1 - smile analysis and design

What are the four parts of the smile design theory?

Facial esthetics
Gingival esthetics
Microesthetics
Macroesthetics

What are the best ways to analyze a gummy smile/excessive gingival display?

Photographs and videos

What does photographic analysis determine?

How lips and soft tissue frame the smile in different positions of speech, smile, and laughter

Why may a video be more beneficial than a photo?

You can interact with the patient, ask them questions, and make them laugh to see their muscles working in real time
Personality before and after is also rewarding when comparing the videos

What two components are important to gingival esthetics?

Gingival health and appearance

What are some gingival features that may detract from an esthetic smile?

Inflamed, uneven gingival lines
Blunted papilla
Asymmetric gingival crests

What is a gingival zenith?

Apical point of the gingival marginal scallop

What is the mean distance of the gingival zenith location on the central incisor?

~1mm distal to the vertical bisected midline of the clinical crown

What is the clinical relationship between the gingival zenith position of the lateral incisor and canine?

Coincident with the cervical bisected midline along the axial inclination of the teeth

What is the gingival zenith level (GZL) for both lateral incisors relative to the adjacent gingival zenith position of the central incisor and canine teeth?

Coronal by ~1mm

What three smile photographs should be taken at the start of a case?

Rest
Regular smile
Exaggerated smile

What ratio should be evaluated to achieve a better distribution of maxillary teeth into the sextant before the delivery of the restorations?

W/L
WIDTH (tooth type) = % x LENGTH(tooth type)

What is the W/L ratio of central incisors?

Width 85% of length measurement

What is the W/L ratio of lateral incisors?

Width 79% of the length measurement

What is the W/L ratio of canine teeth?

Width 83% of the length measurement

How long should restorative provider wait for crown lengthening to heal to ensure margin is confirmed for final restorations?

3 months, but diagnostic mockup can be done beforehand even as a provisional

What component of smile design "involves elements that make teeth actually look like teeth?

Microesthetics

What are examples of microesthetics?

Anatomy of natural anterior teeth (contact, size, emergency profile...)
Location of natural anterior teeth in dental arch
Specific incisal translucency patterns
Characterization
Lobe development
Incisal haloing

(Microesthetics/macroesthetics) represents principles that apply when groupings of individual teeth are considered

Macroesthetics

With respect to macroesthetics, what is the relationship that creates a dynamic and three-dimensional canvas?

Teeth and the surrounding soft tissue and the patient's facial characteristics

Which component of smile design attempts to identify and analyze the relationships and ratios between anterior teeth and surrounding tissue landmarks?

Macroesthetics

What are the principles of macroesthetics?

Facial midline
Axial inclinations
Incisal embrasures
Connectors
Shade progression
Intercommisure line and lower lip framing
Vestibular space
Smile line
Tooth anatomy/basic tooth forms

Which two anatomical landmarks are used for reference as a practical approach to locate the facial midline?

Point between browns, nasion
Base of the philtrum (Cupid's bow) in the center of the upper lip

What does the line representing the facial midline also determine?

Direction of the midline

Axial inclinations follow a progression as the teeth move (towards/away from) the midline

Away

What angle involves the appearance of a tooth tipping medially?

The long axis of the tooth tips toward the midline when assessed from the height of the gingival margin toward the incisal edge

What is the overall esthetic impact of maxillary teeth tipping medially?

Harmonious relationship with the framing of the lower lip

The medial tipping of the axial inclinations (increases/decreases) as one moves further from the midline

Increases

Size and volume of incisal embrasures between teeth (increase/decrease) as dentition progresses away from the midline

Increase

The incisal embrasure space between the lateral incisor and the central incisor should be (smaller/larger) than the incisal embrasure between the central incisors

Larger

The embrasure between the canine and the lateral incisor should be (smaller/larger) than the embrasure between the lateral and central incisors

Larger

Incisal embrasure spaces (increase/decrease) progressively sway from the midline

Increase

What is a connector?

Area in which two adjacent teeth APPEAR to touch

T/F: connector is another term for contact area

False!
Connector = appear touching
Contact area = actual touching

Which component of macroesthetics is associated with the 50-40-30 rule for anterior teeth?

Connectors

If the height of #9 is 10mm, based on the 50-40-30 rule, what are the connector heights between 8&9, 9&10, 10&11?
Note: only for lateral view but ppt is straight on

Centrals: 5mm (50% height central)
Central to lateral: 4mm (40% height central)
Lateral to canine: 3mm (30% height central)

Maxillary central incisors are the (lightest/darkest)

Lightest and brightest

Maxillary lateral incisors have similar hue (color) to that of the central incisor, but are typically just slightly (lower/higher) in value (brightness)

Lower

Which maxillary anterior tooth has greater chroma (saturation) and also are lower in value (brightness)?

Canine

Which teeth appear lighter and brighter than the canines and have a value (brightness) similar to that of the lateral incisors?

1st and 2nd premolars

The position of the incisal edges of the anterior teeth as they relate to the (upper/lower) lip also may have esthetic consequences

Lower

When the visual space created between upper and lower lips in full smile is considered, what % space should the maxillary anterior teeth fill to create a youthful look?

75-100%

What happens over time to create a less youthful look?

Lip droops
Teeth wear down

What condition occurs in patients who have narrow arch form and wide lip detention where tooth reveal behind canines can be in shadow or disappear completely?

Deficient vestibular reveal (DVR)
May have negative consequences in certain patients

What is the traditional orientation of the smile line?

Parallel with a line drawn between pupils of the eyes

When does the traditional orientation of the smile line guideline not work?

In patients with eyes in different planes

Which plane produces a reliable and repeatable position that does not depend on the interpupillary line?

Incisal plane that is perpendicular to the facial midline

What is significant about a reverse smile line?

does not harmonize well with other facial features and also may be associated with occlusal malfunction or loss of vertical dimension

What are the types of smile lines?

Positive
Reverse

What does visagism involve?

Creation of a customized personal image that expresses a person's sense of identity

What are the corresponding to temperaments for the four, basic tooth forms?

Oval = Melancholic
Triangular = Sanguine
Rectangular = Choleric
Square = Phlegmatic

What are the key features of oval/melancholic visigism?

Oval: dominant centrals, rounded cusps, delicate laterals, round arch
Melancholic: organized, perfectionist, artistic, abstractive, timid, reserved

What are the key features of triangular/sanguine visigism?

Triangular: ascendant smile line, converging axis, inclined cusps
Sanguine: extroverted, communicative, enthusiastic, dynamic, impulsive

What are the key features of a rectangular/choleric visigism?

Rectangular: dominant centrals, flat incisal edge, aggressive cusps, vertical axis
Choleric: determined, objective, explosive, intense, entrepreneur, passionate

What are the key features of a square/phlegmatic visigism?

Square: lack of dominance, diverging axis, horizontal arrangement
Phlegmatic: diplomatic, pacific, mystical, spiritual, conformist, discreet

What is the golden proportion?

Point of division that is a mathematical confirmation of:
1) how the eye senses proportion
2) how proportion appears in nature
3) how artists have used proportion

How does the golden proportion relate to dentistry?

Golden proportion states that...
1) If a persons' teeth are viewed straight on AND
2) Using the lateral incisor as the reference tooth...
The adjacent central incisor should be 1.6 times the size of the lateral incisor, and the visible part of the canine

What view is the golden proportion based on with respect to dentistry?

When a person's teeth are viewed straight on

What is the reference tooth when thinking about the golden proportion with respect to dentistry?

Lateral incisor

What is the ratio of the central incisor, lateral incisor, and canine under the appropriate conditions (i.e. teeth viewed straight on with lateral as reference) for the dental golden ratio?

Central: 1.6
Lateral: 1
Canine: 0.6

What are the steps in creating a digital smile design makeover?

Start with a smiling extraoral photo
Find the facial midline (nasion and philtrum)
Find smile line (perpendiular to facial midline)
Find axial inclinations to see if positive or reverse smile line
W/L ratios
Fill template with shade and discuss whitening