle of:
a.Uniformity
b.Simplicity
c.Variety
d.Quantity
13. Which principle of beauty did William
Hogarth refer to when he wrote, “ The
wide ocean awes us”?
a.Variety
b.Quantity
c.Fitness
d.Intricacy
14. Which of the following stated, “Beginning
with the end in mind”?
a.
b.
c.
d.
Dr. Irwin Becker
Dr. Steven Covey
Dr. L.D. Pankey
Dr. Peter Dawson
15. Which aspects of the oral cavity display
the “Lines of Beauty”?
a. The mesial incisal edge of the maxillary canines
b. The interproximal tissue and how it contours
against the emerging profiles of the teeth.
c. The cusp profiles and how they flow over into the
occlusal anatomy.
d. All of the above.
16. The contours of posterior teeth have
which of the following properties?
a. Speech
b. Mastication
c. Beauty
d. All of the above
17. Which of the following is the primary
reason for the “Line of Beauty” in the
interproximal tissue?
a. It is the bulk of the tissue and how it plumps
b. It is only found on older patients who have had
poor dentistry.
c. This only occurs from the application of
orthodontics.
d. It is determined by the bifurcation of teeth and
the concavities that are present on the mesial
and distal and how they emerge from the
tissue.
18. The “Line of Beauty” is found on what
areas of a tooth or teeth?
a. The entire tooth
b. Only the root
c. Clinical aspect only
d. At or near the cementoenamel junction.
19. Successful restorations start with:
a. The best materials
b. Concise, complete and open communication
between a knowledgeable dentist and technician.
c. A good bur kit for preparing teeth
d. A master ceramist
20. The minimum reduction of the central
fossa for most ceramic materials is:
a.1.0mm
b.0.5mm
c.1.5mm
d.2.0mm
21. What is the common protocol of design
preparation for the gingival aspect of
teeth to receive an all ceramic full contour
restoration?
a. Feather edge
b. A trough or ditch-like valley
c. A chamfer exhibiting (at least1mm to 1.5mm)
depth of cut and progressing into a 1.5mm axial
wall reduction.
d. A shoulder type design
22. An underprepared tooth will likely
result in a restoration with which of the
following?
a. Bulky crown
b. Improper color and contour
c. Improper function
d. All of the above
23. Which of the following is primarily
responsible for the esthetics of the papillae?
a. Tooth roots
b. Coronal tooth structure
c. Labial frenum
d. None of the above
24. Crowns that are made on preparations
that do not provide enough reduction
compromise the restoration in what way?
a. Poor color control.
b. Compromised strength and longevity
c. Improper contour and lack of S curves / Lines of
Beauty.
d. All of the above.
25. William Hogarth was able to clearly
identify “Lines of Beauty” in nearly all of
nature. Where did he specifically recognize
these characteristic traits?
a.
b.
c.
d.
Creatures of all sorts that are found on land.
Creatures and fish of the sea.
Birds in the sky.
All of the above.
26. Most masterpieces are a collaborative
effort of like-minded people with a
common:
a.Mindset
b.Goal
c. Personality traits
d.Variety
27. The illustration of the Escher drawing
was used to demonstrate which of the
following?
a. The “S” curve / Line of Beauty
b. Escher’s love for books
c. Amazing artistic talent.
d. Interdisciplinary success
28. As technology and automation
progress it will be just as important
for dentists to provide properly designed
and prepared teeth for which reason?
a. To provide enough space for the restorative
material so that the technician or machine can
incorporate proper contour and “Lines of Beauty”.
b. So the restoration possesses strength and longevity.
c. So there is color control, vitality, and a luminescent appearance in the ceramic.
d. All of the above.
29. According to Lee Culp, which of the following has total control of the gingival third of
the crown or bridge restorative result?
a.Orthodontist
b.Dentist
c.Technician
d.Patient
30. What makes an ugly crown ugly?
a.Bulkiness
b. Occlusal table that is too wide
c. Unusual contours at the tissue line
d. All of the above
ANSWER SHEET
The “S” in Esthetics
Name:
Title:
Specialty:
Address:E-mail:
City:
State:ZIP:Country:
Telephone: Home (
)
Office (
Lic. Renewal Date:
) AGD Member ID:
Requirements for successful completion of the course and to obtain dental continuing education credits: 1) Read the entire course. 2) Complete all
information above. 3) Complete answer sheets in either pen or pencil. 4) Mark only one answer for each question. 5) A score of 70% on this test will
earn you 2 CE credits. 6) Complete the Course Evaluation below. 7) Make check payable to PennWell Corp. For Questions Call 216.398.7822
If not taking online, mail completed answer sheet to
Educational Objectives
Academy of Dental Therapeutics and Stomatology,
1. Describe the “Line of Beauty”
A Division of PennWell Corp.
P.O. Box 116, Chesterland, OH 44026
or fax to: (440) 845-3447
2. Describe how the “Line of Beauty” applies to clinical dentistry
3. Describe the parameters of an inadequate crown preparation
4. Describe and execute a crown preparation providing adequate reduction to achieve excellent esthetic results
Course Evaluation
1. Were the individual course objectives met?Objective #1: Yes No
Objective #2: Yes No
Objective #3: Yes No
Objective #4: Yes No
Please evaluate this course by responding to the following statements, using a scale of Excellent = 5 to Poor = 0.
For immediate results,
go to www.ineedce.com to take tests online.
Answer sheets can be faxed with credit card payment to
(440) 845-3447, (216) 398-7922, or (216) 255-6619.
P ayment of $49.00 is enclosed.
(Checks and credit cards are accepted.)
2. To what extent were the course objectives accomplished overall?
5
4
3
2
1
0
If paying by credit card, please complete the
following:
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3. Please rate your personal mastery of the course objectives.
5
4
3
2
1
0
Acct. Number: _______________________________
4. How would you rate the objectives and educational methods?
5
4
3
2
1
0
Exp. Date: _____________________
5. How do you rate the author’s grasp of the topic?
5
4
3
2
1
0
6. Please rate the instructor’s effectiveness.
5
4
3
2
1
0
7. Was the overall administration of the course effective?
5
4
3
2
1
0
8. Please rate the usefulness and clinical applicability of this course. 5
4
3
2
1
0
9. Please rate the usefulness of the supplemental webliography.
4
3
2
1
0
5
10. Do you feel that the references were adequate?
Yes
No
11. Would you participate in a similar program on a different topic?
Yes
No
Charges on your statement will show up as PennWell
12. If any of the continuing education questions were unclear or ambiguous, please list them.
___________________________________________________________________
13. Was there any subject matter you found confusing? Please describe.
___________________________________________________________________
___________________________________________________________________
14. How long did it take you to complete this course?
___________________________________________________________________
___________________________________________________________________
15. What additional continuing dental education topics would you like to see?
___________________________________________________________________
___________________________________________________________________
AGD Code 780
PLEASE PHOTOCOPY ANSWER SHEET FOR ADDITIONAL PARTICIPANTS.
COURSE EVALUATION and PARTICIPANT FEEDBACK
We encourage participant feedback pertaining to all courses. Please be sure to complete the survey included
with the course. Please e-mail all questions to: [email protected].
INSTRUCTIONS
All questions should have only one answer. Grading of this examination is done manually. Participants will
receive confirmation of passing by receipt of a verification form. Verification of Participation forms will be
mailed within two weeks after taking an examination.
COURSE CREDITS/COST
All participants scoring at least 70% on the examination will receive a verification form verifying 2 CE
credits. The formal continuing education program of this sponsor is accepted by the AGD for Fellowship/
Mastership credit. Please contact PennWell for current term of acceptance. Participants are urged to contact
their state dental boards for continuing education requirements. PennWell is a California Provider. The
California Provider number is 4527. The cost for courses ranges from $20.00 to $110.00.
Provider Information
PennWell is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association
to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP
does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours
by boards of dentistry.
Concerns or complaints about a CE Provider may be directed to the provider or to ADA CERP at www.ada.
org/cotocerp/.
The PennWell Corporation is designated as an Approved PACE Program Provider by the Academy of General
Dentistry. The formal continuing dental education programs of this program provider are accepted by the
AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance
by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from
(11/1/2011) to (10/31/2015) Provider ID# 320452.
RECORD KEEPING
PennWell maintains records of your successful completion of any exam for a minimum of six years. Please
contact our offices for a copy of your continuing education credits report. This report, which will list all
credits earned to date, will be generated and mailed to you within five business days of receipt.
Completing a single continuing education course does not provide enough information to give the
participant the feeling that s/he is an expert in the field related to the course topic. It is a combination of
many educational courses and clinical experience that allows the participant to develop skills and expertise.
CANCELLATION/REFUND POLICY
Any participant who is not 100% satisfied with this course can request a full refund by contacting PennWell in writing.
Image Authenticity
The images provided and included in this course have not been altered.
© 2013 by the Academy of Dental Therapeutics and Stomatology, a division of PennWell
SESTH1013DIG
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Customer Service 216.398.7822
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