In my opinion, it is in the smile of a face that the essence of what we call beauty lies. If the smile heightens the charm of the face, then the face is a beautiful one. If the smile does not alter the face, then the face is an ordinary one. But if the smile spoils the face, then the face is an ugly one Indeed.
Tolstoy, Lev Nikolayevich
According to a recent survey by the American Academy of Cosmetic Dentistry, 9 out of 10 people surveyed agreed that an attractive smile is an important asset to their overall appearance. In addition, three-fourths of the same group said that an unattractive smile could hurt their chances for career success. Despite this overwhelming perception, most people are unaware that their smile can be improved with cosmetic dentistry. With recent advances in materials and techniques, cosmetic dentists are able to take a worn, dull, chipped, crooked smile and transform it, in many cases, in as little as two visits. The term for this transformation of a person’s smile is referred to as Smile Design.
During the last decade, the term ‘smile design’ has gradually become commonly used in the ever more popular esthetic dentistry.
But what does smile design actually mean?
In the everyday language, the term ‘smile design’ is often used as the synonym of a dental treatment with esthetic purposes. However, smile design is actually a process before the treatment starts:
Smile design is the planning and pre-visualization of the desired end result of an esthetic dental treatment targeting a more harmonious state instead of the current disharmony, according the rules of facial, smile, tooth and gingival harmony and the individual needs of the patient, paying particular attention to the functional aspects and the feasibility.
Rules of Harmony
A smile design is not simply based on the esthetic sense of the dentist or the dental technician. Nowadays, the design procedure is a complex task, guided by closely interrelated facial, smile, tooth and gingival harmony aspects and rules, taking into consideration the properties specific to the patient's age group.
Functionality should never be overridden by esthetics. Besides esthetic aspects, the functional requirements (i.e., the operating requirements of the teeth and the Mandibular joint) should also be considered by the dentist to a maximal degree.
Besides the principles of harmony and the ideas of the patient, the appropriate smile should be chosen with feasibility considerations taken fully into account.
There are several means of pre-demonstrating the different possibilities and the designed smile to the patient, but computer-assisted smile design is, without doubt, the most effective one.
Computer-assisted smile design can be performed by the dentist using a custom graphic design program or a special smile design software.
Modern dental offices can provide the patients with the opportunity to view thousands of possible dentures quite realistically represented in their own facial photos, and thus, to choose—staying within the limits of feasibility—a smile type, together with the dentist, that suits the principles of harmony and the individual preferences. The printed or saved smile design images can be given to the patients to help his/her decision.
Individual Needs of The Patients
The dentist should not ignore the opinion of the patient. In most cases, the instructions, taste and style of the patient all contribute to the creation of a truly harmonious smile.
To sum up SMILE DESIGNING can be defined as a science and art of planning and pre-visualization of a more harmonious smile instead of a current disharmony, and then executing it by means of repositioning, reshaping and recon touring of teeth and gingiva, based on certain set of esthetic principles and guidelines after considering patients functional, biological, individual and emotional needs and feasibility, so that teeth harmonize with gums, lips and face and thus enhances the smile and overall personality and self esteem of an individual
After smile design, i.e. the planning and pre-visualization of the desired end result of the esthetic dental treatment follows the creation of the designed smile, which is actually the treatment itself. There are several techniques of esthetic treatments. Your dentist has to decide with you which one to apply based on your current tooth conditions, the desired end result (i.e. the designed smile), the affordable budget and some other factors. The length of the treatment period can also be important, and sometimes the reversibility can also play a role. The trend is applying more and more non- or minimal-invasive techniques, i.e. your dentist should keep from your original teeth as much as possible. Besides other aspects, the functional requirements should also be considered by the dentist to a maximal degree, after the treatment you have to be able to use your teeth at least you could use them before.
As your dentist should pay attention to the aspect of feasibility already at the phase of planning and pre-visualization, actually, the decision on the applicable technique is to be taken at the very beginning, before the pre-visualization.
Some techniques your dentist can use to create your smile :
Using a very fine polishing disc or diamond bur teeth can be reshaped or recontoured. The most angled tooth edges, the too convex, bulging or rotated part of the teeth can be slightly removed by polishing, not exposing dentine. By this method teeth can be rejuvenated, the smile can become more harmonious.
This is a minimal-invasive method using specific esthetic composite materials according to a natural layering concept or anatomical stratification technique. Using these materials teeth can be reshaped or rebuilt by a very thin, tooth-colored composite layer coated to the outer surface of the teeth.
For reshaping teeth, solving gaps, inherited or acquired tooth shape problems, treating discoloration problems or just making a new smile porcelain veneers are the perfect solution instead of crowns. For veneers 0.6 mm deep preparation is needed in the tooth structure before bonding them to the outer surface of the teeth.
Non-prep (tenuia) Veneers, Lumineers
Tenuia veneers are the so called „non-prep veneers”. One of the most non-invasive procedures. This type of veneer is a 0.3-0.4 mm thin porcelain which can be placed without any preparation. However, recontouring is necessary before placing this type of veneers.
Prosthetic works include metal-fused porcelain works, full-ceramic or zirconium bridges, combined works, front crowns and dentures. For making a perfect smile new crowns may be needed or the old ones has to be replaced. It is also possible to make bridges from full-ceramic, metal-fused porcelain or zirconium materials. If you are toothless, a denture can be made. The rules of smile design and of the gnathology have always to be considered.
Implant Works - Implant Suprastructure Design
For making fixed individual crowns or fixed bridges for toothless patients implant screws have to be placed into the bone. This is a specific method for dissolving toothless problems and simulating the feeling of natural teeth. The design of the suprastructure on the abuttment always has to be based on the rules of smile design and gnathology.
Using some above mentioned techniques the patient’s old smile can be changed into a complete new one. Smile makeover is usually required in case of deep bite, disadvantageous teeth exposition during smiling or speaking and serious esthetic problems. Direct or indirect veneers, crowns, onlays can be made for changing the incisal curve, the smile type, the tooth shape, the tooth harmony or adjusting the deep bite. As the outcome of the treatment it can be possible to give the patient back a high level of smile and face harmony.
All the above mentioned techniques that can make younger your tooth shape, tooth character, or your whole smile can be called smile rejuvenation. Most common methods are veneers and crowns for the front teeth.
In case of slightly crowded teeth recontouring or direct veneers are the best solution to straighten the teeth in 1 or 2 hours. Actually, all the methods that can solve crowding in a very short time are one kind of instant orthodontics.
Soft Tissue Management
Red and white esthetic in smile design are essential. Therefore for the perfect gingival contour it is sometimes necessary to reshape the gingiva. In case of slight asymmetry gingival contouring by laser might be enough. For solving gummy smile or low gingival horizon general or local crown lengthening is needed. In case of loss of papilla or gingiva soft tissue transplantation could be the best method. These are already very sophisticated surgical interventions. As the outcome can be influenced by several factors, a deep consultation is definitely necessary before the treatment.
Some smile design cases can be solved properly only combined with orthodontics. In case of overjet, overbite, narrow jaw, crowded teeth, gnathological problems, maxillofacial disorders, face disharmony problems one of the orthodontic treatments (conventional techniques, Damon system, Incognito system, Invisalign system, etc.) is recommended. The treatment can last for 1.5-3 years depending on the case.
The effect of esthetic dental procedures can be highly influenced and enhanced by some cosmetic and plastic surgery interventions like refillers, botox, etc. These techniques can be suggested in some cases.
There are a lot of simple cases when creating the designed smile, but sometimes it is more complicated and a mix of different techniques is to be applied. In these cases the smile creation is suggested to be carried out by a dentist team.
The periodontologist can make a perfect marginal contour by applying crown lengthening techniques, soft tissue management and can create a healthy gum.
The orthodontist can widen the jaws, straighten the teeth, improve the exposition of the teeth during smiling or speaking, adjusting the bite high, reestablish the face soft tissue harmonious design or reestablish the perfect ratios.
The prosthodontist can reconstruct the tooth and soft tissue function by replacing missing teeth (denture, combined work, implant suprastructure).
The gnathologist can treat gnathological problems, TMJ disorders, and can create a harmonious function with the new dental work.
The esthetic dentist can create esthetic, harmonious dental work with special direct or indirect techniques.
The implantologist can place implants for solving missing teeth problems.
The dental technician can make a perfect, living ceramic work.Using any of the smile creation techniques, the rules of smile design have always to be considered.
Whether you like it or not, your smile tells people something about who you are.
A charming smile can open doors and knock down barriers that stand between you and a fuller, richer life.
Answer the following questions and find out it yourself whether you are the right candidate for cosmetic dentistry or not :
01. Are you self confident about smiling? Yes / No
02. Do you ever put your hand over your mouth when you smile? Yes / No
03. Do you shy away from smiling in public, especially in front of strangers? Yes / No
04. Do you photograph better from one side of your face? Yes / No
05. Do you look at pictures of models and actors, and wish that you had a smile like theirs? Yes / No
06. When you look at your pictures, do you like your smile? Yes / No
07. When you look at your pictures, do you see a full smile? Yes / No
08. When you look at your smile in the mirror, do you see any defects in your teeth or gums? Yes / No
09. Do you wish your teeth were whiter? Yes / No
10. Is the surface of your teeth smooth? Yes / No
11. Do you have irregular, decayed, missing or chipped teeth? Yes / No
12. Do you have spaces between your teeth? Yes / No
13. Are you satisfied with the way your gums look?Yes / No
14. Do the edges of your teeth follow the curve of the lower lip? Yes / No
15. Do you show too many or too few teeth when you smile? Yes / No
16. Do you show too much or too little gum when you smile? Yes / No
17. Are your teeth too long or too short? Yes / No
18. Are your teeth too wide or too narrow? Yes / No
19. Are your teeth too square or too round? Yes / No
20. Do you like the way your teeth are shaped? Yes / No
21. Do you have ill-fitting dental work done on your front teeth? Yes / No
22. Do your gums bleed on brushing or appear swollen? Yes / No
23. Do you have recession of the gums? Yes / No
If you answered NO to every question except 1,6,7,10,13,14,20, you are content with your smile.
We all live in a modern ,beauty conscious competitive society, where an individual with a pleasing appearance definitely has an edge over the one who does not have that charming appearance. Smile plays a major role in how we perceives, as well as in the impressions we make on the people around us. So how important is your smile? The reality for today is that once smile is increasing in importance well beyond the documented proof. Your smile can have a distinct impact on your psychosocial well being and self esteem. To paraphrase.... “ A smile cost nothing , but gives so much; a smile takes but a moment , but can last forever"
Your smile truly animates your face!
We are all familiar with the cold lifeless appearance to many faces. We also should be familiar with the fact that many faces really come to life when a person smiles. The face becomes animated and the personality of the person really starts to shine through the smile. This smile can have a dramatic affect on all other people in proximity to the smile and is contagious with its positive impact on all present.
Your smile is important to all your interpersonal relationship!
Research clearly indicates that people with a more attractive smile are generally regarded as a more popular. An attractive smile tend to suggest that you have more desirable social characteristics and are more desirable as a dating partner.
People with an attractive smile are perceived as having greater intelligence and thus greater educational potential. You are , in other word, more likely to have higher grades at school if you have an attractive smile. In terms of business potential, the probability is higher that you will succeed in business with an attractive smile. For example, if you are a sales person, your sales number will be higher with an attractive smile.
Your smile will define the character of your face!
Your smile for example can be characterized as being either feminine or masculine. Your smile can dramatically age your face or conversely give your face a more youthful appearance. Your smile can create the perception of an aggressive character or a more passive character.
Your smile is absolutely important to establishing personal contacts!
A common question during social interactions is often oriented around what attracts you to a perspective mate. Research tends to suggest that during similar social interactions your eyes will primarily scan the other person’s eyes and areas of the mouth (smile) with little time spent in observations of the other features. Thus your smile is the first and most important impression a prospective mate will remember you by after initial contact.
The principles of smile design require an integration of esthetic concepts that harmonize facial esthetics with the dental facial composition and the dental composition. The dental facial composition includes the lips and the smile as they relate to the face. The dental composition relates more specifically to the size, shape, and positions of the teeth and their relationship to the alveolar bone and gingival tissues. Therefore, smile design includes an evaluation and analysis of both the hard and soft tissues of the face and smile.
Facial beauty is based on standard esthetic principles that involve the proper alignment, symmetry, and proportions of the face. The basic shape of the face is derived from the scaffolding matrix comprised of the facial bones that form the skull and jaw as well as of the cartilage and soft tissues that overlay this framework.
Facial features in smile design include facial height, facial shape, facial profile, gender, and age. In classical terms, the face height is divided into three equal thirds: from forehead to brow line, from brow line to the base of the nose, and from the base of the nose to the base of the chin. The upper third is considered the cerebral ox intellectual portion. The middle third is considered the sentimental or social portion. The lower third is considered the sensual or physical portion. Increased dimension of any area increases perceived personality of a person The width of the face is typically the width of five “eyes” As viewed from the frontal position, the four basic facial shapes recognized in the Trubyte denture tooth mould selection guide are square, tapering, square tapering, and ovoid. Lateral facial profiles can be straight, convex, or concave. A cephalometric analysis of the head in frontal and lateral views is useful in determining bony relationships of the face and the mandible, and their relationship to the teeth in the alveolar bone. The facial features related to gender and age involve the soft tissues and include the texture, complexion, and tissue integrity of the epithelial tissues.
Golden or divine proportion
The first mathematical formula for beauty came from Italy in the 1495 from Fibonacci who described the “golden ratio” which is 1:1.618. This ratio is often designated by the Greek letter ‘phi’ and is used to create geometrical forms including the golden rectangle, golden triangle and the golden spiral (Nautilus shell).
In 1509, Pacioli published a dissertation De Divina Proporcione (divine proportions) that related these proportions to human form art and architecture. Leonardo DaVinci illustrated that dissertation. Subsequently, the art and architecture of DaVinci demonstrated the use of golden proportions and golden spirals, keeping elements in the 1:1.618 ratio of the “Golden Proportions”.
We use the same principles and proportions to create natural, balanced, harmonious smiles for you.
Facial Beauty / Divine Proportion
Everything in the universe is based on the proportion: 1 to 1.618
1 to 1.618 =
Divine proportion =
Golden proportion =
Balance & Harmony =
Divine proportion is everywhere! In art, architecture, advertisement, music, birds, insects, flowers, etc.
Now let us discuss the possible effect of Divine Proportion to the human body.
The concept of divine proportion is not new. Even the great artist Leonardo Da Vinci over 500 years ago illustrated it.
Man in a circle illustrating proportion by Leonardo Da Vinci, 1485-90
There are millions, possibly billions of examples of Divine Proportion in and on the human body. The illustration to the right only shows a few example.
Top of head to belly button = 1, then belly button to bottom of the feet = 1.618 Shoulder to fingertip =1, then the ideal height of man or woman = 1.618
All beautiful faces regardless of race, age, sex, and other variables conform to the Divine Proportion.
Ideal vertical proportion. If the Cheilion- corner of the mouth (CH) to the bottom of the chin (ME) is one, then the distance between corner of the mouth (CH) to lateral canthus of eye (LC) is 1.618. If the distance from LN (Lateral side of nose) to bottom of the chin ME is 1, then the corner of the nose LN to TRI trichion-begining of forehead wrinkling when one lifts the eyebrow is 1.618.
Ideal transverse proportion. If the width of the nose (LN) is 1, then the width of the mouth (CH) is 1.618; the width between two corners of the eyes (LC) is (1.618)2, and the width between two temples (TS) is (1.618)3.
Ideal height and width of a face. If the distance between the two cheeks are 1, then the ideal height is 1.618
Above photograph illustrates the following golden sections in the human face:
- Centre of pupil; Bottom of teeth; Bottom of chin
- Centre of pupil; Base of nose; Bottom of teeth
- Centre of pupil; base of nose; Bottom of chin
- Base of nose; Bottom of teeth; Bottom of chin
- Outer & inner edge of eye: Center of nose
- Outer edges of lips : Upper ridges of lips
- Width of center tooth : Width of second tooth
- Width of eye : Width of iris
Even when viewed from the side, the human head illustrates the Divine Proportion.
The first golden section (blue) from the front of the head defines the position of the ear opening. The successive golden sections define the neck (yellow), the back of the eye (green) and the front of the eye and back of the nose and mouth (magenta). The dimensions of the face from top to bottom also exhibit the Divine Proportion, in the positions of the eye brow (blue), nose (yellow) and mouth (green and magenta).
Even the dimensions of our teeth are based on phi
The front two incisor teeth form a golden rectangle, with a phi ratio in the height to the width.
The ratio of the width of the smile to the third tooth from the center is phi as well.
The four front teeth, from central incisor to premolar are the most significant part of the smile and they are in the Golden Proportion to each other.
Relationship of Eyes to teeth
The WHITE of the eyes AB is in the Golden Proportion to the space between the eyes BC as seen in the children's photo of eyes fig below.
From this we can conclude that the WHITE width FG of the Anterior Aesthetic Segment is in the Golden Proportion to the WHITE of the eyes AB, as follows:
By measurement it will be found that the width of the smiling lips from one corner of the mouth to the other is equal to the distance between the bridge of the nose plus the width of the eye, AC=DE
Eyes & Smile
Dr. Jefferson believes that there is a universal standard for facial beauty regardless of race, age, sex, etc.!
As discussed previously, Divine Proportion is everywhere. It is found in living and non living dynamic entities, like the galaxy.
Entire human population is genetically encoded to develop toward the Divine Proportion. Since Divine Proportion applies to every human individual, then there is a universal standard for facial beauty based on balance and harmony.
Dr. Stephen Marquardt, maxillo-facial surgeon, developed a beauty mask overlay based on the Divine Proportion. If an individual’s face conforms to the beauty mask, then the face will be beautiful. There is a beauty mask for males and females based on the Divine Proportion regardless of race, age, or nationalities.
This models face is beautiful because it conforms to the Divine Proportion.
Nefertiti, from about 1370 to 1350 B.C., considered beautiful in her time conforms to the beauty mask. This shows that the standard of beauty back then, 3,200 years ago, was the same as it is today. Beauty is timeless!
This face was voted to be the most beautiful by 10,000 website voters. It conforms to the beauty mask.
Facial features that have a particularly important impact on the dental–facial composition are those that relate the interpupillary plane with the commisure line and the occlusal plane. The interpupillary line should be parallel with the horizontal line and perpendicular to the midline of the face. In addition, the interpupillary line should be parallel with the commisure line and occlusal plane.
A smile line parallel to the horizontal is often thought to be most attractive. Even when the eye line does not coincide with this, the illusion of horizontal alignment should be created.
The lips play an important role in that they create the boundaries of the smile design's influence.Genetic traits; the position of the teeth, alveolar bone, and jaws; and their relationships influence the shape of the lips. The upper lip is somewhat more arched and wider than the lower lip. Because the maxillary arch with the teeth overlaps the mandibular arch, the upper lip is the longer of the two. The lower lip, therefore, is recessed beneath the upper lip approximately 30° in relation to the upper lip when the arches are properly aligned.
Morphology of lips
There are three aspects of the lip morphology that should be considered: width, fullness, and symmetry.
Wide lips make for a wide smile. In general terms, a smile that is at least half the width of the face, at that level of the face, is considered esthetic.
The fullness of the lip, or lip volume, can be categorized as full, average, or thin.
Lip symmetry involves the mirror image appearance of each lip when smiling.
The upper and lower lips should be analyzed separately and independently of one another. Independent evaluation of the upper and lower lip is essential when analyzing both symmetry and fullness. The question should be asked: “Are the upper and lower lips symmetric on both sides of the midline and do they have the same degree of fullness?” In Fig.A, the upper and lower lips are symmetric but they differ in fullness. In Fig.B the upper lip is asymmetric and the lower lip is symmetric and the fullness is similar. Recognizing the etiology of lip asymmetries is helpful in determining if there is a dental solution for improvement or if plastic surgery is necessary. Sometimes both are necessary to provide the results desired by the patient.
Fig. (A) The upper and lower lips are symmetric but they differ in fullness. (B) The upper lip is asymmetric.
Position of lips
The position of the lips in the rest position should be evaluated for lip contact as well as for the range of lip mobility when smiling. These two determinants establish how much tooth structure and gingival tissue are revealed when comparing the repose and full smile positions. Lip evaluation is also useful when considering the patient's expectation and, more importantly, for revealing tooth and tissue asymmetries or defects.
When smiling, the inferior border of the upper lip as it relates to the teeth and gingival tissues is called the lip line. An average lip line exposes the maxillary teeth and only the interdental papillae. A high lip line exposes the teeth in full display as well as gingival tissues above the gingival margins. A low lip line displays no gingival tissues when smiling.
In cases where there is a high lip line and an excessive gingival display exists, an unwanted “gummy smile” becomes evident. Several corrective options are available, depending on conditions and patient limitations. With cephalometric analysis, vertical maxillary excess can be determined. Orthodontics and orthognathic surgery to impact the maxilla are ideal when these conditions are confirmed as skeletal displasias in nature.
In other cases where apparent diminished tooth size in combination with a high lip line creates a gummy smile, corrective periodontal procedures are an option. This involves cases where altered passive eruption makes a normal-sized tooth appear small..
The frenum attachment can also affect the upper-lip shape and the amount of tooth exposure. In such cases, especially where the attachment is broad, a frenectomy that is dissected out from origin to insertion, removing the elastic fibers, can also free up the lip for normal lip movement. This can also be useful when a redundant flap of tissue,called as a “lip curtain” (Fig.C, is visible hanging beneath the upper lip when smiling.
Fig. C. A broad attachment of frenum creates second band of tissue, a “lip curtain,” below the lip.
The incisal display refers to the amount of visible tooth displayed when the lips and lower jaw are in the rest position. The average incisal display of the maxillary centrals for males is 1.91 mm and the average for females is 3.40 mm. With age, the amount of incisal display of the maxillary centrals diminishes and the amount of incisal display of the mandibular centrals increases.
The inferior border of the upper lip and the superior border of the lower lip form an outline of the space that is revealed when smiling. The space that includes the teeth and tissues is called the smile zone. There are six basic smile-zone shapes: straight, curved, elliptical, bow-shaped, rectangular, and inverted. The first three shapes are the most common.
Smile zone shapes.
Health, symmetry, and architecture of the gingival tissues.
These tissues frame the teeth and add to the symmetry of the smile. The health and subsequent color and texture of these gingival tissues are paramount for long-term success and the esthetic value of the treatment.Healthy gingival tissues are pale pink and can vary in degree of vascularity, epithelial kertinization, and pigmentation, and in the thickness of the epithelium. The papillary contour should be pointed and should fill the interdental spaces to the contact point. An unfilled interdental space creates an unwanted black interdental triangle in the gingival embrasure and makes a smile less attractive. The architecture has a positive radicular shape forming a scalloped appearance that is symmetric on both sides of the midline. The marginal contour of the gingiva should be sloped coronally to the end in a thin edge. The texture of the tissues should be stippled (orange-peel–like appearance) in most cases. The stippling may be fine or coarse and the degree of stippling varies. In younger females, the tissue is more finely textured and has a finer stippling when compared with that of males. The tissue should be firm in consistency and the attached part should be firmly anchored to the teeth and underlying alveolar bone. A normal, healthy gingival sulcus should not exceed 3 mm in depth.
The black triangle between the central and lateral incisors.
The gingival contours should be symmetric and the marginal gingival tissues of the maxillary anterior teeth should be located along a horizontal line extending from cuspid to cuspid. Ideally, the laterals reach slightly short of that line) . It is also acceptable, although not ideal, to have the gingival height of all six anteriors equal in gingival height on the same plane. In such cases, however, the smile may appear too uniform to be esthetically pleasing. A gingival height of the laterals that is more apical to the centrals and cuspids is considered unattractive.
The gingival margins of the centrals and cuspids are apical to that of the laterals. This appearance is considered more attractive.
Similar gingival heights of the six anterior teeth are acceptable although not considered ideal.
When the gingival margins of the lateral is apical to that of the centrals, cuspids, or both, the anterior gingival relationship is considered unattractive.
The gingival zenith point is the most apical point of the gingival tissues along the long axis of the tooth. Clinical observations along with a review of diagnostic models reveal that this most apical point is located distal to the long axis on the maxillary centrals and cuspids. The zenith point of the maxillary laterals and the mandibular incisors is coincident with the long axis of these teeth..
. Gingival shape, zenith point (arrow), and longitudinal axis (dotted lines).of upper anterior teeth
Gingival shape of maxillary laterals (upper curved lines) and mandibular incisors (lower curved lines)..
The smile line can be defined as an imaginary line drawn along the incisal edges of the maxillary anterior teeth. In an ideal tooth arrangement, that line should coincide or follow the curvature of the lower lip while smiling. Another frame of reference suggests that the centrals are slightly longer than the cuspids. In a reverse smile line, the centrals appear shorter than the cuspids along the incisal plane and create an aged or worn appearance.
Ideal smile line.
Reverse smile line.
POSITION, SHAPE and SIZE of ARCHES
The position and size of one jaw in relation to the other may determine tooth placement, tooth size and factors such as space management with use of overlapping or diastema. The shape of arches can be square, square tapering, tapering and ovoid.
The square arch form gives a broad, straight line smile from cuspid to cuspid. There tends to be very little overlapping, crowding or labial tipping.
The tapering arch is narrow from cuspid to cuspid with the centrals being quite anterior to the cuspids. A decrease in space usually means there is considerable overlapping and crowding.
The square tapering arch combines both square and tapering arch characteristics. There is little crowding and overlapping of teeth. The incisors show their full labial surfaces but the cuspids tend to have more distal rotation sometimes referred to as turning the corner.
The ovoid arch resembles the tapering arch form but is wider from cuspid to cuspid forming an arc around the ridge.
The arch can vary in the anterior section or posterior areas separately. Factors such as tongue thrust or crossbite can influence development.
GENERAL SIZE OF TEETH
Tooth size is relative to face size and other teeth. Visual inspection and a rule of individual teeth being one sixteenth the dimensions of the face is a good starting point.
SIZE OF UPPER INCISOR AND INCISAL DISPLAY
Average height from the cementoenamel margin to the incisal edge is 10.5 mm. According to Dr. G.V. Black the average height of a maxillary central was noted as 10 mm with the greatest being 12 mm and the least being 8 mm. Another text records the crown height of a maxillary unworn central incisor ranging from 11 to 13 mm with the average height being 12 mm.
For esthetic purposes, the height of the central incisors can vary depending upon the incisal display and the influence of the smile line. Other guidelines for determining the dimensions of the maxillary central incisors include the following:
Central incisor length is approximately one sixteenth of the facial height.
The ratio of width to height is 4:5 or 0.8:1. In general, the accepted range for the width of the central is 75% to 80% of the height.
Proportion of centrals.
The centrals are most likely too long if they interfere or impinge on the lower lip causing dimpling or entrapment during the formation of the “F” and “V” sounds.
The length of the incisors can also be evaluated using the occlusion. The central is most likely too short or positioned wrong if it is short of a line drawn from the mesial buccal cusp tip of the maxillary first molar and the cusp tip of the cuspid.
PROPORTION OF TEETH
The relative proportions of the maxillary six anterior teeth to each other is another analytical consideration. Many clinicians accept and apply the principles of the Golden Proportion to dentistry.The Golden Proportion suggests an ideal mathematical proportion of 1:1.618. When applied to dentistry, this relates the apparent widths of the maxillary six anterior teeth from a frontal view. The discrepancy between the apparent width and actual width is explained by the positioning of these teeth along the curve of the maxillary arch..
The midline refers to a vertical line formed by the contact of the maxillary central incisors. The midline should be perpendicular to the incisal plane and parallel or coincident to the midline of the face. Studies have shown that minor discrepancies between facial and dental midlines are acceptable and that in many cases these discrepancies are not noticeable. A canted midline, however, is a more perceptible deviation from the norm and should be avoided.
Midline (vertical dotted line).
Several anatomical landmarks can be useful guides to assess the midline of the face as it relates to dental midline. They include the midline of the nose, forehead, interpupillary plane, philtrum, and chin. Some anatomical landmarks may vary in midline accuracy due to variations in genetic structure, such as chin position and the cartilaginous structure of the nose. The philtrum of the lip is considered to be one of the most accurate of these anatomical guideposts as it is always in the center of the face. The exceptions are surgical, accident, and cleft-lip cases. The center of the philtrum is the center of Cupid's bow and it matches the papilla between the centrals. This places the central papilla directly over the dental midline.
From a frontal view, the axial inclination of the anterior teeth tends to incline mesially toward the midline and become more pronounced from the central incisors to the canines. This inclination is least noticeable with the centrals and becomes more pronounced with the laterals and even more so with the canines. The axial inclination of the posterior teeth from the frontal view exhibits the same mesial inclination toward the midline as the cuspid. This also creates a natural visual gradation, making the teeth appear to diminish in size as they progress posteriorly.
Axial inclination (vertical solid lines).
The area between the corners of the mouth during smile formation and the buccal surfaces of the maxillary teeth (particularly the bicuspids and molars) form a space known as the buccal corridor. The greater and more pronounced this negative space becomes, the more these posterior teeth are concealed, restricting the full breadth of the smile. A full and symmetric buccal corridor is an important element of an esthetic smile. The buccal corridor should not be completely eliminated because a hint of negative space imparts a suggestion of depth to the smile.
A dark buccal corridor exists because of the relationship of the anterior teeth with the posterior segments.
Several factors influence the appearance of the buccal corridor. These factors include the width of the smile and the maxillary arch. Other factors include the tonicity of facial muscles and individual smiling characteristics; the position of the labial surfaces of the maxillary bicuspids; the predominance of the cuspids, particularly at the distal facial line angle; and any discrepancy between the value of the bicuspids and the six anterior teeth. This negative space is often accentuated when smile rejuvenation is limited to the maxillary six anterior teeth and the hue and value of newly restored teeth do not blend with the untreated teeth The result is an unwanted exaggeration of the sense of depth, darkness, and the prominence of the buccal corridor.
(A) Shadowing effect of the buccal corridor in the posterior segment (B) Properly treated buccal corridor demonstrates uniformity in color and alignment of the anterior segment with the posterior teeth in the smile zone.
ANATOMY OF TEETH
The anatomy of the anterior teeth plays an important role in a natural appearance and the individuality and personality of a smile. Some anterior teeth are flat and some are convex. Some have a square appearance while others have a fan-shaped appearance. These and other distinctive contours give each patient's smile individuality. The labial contour of these teeth should exhibit three planes when viewed from a lateral profile and. The surface texture can also add personality to the appearance of the teeth. All of these factors should be considered when restoring teeth in this area.
Labial contour, three planes (cross-sectional view) (lines perpendicular to arrows).
Labial contour (lateral view)
INCISAL EMBRASURE AND CONTACT POINTS
With ideal anatomy and alignment of these six teeth, an open space is formed between the proximal surfaces of incisal edges from the contact points. This area is called an incisal embrasure. These embrasure spaces terminate at the contact points with the adjacent teeth. The contact areas of both centrals are located at the incisal third of the crowns. Therefore, the incisal embrasure space between the centrals is slight. The contact point between the central and lateral incisor approaches the junction of the middle and incisal thirds of each crown, making it slightly deeper than the junction between the centrals. The contact point of the lateral incisor and the cuspid is approximately at the middle third. Therefore, the incisal embrasure spaces of the anterior teeth display a natural and progressive increase in depth from the central to the cuspid.
Incisal embrasures (arrows). Size increases progressively from the central to the cuspid.
Line angles are defined as the transition from one surface to another. Altering the degree of curvature and placement of line angles can change perception of tooth width and length. Line angles closer to the midline result in a shorter incisal edge, a smaller tooth face and larger embrasures. The teeth look smaller.
HEIGHT OF CONTOUR
Height of contour is established by the contour of teeth. Knowledge of dental anatomy is required to evaluate where is should be.
The surface of teeth is textured or smooth. It determines light reflection and blending into other teeth. Placement of lines as developmental grooves or craze lines and dimples can affect perceptions of width and length and alter light reflection patterns. Concave lines that run gingival to incisal increase perception of tooth height while lines that run mesial distal alter perception of tooth width.
When designing your new smile it is possible to change the shade (colour), of your teeth. Teeth are not pure white, they possess a range of colours and translucencies. A tooth may be divided into three regions:
1. The cervical third should be more yellow in appearance, even in bright white smiles.
2. The middle third or body of the tooth will be the prominent shade, generally less yellow and brighter in appearance.
3. The incisal third possesses varying degrees of translucency and may appear a little blue or grey.
The most attractive smiles incorporate all these features, without which teeth look artificial.
Case 1: Patient had mid line diastema, Disproportion upper anteriors, a new smile was given using eight ceramic veneers
Case 2: Patient had many existing discolored dental restorations, dark stained teeth, Broken and attired teeth, which were treated with 28 Ceramic Crowns and Veneers
Case 3: Patient had worn all his teeth down ,which were restored back to ideal form in a new esthetic and balanced position ,with all ceramic crowns and veneers.
Case 4: Patient had some gum recession and dark space between her front 2 teeth, which were restored with 8 veneers to create a beautiful smile