Ministry of Higher Education

And Scientific Research

University of Ahl AL-Bayt
Collage of Dentistry

Bio-Emulation:
biomimetically emulating nature utilizing
a histoanatomic approach; visual
synthesis

A Project Submitted to the Council of the College of Dentistry

at Ahl AL-Bayt University Department of Conservative Dentistry in Partial
Fulfillment of the Requirements for B.D.S degree.

Prepared by:
Ahmed Ridha H. & Zaynep Aicer

Supervised by:
Dr. Mohammed Ali Fadhil
B.D.S., M.Sc., Ph. D., Restorative & Aesthetic Dentistry

1445 2024

1
 ‫بسم ال الرحن الرحيم‬

‫ُأوَلِمَِ ََِلى ُهًدى ِمْم رِّبِهْم‬

‫وُِأوَلِمَِ ُهْه اَفُهْفَمُهوَِ‬

‫صدق ال العلي العظيم‬

‫‪2‬‬
Dedication

To my family, the reason of what I became,

Thanks for your great support and continues care.

To our respected teachers whose efforts and wishes

are an inspiration.

Thanks to my dear friends and colleagues for their

loyal support

sincerely

3
 Acknowledgments

First of all, we would like to extend our thanks to“ God” for giving us
energy and strength to accomplish this work, and we pray for His great
Prophet Mohammed (peace be upon him).

We would like to thank Dr. Selma Merza Hassan the Dean of the college of
Dentistry/Ahl al-Bayt University, peace be upon them, for supporting the
undergraduate students.

We are highly indebted to Dr. Rafid J. Al-badr, the head of conservative

department, for his scientific support, excellent guidance, caring, continuous
helpful advice throughout our study, his efforts were deeply appreciated.

We express our deepest gratitude to our supervisor Dr. Mohammed Ali

Fadhil for his unlimited cooperation ,scientific sponsorship, and high moral
spirit that always encourages and advised us in the right way during this
research.

Our deepest respect goes to Dr. Manar Modher Nbat, for his scientific
support, encouragement, high ethics, advices, unforgettable efforts, and
assistance during our study.

Finally, we would like to express our gratitude to our beloved family, my

wonderful parents for everything.

4
 List of Content

Objective Page
Acknowledgments 4
List of content 5
List of figures 6
Introduction 9
Review of literatures 11
Dynamic light Interaction 11
Relative refractive index 14
Light guiding by scattering in enamel and dentin 14
The nine elements of visual synthesis 19
Objective color elements 19
Subjective optical elements 22
Dynamic infinite optical thickness 24
Amplified visual perception effect 26
Diversification of photographic illumination techniques 27
Reflective Illumination 28
Reflective cross-polarized illumination 29
UV Illumination 29
Transillumination 29
Discussion 30
Conclusion 32
References 33

5
 List of figures

figure Title page

Relative attribution: although translucent by nature, the coronal
1 structural elements can be graded with regards to their relative 10
dynamic light interactivity and unique optical expression.
Dynamic light interaction will generate the visual synthesis which is
influenced by nine elements: surface texture, gloss and luster
2 11
(S/G/L); hue, chroma and value (H/C/V) and translucency,
opalescence and fluorescence (T/O/F).
The term reflectance is used to denote the fraction of light energy
that is reflected by the surface of a given material. If the surface is
3 not plane but curved, as is the case with enamel above, it may still 12
be considered to be made up of many very small, elementary plane
surfaces.
The term refraction is used to denote a change in direction of
propagation of light waves as a result of its traveling at different
4 speeds at different points among the wave front between mediums 12
of varying optical densities. Primary subsurface scattering is
denoted by the radial arrow depictions.
Light interactivity model. From the cervical to the incisal regions,
the dominance of the dentin core gradually gives way to that of the
enamel shell respectively, achieving a brief equilibrium in the
middle region. Multi-directional forms of scattering (colored
5 13
arrows) and refractive index variations between the
enamel/dentinoenamel complex/dentin substrates create infinite
photonic pathways, collectively rendering a unique visual synthesis
depending upon the incident light direction and intensity.
The frontal longitudinal tooth section was submerged in distilled
water and photographed on a black background. Despite using the
same amount of direct reflective illumination per exposure, a
directional change of 90 degrees reveals stunning and complex light
transmissive and reflective pathways, emphasizing the optical
anisotropy of dentin. Sharp details and remarkable contrast within
6 15
the dentin shade is seen (c). Pronounced backscattering across the
enamel prisms and the dentin tubules render a diffuse appearance
obscuring critical details as evident in depiction (d), based on
incident light direction. Parallel illumination with respect to the
long axis of the tooth present on the left and perpendicular on the
right.
Dentin subadjacent to the DEC exhibits a transitional orthogonal
7 16
rotational orientation from cervical to incisal with regards to the

6
 dentin tubules. Hence, despite the fact that cervical dentin is thicker,
due to the parallel orientation of of the tubules, it is rendered more
translucent. The opposite happens with respect to incisal dentin,
despite the fact that it is thinner, due to the perpendicular orientation
of the tubules, it is rendered more opacious.
Direct illumination is used to enhance the sensation of surface
topography of the maxillary central incisors. Moderate wear is
viewed on the vertical developmental lobular heights of contour
8 18
whereas the concave depressions have retained parts of their
original horizontal structural anatomy; diffuse light was utilized via
indirect illumination to enhance the sensation of gloss and luster.
The intact teeth comprising the maxillary triad were extracted
concurrently due to periodontal reasons and deemed as exemplary
dental specimens for exploring interdental structural and optical
9 20
inter-relationships. Aggressive acidulation led to the selective
enamel dissolution and revealed the dentin substructure. Lobular
coalescence is particularly prevalent in the central incisor.
The objective color elements as viewed and estimated; general
congruency is observed among the cervical (C), middle (M) and
incisal (I) thirds amongst the maxillary triad. A multitude of hues is
found at the incisal third due to the phenomena of opalescence and
10 21
counter-opalescence. Chroma is more pro- nounced at the cervical
third due to the thickness of dentin.31 In all instances Value is
highest at the middle third, due to the fact that the enamel and
dentin present an equilibrium in terms of thickness ratios.32
The longitudinal histological tooth section of a maxillary central
incisor, 1 mm in thickness, was submerged in distilled water and
11 22
photographed via transmissive illumination (upper) and reflective
illumina- tion (lower) to epitomize the opalescent nature of enamel.
A submerged maxillary premolar was photographed with reflected
long wavelength UV illumina- tion (365 nm), enabling the
12 visualization of dentin exhibiting three times the fluorescence 23
intensity than that of enamel. Note that the DEC also exhibits
pronounced fluorescence.39-41
Individual and pooled averages with regards to labial enamel
13 thickness for the maxillary triad at the cervical (C), middle (M) and 25
incisal (I) thirds.44-46
Pooled averages with regards to labial dentin thickness for the
14 26
maxillary triad at the cervical (C), middle (M) and (I) thirds.44
Enamel is responsible for creating an optical illusion of the apparent
15
versus the actual position with regards to the visualization of the 27
underlying incisal dentin.

Facial illumination techniques from top to bottom: reflective,

16 28
reflective cross-polarized, reflec- tive UV and transillumination.
17 Palatal illumination techniques from top to bottom: reflective, 28

7
 reflective cross-polarized, reflec- tive UV and transillumintion
Stone replicas facilitate visual assessment and rumination of the
variability between enamel and dentin surface topography.
Mesiobccal (left) and Mesiopalatal (right) oblique views of central
incisor, lateral incisor and canine (top to bottom). Generalized
18 external enamel macromorphological congruency is seen upon the 30
dentin counterpart, with amplified vertical corrugations, providing
added roughness and waviness that is critical to be emulated during
restorative stratification techniques.64

8
Introduction

A thorough understanding of the spatial distribution pertaining to the

histo-anatomic coronal structures and dynamic light interaction of the
natural dentition provides the dental team with the ultimate strategic
advantage with regards to optical integration of the final restoration. The
second part of this two-part article will attempt to provide insight on the
illumination interactivity and the spatial arrangement of the coronal elements
of natural teeth through the utilization of this knowledge in the clinical and
technical restorative approach.
The main goals for this article are to cognize histo-anatomic
visualization by introducing: (1) Dynamic light interaction, (2) the 9
elements of visual synthesis, (3) dynamic infinite optical thickness, and (4)
amplified visual perception effect of the hard dental tissues. Furthermore, a
diversification of photographic illumination techniques will be illustrated in
order to juxtapose optical associations between the enamel/dentinoenamel
complex/dentin nexus.

9
 Fig 1 Relative attribution: although translucent by nature, the coronal structural
elements can be graded with regards to their relative dynamic light interactivity and
unique optical expression.

In the modern dental practice, recreating the optical features of the

intact tooth presents a formidable task, due to the inherent translucent nature
of enamel, the dentinoenamel complex (DEC) and dentin. Translucent
materials offer a significant color measurement challenge since they interact
with light in a far more complex manner than most other materials. While
being translucent by nature, when coronal structures, such as enamel, the
DEC and dentin, are compared among each other, they seem to possess
relative translucency, transparency and opacity respectively (Fig 1).
Anachronistic traditional visual estimation approaches that solely
employ the Munsell color model system based on hue, chroma, and value
(H/C/V) dominate the dental market appear to be inadequate when
conveying the pertinent information among the dental team members
(clinician/technician/patient). Further information regarding the description
of surface texture, gloss, and luster (S/G/L) should also be appraised in
conjunction with translucency, opalescence and fluorescence (T/O/F) as part
of the process of visual assessment (Fig 2).

10
 Review of Literature

Dynamic light Interaction

Reflection and refraction in enamel and dentin

Incident light ray interactivity with a tooth can be:

 Reflected specularly and/or diffusely from its surface (Fig 3)

 Refracted and either:

 scattered within it and subsequently reflected, a process largely

responsible for color perception (Fig 4)
 transmitted diffusely through it (relating to the properties of transparency,
translucency and opacity) (Fig 5)
 absorbed within it (the electromagnetic energy is transformed to other
forms of energy, eg, heat, photolu-minescence, photoelectric effect etc)
 re-radiated with a lower energy state (eg, fluorescence)

Fig 2 Dynamic light interaction will generate the visual synthesis which is influenced by
nine elements: surface texture, gloss and luster (S/G/L); hue, chroma and value (H/C/V)
and translucency, opalescence and fluorescence (T/O/F).

11
Fig 3 The term reflectance is used to denote the fraction of light energy that is reflected
by the surface of a given material. If the surface is not plane but curved, as is the case
with enamel above, it may still be considered to be made up of many very small,
elementary plane surfaces.

Fig 4 The term refraction is used to denote a change in direction of propagation of light
waves as a result of its traveling at different speeds at different points among the wave
front between mediums of varying optical densities. Primary subsurface scattering is
denoted by the radial arrow depictions.

12
Fig 5 Light interactivity model. From the cervical to the incisal regions, the dominance
of the dentin core gradually gives way to that of the enamel shell respectively,
achieving a brief equilibrium in the middle region. Multi-directional forms of scattering
(colored arrows) and refractive index variations between the enamel/dentinoenamel
complex/dentin substrates create infinite photonic pathways, collectively rendering a
unique visual synthesis depending upon the incident light direction and intensity.

13
Relative refractive index

Due to the fact that enamel and dentin are heterogeneous hydrated
substrates of variable inorganic and organic composition, one must consider
collectively the volume fraction of their individual elemental component’s
refractive index (RI), resulting in their respective relative refractive index
(RRI). Moreover, depending on the localized mineral content of these
substrates, minor fluctuations in the RI may ensue,with the highest values
always occurring within the more mineralized locations (Hariri, 2013,
Wiemann et al., 1070).The structural orientation and the arrangement of the
enamel prisms do not seem to have a significant effect on light attenuation,
resulting in an RRI value of 1.63. (Meng et al., 2009 ; Hariri et al., 2012).
Unlike enamel, the structural orientation and arrangement of the
dentin tubules seem to play a significant role with regards to the RRI of
dentin. Traditionally, dentin has been cited with a generalized RRI value of
1.54. (Meng et al., 2009). Contemporary localized RRI values for dentin
subadjacent to the dentinoenamel complex (DEC) include 1.60 (cervical),
1.56 (middle), and 1.49 (incisal). (Hariri et al., 2012). The DEC, being an
organic proteinaceous continuum (Bodier-Houllé et al., 2000). that is
dominated primarily by Type I collagen, has an RRI value of 1.43.
(Wang et al., 1996 ; Bashkatov et al., 2000).

Light guiding by scattering in enamel and dentin

The heterogenous composition and asymmetric directional

distribution of the hard dental tissue structural components add to the level
of complexity with regards to microscopic light interactivity. Natural
waveguides,(Zolotarev and Grisimov, 2001). such as enamel and dentin,

14
are differentiated from conventional optical fibers by being nonuniform and
containing scattering particles. Nonetheless, they have the ability to collect
light and transport it purposely towards the pulp chamber (Fig 5). (Altshuler
and Erofeev, 1995 ; Altshuler and Grisimov, 1990). Scattering generally
implies a forced deviation of light from a straight trajectory by localized
non-uniformities (scatterers), found upon or within the medium through
which it interacts, without the loss of energy.
Reflection, refraction and diffraction represent various forms of
scattering. With regards to enamel and dentin, multiple scattering pathways
are prevalent. In the quantum picture, when the wavelength (frequency) of
the scattered light is the same as the incident light, elastic scattering
occurs.Conversely, when the emitted radiation has a wavelength different
from that of the incident radiation,inelastic scattering occurs.
The inorganic component of the dental hard tissues is responsible for
elastic scattering; via Rayleigh scattering (rather isotropic, only depending
on the polarization of the wavelength) in the case of enamel and via Mie
scattering (rather anisotropic, forward scattering is predominant) in the case
of dentin,(Raulin and Karsai, 2011). while the organic component of the
dental hard tissues is responsible for inelastic scattering; via fluorescence.
Fig 6 The frontal longitudinal tooth section was
submerged in distilled water and photographed on a
black background. Despite using the same amount of
direct reflective illumination per exposure, a directional
change of 90 degrees reveals stunning and complex
light transmissive and reflective pathways, emphasizing
the optical anisotropy of dentin. Sharp details and
remarkable contrast within the dentin shade is seen (c).
Pronounced backscattering across the enamel prisms
and the dentin tubules render a diffuse appearance
obscuring critical details as evident in depiction (d),
based on incident light direction. Parallel illumination
with respect to the long axis of the tooth present on the
left and perpendicular on the right.

15
Fig 7 Dentin subadjacent to the DEC exhibits a transitional orthogonal rotational
orientation from cervical to incisal with regards to the dentin tubules. Hence, despite
the fact that cervical dentin is thicker, due to the parallel orientation of of the tubules, it
is rendered more translucent. The opposite happens with respect to incisal dentin,
despite the fact that it is thinner, due to the perpendicular orientation of the tubules, it is
rendered more opacious.

In the case of enamel, major random scattering occurs on the

ultrastructural level from the hydroxyapatite (HAp) crystal subunits, whereas
minor random scattering occurs on the microstructural level due to the prism
sheaths/interprismatic material orientation in conjunction with the sinuous
paths of Hunter- Schreger bands.(Vaarkamp et al., 1995 ; Zijp et al., 1995).
The scattering coefficient appears to increase with shorter
wavelengths,(Spitzer and ten Bosch, 1975). while thin enamel sections also
exhibit a Fraunhofer diffraction pattern in the plane perpendicular to the
enamel prisms,(O’Brien, 1988).
acting as a diffraction grating which in turn may be responsible for
generating iridescent reflections (Fig 6). In the case of dentin, multiple
directional scattering occurs on the microstructural level due to the presence
and spatial arrangement of the dentin tubules and the collagen fiber
mesh.(Vaarkamp et al., 1995 ; Kienle et al., 2003 ; Kienle and Hibst,
2006). In contrast with enamel, the scattering coefficient does not change

16
significantly with wavelength.(Fried et al., 1995). Directly below the DEC,
scattering is decreased due to low tubule density with small tubule size,
compared to the dentin directly adjacent to or above the pulp due to high
tubule density with large tubule size.(Garberoglio and Brännström, 1976).
Thus there exists a significant translucency gradient, that of superficial
dentin which is more translucent and that of deep dentin, which is three
times more opacious.(ten Bosch and Zijp, 1987).
Additionally, the regional variation of dentin tubule orientation is of
particular relevance with regards to light transmission, rendering cervical
dentin as highly transmissive, middle dentin as moderate, and incisal dentin
as low (Fig 7). Conversely, the DEC lacks significant scatterers. The
elevated lateral light diffusion that occurs at the DEC has been described as
the “glass layer” or “high diffusion layer” or “brilliance zone.” (Vanini,
1996 ; Touati et al., 1999).
Factors that may be considered for this enhanced light diffusion is that
the inner aprismatic enamel presents a more uniform HAp crystal orientation,
con-sequently producing an elevated lightflux density concentration at this
junction, (Odor et al., 1996 ; Seka et al., 1995). while the underlying
mantle dentin exhibits low tubule density and small tubular size, providing
minimal scattering. Furthermore, the change in the RRI between dentin and
enamel results in partial reflections of light at this junction and theoretically,
when conditions are favorable for short distances, localized total internal
reflections may be attained.

17
Fig 8 Direct illumination is used to enhance the sensation of surface topography of the
maxillary central incisors. Moderate wear is viewed on the vertical developmental
lobular heights of contour whereas the concave depressions have retained parts of their
original horizontal structural anatomy; diffuse light was utilized via indirect illumination
to enhance the sensation of gloss and luster.

18
The nine elements of visual synthesis

Descriptive surface elements:

Surface texture describes the physical characteristics of the enamel

surface, being directional (vertical developmen- tal lobes/horizontal cervical
ridges) and structural (perikymata). Perpetual sur- face texture adaptation is
a function of the inherent microstructure at eruption and the subsequent
physical and chem- ical processes that modify it: attrition, abrasion, and
erosion (Fig 8)
Gloss describes the visual perception based on the interaction of light
with the physical characteristics of the enamel surface, relating to the ability
to reflect light in a specular (“glossy appearance” observed on polished
convex con- tours) or diffuse (“matte appearance” observed within concave
depressions) manner. Like color, it exhibits physical, physiologic, and
psychological aspects (Fig 8). Luster describes the qualitative correla- tion
of the visual appearance produced by the reflection of light with the enamel
surface. Also known as contrast gloss, luster can be somewhat subjective,
ex- pressed in relative terms such as satin- like, pearly, metallic, glass-like
(Fig 8).

Objective color elements

Hue Is defined as the name that distin- guishes one family of colors
from an- other. Hue is specified as the dominant range of wavelengths in the
visible spec- trum that yields the perceived color.(Fondriest J, 2003)The
base shade of dentin primarily de- termines the hue of a tooth.

19
(ten Bosch and Coops, 1995 ; Dietschi et al., 2006). Hue can be considered
the quality of pigment (Figs 9 and 10).

Chroma is defined as the saturation, intensity, or strength of the hue. Unlike

value, which occurs independently of hue, chroma is only present when there is
hue.(Preston and Bergen, 1980) Chromaticity is an objective specification of the
quality of a color regardless of its value, that is, as de- termined by its hue and
chroma, and is readily visualized via cross-polarized reflective photography (Figs
9 and 10).

Value is defined as the relative white- ness or blackness of a color and is

de- termined by comparing it to a gray of similar brightness. Value is also called
lightness, brightness or luminance (Figs 9 and 10).

Fig 9 The intact teeth comprising the maxillary triad were extracted concurrently due to
periodontal reasons and deemed as exemplary dental specimens for exploring interdental
structural and optical inter-relationships. Aggressive acidulation led to the selective
enamel dissolution and revealed the dentin substructure. Lobular coalescence is
particularly prevalent in the central incisor.

20
Fig 10 The objective color elements as viewed and estimated; general congruency is
observed among the cervical (C), middle (M) and incisal (I) thirds amongst the maxillary
triad. A multitude of hues is found at the incisal third due to the phenomena of
opalescence and counter-opalescence. Chroma is more pro- nounced at the cervical third
due to the thickness of dentin.31 In all instances Value is highest at the middle third, due
to the fact that the enamel and dentin present an equilibrium in terms of thickness
ratios.(Altshuler, 1995).

21
Fig 11 The longitudinal histological tooth section of a maxillary central incisor, 1 mm in
thickness, was submerged in distilled water and photographed via transmissive
illumination (upper) and reflective illumina- tion (lower) to epitomize the opalescent
nature of enamel.

Subjective optical elements

Translucency
Translucency is defined as a gradi- ent between transparency (complete
transmission of light) and opacification (complete reflection of light). The
light transmission of enamel has been shown to be wavelength specific, age
related and is influenced by its state of hydra- tion. A decrease in
translucency during dehydration is explained as a result of an increased
difference in refractive in- dices between the enamel prisms and the
surrounding medium when water is replaced by air.(Brodbelt et al., 1980)

Opalescence
Known as the Rayleigh scattering ef- fect; enamel demonstrates this dichroic
effect, which is caused by scattering particles with typical dimensions much
smaller than the wavelength of illumina- tion used. The mineral crystals
present in the enamel prism (measuring 4 μm wide to 8 μm high) meet this
property be- cause the HAp subunit crystals exhibit thicknesses of 25 to 40

22
nm, and widths of 40 to 90 nm. For that reason the short blue wavelengths
reflect preferentially from the enamel, while the longer am- ber wavelengths
transmit accordingly through it (Fig 11).

Fluorescence
An example of photoluminescence is a phenomenon in which invisible UV
light is absorbed and then re-emitted almost immediately(Frazier et al.,
1967). (10-8 s) at a less energet- ic wavelength in the visible spectrum.
Enamel and dentin both possess fluo- rescent properties, with dentin
generally exhibiting three times the intensity than that of
enamel(Monsénégo et al., 1993) upon longitudinal section, emitting a
white-blue luminescence after excitation, imparting additional vi- tality and
brightness to the natural tooth appearance predominantly in UV rich
environments only. The DEC also exhib- its elevated fluorescence due to the
col-lagen-rich, highly cross-linked composi- tion, with primary intrinsic
(endogenous) fluorophores being the aromatic amino acid tryptophan
(Hoerman and Mancewicz, 1964 ; Foreman, 1980). and the collagen
cross-linking agent hydroxypyridium (Fig 12).(Walters and Eyre, 1983)

Fig 12 A submerged maxillary premolar was photographed with reflected long

wavelength UV illumina- tion (365 nm), enabling the visualization of dentin exhibiting
three times the fluorescence intensity than that of enamel. Note that the DEC also
exhibits pronounced fluorescence.(Villa, 1949 ; Villa, 1958).

23
Dynamic infinite optical thickness
Perceived color can be considered a combination of the reflected color
of the translucent enamel layer plus the color reflected from the underlying
relatively opacified dentin layer. As the enamel and dentin layers vary
inversely in rela- tive thickness from cervical to incisal, the amount of color
contribution from the two tissues will be reciprocal (vice versa) (Figs 13 and
14). (Shillingburg and Grace, 1973 ; Ferrari et al., 1992). The thickness
of a given translucent material at which any further material ad- dition does
not alter the transmission of light, nor the perceived reflected color of that
material either on a white or black background, defines its infinite optical
thickness (IOT).
Although light transmission in enamel at 1 mm has been tentatively
measured to be 66% ± 11%, while that of dentin at 1 mm is 44% ± 12%
(Cook and McAree, 1985). one must con- sider the significance of sample
loca- tion, the relative thickness distribution of both tissues as well as stage
of tissue maturation.(Dietschi et al., 2006). With regards to dynamic aging
on the macrostructural level, enamel inad- vertently goes through a
volumetric re- duction via functional wear, mechanical abrasion and
chemical erosion, result- ing externally in a hyperpolished sur- face.
Conversely, internally the dentin volume increases via secondary and tertiary
dentin deposition.
On a microstructural level, a signifi- cant reduction in the porosity of
the enamel is due to posteruptive matura- tion via hypermineralization
(Glick, 1979 ; ten Bosch et al., 2000). and homogenization leading to HAp
crys-tal elongation,(Eimar et al., 2011). while in a homologous appearing
more transparent grey (lower manner, hypermineralization of dentin value)
due to less light scattering. ensues via natural tubular obliteration, Further

24
research is desired in order rendering dentin more translucent over to
estimate the dynamic IOT values for time. enamel and dentin at different
stages of Due to this dynamic cycle of events, tissue maturation, thus
establishing uni- juvenile enamel, which is thicker, pos-versal industry
standards for composite sesses a texturized surface and is com-resins and
etchable ceramics. Possess- posed of small HAp crystals,

Fig 13 Individual and pooled averages with regards to labial enamel thickness for the
maxillary triad at the cervical (C), middle (M) and incisal (I) thirds.(Shillingburg
and Grace, 1973 ; Ferri et al., 1992).

(higher value) the degree of translucency and opacity due to more

light scattering, while adult of dental resins (Villarroel et al., 2011 ;

25
 Fig 14 Pooled averages with regards to labial dentin thickness for the maxillary triad
at the cervical (C), middle (M) and (I) thirds.(Shillingburg and Grace, 1973).

Schmeling et Al., 2012). and etchable ce- (and senior) enamel, which is
thinner, is ramics at given thicknesses will auto- characterized by a polished
surface and matically enable clinicians and techni- composed of large HAp
crystals, thus cians to strategize accordingly in order to provide adequate
tooth reduction to meet the specific objectives that are required .

Amplified visual perception effect

Due to the convex lens-like shape of enamel in conjunction with

possessing an RRI of 1.63, optical distortion oc- curs. Thus, light being
refracted within enamel, the DEC and subsequently in- ternally reflected
from dentin produces a stunning effect; an optical illusion of magnification
(Hajtó et al., 2006). and spatial proximity is quired.perceived with regards
to the underlying dentin mamelons.
This apparent mag- nification manifests in an incisobuccal direction,
creating an optical illusion with regards to the position and dimension of

26
dentin mamelons. This optical illusion is subdued in part by the birefringent
nature of enamel, obscuring details ren- dering a hazy net appearance (Fig
15). Concurrently, dentin also exhibits mag- nification properties(Walton et
al., 1976 ; Kienle et al., 2006). due to the di- vergent radial fanning of the
dentin tu-bules when light is reflected internally from the deeper strata.

Fig 15 Enamel is responsible for creating an optical illusion of the apparent versus the
actual position with regards to the visualization of the underlying incisal dentin.

Diversification of photographic illumination techniques

Intact dental specimens provide the ul- timate reference for the perpetual
de- votion of time and attention to acquire the needed knowledge with regards to
visual interpretation. (Dietschi, 1997 ; Dietschi, 2001). Over the last decade, there
has been profound interest in alternative photo-graphic techniques aimed at
increasing the accuracy and objectivity of dental shade evaluation and laboratory
com- munication. In order to minimize the user-dependent error in future clinic- al

27
 practice, it is necessary to develop standardized, reproducible imaging modalities
and objective image analysis methods (Figs 16 and 17).
Reflective Illumination
Direct reflective illumination utilizing a macro twin flash, via manual
standardi- zation of power output, remains the pho-tographic standard for
providing pre- dictable and repeatable levels of light for shade estimation. Indirect
reflective illumination (Lumiquest, Pocket Bounc- ers,) on the other hand, aids in
revealing fine surface texture details.

Fig 16 Facial Fig 17 Palatal

illumination techniques illumination
from top to bottom: techniques from top
reflective, reflective to bottom: reflective,
cross-polarized, reflec- reflective cross-
tive UV and polarized, reflec-
transillumination. tive UV and
transillumintion

28
Reflective cross-polarized illumination
This photography technique significantly mitigates unwanted specular
reflections which obscure the fine details of dental structures (Vanini, 1996 ;
Vanini and Mangani, 2001). while providing a high contrast/hypersaturated
dental im- age to be objectively analyzed via a cali- brated RAW workflow
utilizing a generic software program (Adobe Photoshop) in the CIE L*a*b
color space. To obtain such a photographic image intraorally, a cross-
polarization filter is utilized (polar eyes, Emulation).

UV Illumination
Ultraviolet Illumination is utilized in or- der to induce fluorescence
and aid in the selection of the restorative material (etchable ceramics and
resins) with a similar fluorescence intensity,(Rey et al., 2012 ; Sensi et al.,
2006). pro- viding the restoration with optimal inte- gration primarily in the
event of exposure to a UV dominant lighting environment, such as a
dancehall or a nightclub. To obtain such an image intraorally, a cus- tom
modified xenon flash tube is utilized (fluor eyes, Emulation).

Transillumination
Transillumination reveals histo-anatomic relative opacity levels
(transparent den- tin vs opaque) and visual quantitative estimation of incisal
enamel distribu- tion. Opalescence may also be visually assessed and gauged
via this type of photography. To obtain such an image intraorally, a fiber
optic transilluminator is utilized (Micro-Lux, AdDent).

29
Discussion
The restorative task is elaborated along four levels of integration:
biological, functional, mechanical, and optical. To meet contemporary
challenges, the dental team must enhance its capacity in all four levels
equally. From an optical standpoint in ambi- ent light, enamel can be
considered isotropic,

Fig 18 Stone replicas facilitate visual assessment and rumination of the variability
between enamel and dentin surface topography. Mesiobccal (left) and Mesiopalatal
(right) oblique views of central incisor, lateral incisor and canine (top to bottom).
Generalized external enamel macromorphological congruency is seen upon the dentin
counterpart, with amplified vertical corrugations, providing added roughness and
waviness that is critical to be emulated during restorative stratification
techniques.(Wang et al., 2011)

30
 with the visual gradient being expressed in the vertical direction (cer-
vical/incisal) due to thickness variation, whereas dentin can be considered
ani- sotropic, with the visual gradient being expressed: a) in a radial
direction due to the dentin tubule attributes of diam- eter and density
(qualitiative), and b) in a horizontal zonal direction (cervical/mid- dle/incisal)
due to thickness variation and differing RRI indexes (quantitative). Hue and
chroma are predominately determined by the properties of dentin,
dynamically changing over time as sec- ondary deposition occurs. In some
in- stances, as in the cases of severe incisal wear, dentin can be breached to
such an extent that external chromophores become readily absorbed, resulting in
infiltration staining (Fig 10).

While the opacity of dentin provides and establishes a baseline for

value, the luminosity is predominately regulated by the properties of enamel.
The surface texture influences the primary interac-tion of the incident light.
A highly tex- tured surface renders higher amounts of diffuse surface
scattering, thus elevat- ing the perceived value, appearing to be more
translucent. This is in contrast to a smooth surface, which would ex- hibit
lesser amounts of diffuse surface scattering, thus demoting the perceived
value, and appearing to be more trans- parent.
The relative thickness of enamel dictates the proportional amount of
diffuse subsurface scattering (quantita- tive), while the degree and
postmatura- tion stage of the HAp crystals affects the type of photonic
interaction (qualitative). Transparency, translucency and opacification are all
visual representa- tions of the amount of light that is scat- tered and
subsequently reflected to the observer by the microstructural features of a

31
given substrate. Embracing the paradigm shift of thinking in terms of
dynamic light interactivity via the principle of scattering enables the
clinician and technician to choose the level of sophis- tication within the
stratification protocol they opt to employ; a trilaminar technique
(enamel/DEC/dentin) for a simplex inter- pretation or a pentalaminar
technique (Exo enamel/eso enamel/DEC/exo den- tin/eso dentin) for a
complex one. The utilization of this knowledge in the clin- ical and technical
restorative approach is to be described thoroughly in articles that will be
published in future issues of this journal.

Conclusion
This article presented fundamental yet simplified photonic
interactions with re- gards to the histoanatomic elements, ren- dering the
final visual synthesis. It should be emphasized that a thorough under-
standing of the light propagation within the coronal structures is a
prerequisite in order to elucidate color and shade, however mastery of spatial
distribution of the three-dimensional histoanatomic relationships is
paramount in the quest for restorative dental emulation (Fig 18).

32
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