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Smile design

Presented by

Dr. P. Baskar
PG student
Department of conservative dentistry and Endodontics
 Guidelines in smile design
 Shade selection and multidisciplinary
approach in smile design
Guidelines in smile
Dentistry has always been aware of the
importance of dental esthetics but
recently the patients and many
dentists have emphasized this branch
of dentistry because of the high
value, society gives to a person’s
The development of new techniques
and restorative materials to meet this
new demand has allowed a greater
number of treatment options capable
of improving or restoring the natural
appearance of teeth. These options
are becoming more simple and
The different factors influencing the
smile can be divided into two
categories: those which can be
changed by the clinician and those
which he/she cannot modify.

The two main aims of aesthetic

dentistry are
 to create teeth with pleasing
proportions and
 to create a dental arrangement that is
in harmony with the patient’s gums,
 Pierre Fauchard(1678-
1761) of France,
advocated esthetic
practices with the use
of gold shell crowns
with enamel “veneers”.
They also introduced a
technique for the
manufacture of mineral
(as opposed to ivory or
bone) incorruptible
teeth for use in
 Transplantation of teeth between
patients was practiced, with donors
being paid for their trouble.
 The introduction of mineral teeth in 1817
was soon followed by the manufacture of
porcelain teeth. Dentures were
fabricated with a gingival component
made of carved ivory or animal bone
that was designed for adaptation to
ivory or bone base.
 open-faced crown was invented around
1880, the interchangeable porcelain
facing was developed in 1880’s, and the
porcelain jacket crown came into vogue
in the early 1900’s.The three-quarter
 In the 1930s, chemically activated
acrylic resins were developed. In the
1940s, acrylic-veneer facings came
into widespread use. By the 1970s
composite resins virtually replaced
acrylic resins and silicate cements as
“permanent” restorations.

 Acid etching radically changed cavity

treatment by emphasizing
conservation of tooth structure. It also
allowed for the numerous veneering
techniques introduced in the
1970s.Variations include direct resin
veneers, commercially produced
is the predominant force, taking precedence over form,
angles and lines. The difficulty in assessing the value
(brightness component) for a shade prescription
,because the eyes are distracted by the colour (hue and
chroma components) of the tooth.
the three basic shapes of a circle, triangle and square.
These geometric shapes were, and are associated with
religious, mystical and esoteric connotations. The
maxillary anterior teeth are a fusion of these basic
The direction of lines can also create optical illusions.
Prominent vertical lines on the facial surface of an
anterior tooth will infer a longer tooth, while distinct
horizontal lines have the opposite effect (wide and short
 Proposed by the Pythagoreans’ was
the Golden Number, represented
by the Greek symbol, ∆. The
reciprocal of is 0.618 and has
been termed
the Golden or Divine Proportion.

 Objects, animate or inanimate,

whose features or details
conform to this ratio, are
perceived as having innate
 defined as static or
 Static symmetry is
evidenced by repetition
in inanimate objects
such as crystals or
arrangements .
 Dynamic (radiating)
symmetry refers to
repeated proportions in
animate, living or vital

 unity in a composition is achieved by

incorporating balancing forces as well
as a dominant key element. It is
important to realize that teeth are
arranged with tectonic spacing.

 Tectonic refers to an arrangement

that is both functional and aesthetic
There are two types of
visual forces requiring

 cohesive forces, which provide unity

and harmony, e.g. two parallel objects
or an encircling frame (lips bordering
the anterior teeth).
 The opposite are segregative
forces, which convey tension and
interest, e.g. objects that bisect each
other in a perpendicular arrangement.
Segregative forces are essential for
avoiding monotony and adding
curiosity and variety to a composition.
 Dr Max Wertheimer initiated the Gestalt
theory of psychology in Germany around
1912, and put succinctly, its definition is
“the whole is different from the sum of
its parts

 These concepts allow the observer to

achieve a better object-background(figure-
ground) relationship by encapsulating the
following four constituents:
• Proximity
• Similarity
• Continuity
• Closure.
 Proximity
facilitates association, linking, grouping,
learning, and therefore adds interest.
A dental example is teeth arranged
adjacent to each other, without
diastemae, avoids detachment and
 Similarity
ensures objects have similar form,
colour, position and line angles, e.g.
teeth with similar shade, form and
arch alignment.
 Continuity
ensures progression, e.g. recurring or
repeated ratios from the maxillary
incisors to the canines.
 Closure
assures cohesiveness, such as a frame
or border, e.g. lips surrounding the
Smile design theory can be broken
down into at least four parts:
 facial esthetics,
 gingival esthetics,
 micro esthetics and
 macro esthetics
 Micro esthetics

involves the elements that make teeth

actually look like teeth. The anatomy of
natural anterior teeth is specific for each
tooth and that tooth’s location in the dental

Specific incisal translucency patterns,

characterization, lobe development and
incisal haloing all are components of the
micro esthetics of each tooth.

Dentists and technicians alike endeavor to

replicate the micro esthetics of teeth in
Macro esthetics

 The relationship between those teeth

and the surrounding soft tissue and the
patient’s facial characteristics creates a
dynamic and three-dimensional canvas.

 The artistic work of the dentist and the

technician can combine to create a
natural and pleasing overall appearance
—or not—depending on how well the
relative shapes, sizes and arrangement
of the individual teeth harmonize with
the features of any given patient
to locating the facial midline references two anatomical
The first is a point between the brows known as the
The second is the base of the philtrum, also referred to
as the cupid’s bow in the center of the upper lip.

A line drawn between these landmarks not only locates

the position of the facial midline but also determines
the direction of the midline

the midline between the maxillary central incisors should

be coincidental with the facial midline.
In cases in which this is not possible, the midline
between the central incisors should be parallel to the
facial midline.
If the visual junction of maxillary central incisors
is at an angle to the facial midline, it is referred
 Incisal embrasures.
 The pattern of silhouetting created by the
edges and separations between the
maxillary anterior teeth against the darker
background of the mouth helps define a
good-looking smile. These spaces between
the edges of the teeth known as embrasure
 The size and volume of the incisal
embrasures between teeth increase as the
dentition progresses away from the midline.

 the incisal embrasure space between the

lateral incisor and the central incisor should
be larger than the incisal embrasure
between the central incisors.

 The embrasure between the canine and the

lateral incisor should be larger than the
 Connectors.
 The places in which the anterior teeth appear to
touch have been referred to as the connector
 The contact points between the anterior teeth are
generally smaller areas (about 2 x 2 millimeters)
that can be marked by passing articulating ribbon
between the teeth.
 The connector is a larger, broader area that can
be defined as the zone in which two adjacent
teeth appear to touch.
 An esthetic relationship exists between the
anterior teeth that are referred to as the 50-40-30
 This rule defines the ideal connector zone
between the maxillary central incisors as 50
percent of the length of the central incisors.
 The ideal connector zone between a maxillary
lateral incisor and a central incisor would be 40
percent of the length of the central incisor.
 The optimum connector zone between a
 Axial inclinations: Each
combination of tooth inclinations in a
smile is unique. The long axis of, or
direction of the anterior teeth in, an
esthetic smile also follows a
progression as the teeth move away
from the midline.
 Shade progression.: Even the shade and
color patterns of the maxillary teeth follow a
progressive pattern based on the distance
from the midline. The maxillary central
incisors are the lightest and brightest teeth
in the smile. The maxillary lateral incisors
have a similar hue to that of the central
incisors but are typically just slightly lower
in color, or value.
 The canines have greater chroma saturation
and also are lower in value than any of the
other anterior teeth.
 First and second premolars appear lighter
and brighter than the canines and have a
value similar to that of the lateral incisors.
 Reproduction of shade progression in
anterior restorative and cosmetic treatment

 "Tooth reveal" is a term for the

amount of tooth structure or gingiva
that shows in various views and lip
positions. Even the most beautiful
anterior tooth or teeth will have little
esthetic value for the patient if the
amount of reveal is unflattering to the
 "M" position.:
 By having the patient say the letter "M"
repetitively and then allow his or her lips
to part gently, the clinician can assess
minimum tooth reveal.
 While younger patients may show
between 2 and 4 mm of maxillary incisal
edge in this position, the maxillary
incisal edge reveal shrinks and even
disappears as people age.
In some elderly patients, the mandibular
incisal edges begin to show. Carefully
locating the "M" position reveal and
creating the restoration accordingly can
have the fluid effect of making a smile
 "E" position.: When
patients say the letter "E"
in an uninhibited and
exaggerated way, the
clinician can ascertain
the maximum extension
of the lips..
During photographic
analysis of the smile,
everything that shows
can be considered to be
in the esthetic zone.
Restorative, surgical and
periodontal treatment
within the esthetic zone
should take into
consideration both the
cosmetic and the health
consequences of the
 Inter-commissure line and lower lip framing. :

 When a patient’s mouth is in broad smile position, the

clinician can draw an imaginary line through the
corners of the mouth. This line is known as the inter-
commissure line, or ICL.

 The amount of maxillary tooth reveal below the ICL

interacts with the viewer’s perception of the patient’s

 In a youthful smile, approximately 75 percent to 100

percent of the maxillary teeth would show below this
line. The position of the incisal edges of the anterior
teeth as they relate to the lower lip also may have
esthetic consequences.

 When the visual space created between upper and

lower lips in full smile is considered, the maxillary
anterior teeth should fill 75 percent to 100 percent of
that space to create a youthful look.
 Vestibular space. : In a broad
smile, the amount of reveal of the
maxillary posterior teeth also can
become an esthetic consideration.

In patients who have narrow arch form

and wide lip extension, tooth reveal
behind the canines can be in shadow
or disappear completely. This
condition has been called deficient
vestibular reveal, or DVR.DVR may
have negative esthetic consequences
in certain patients.
 Smile line.: The plane of
the incisal edges of the
maxillary anterior teeth also
can be related to the two
fundamental criteria of
midline and reveal.

 Traditional orientation of the

smile line calls for it to be
parallel with a line drawn
between the pupils of the

 When the incisal edges of

the maxillary central
incisors appear to be below
the tips of the canines, the
smile line has a convex
appearance that can
approximate and harmonize
with the line of the lower lip.
A so-called “reverse smile
line” result when the tips of
the canines or premolars
Various proportion in smile
surgeons have long used the idea of
proportions to define desirable facial
 The rule of thirds divides the face
vertically into three approximately equal
the superior border of the face is the
trichion (ideal hairline),
the junction between the upper and
middle thirds is the nasion, the junction
of the middle and lower third is
subnasale, and
the inferior border is the menton.
If the lower third of the face subsequently
is subdivided into thirds, the ideal
been stated throughout dental
literature that the height of the
central incisor should be 1/16 the
height of the face from ideal hairline
to the chin and that the width of the
ideal central incisor should be 1/16
the interzygomatic width.

 Another common rule of smile design

is that the widths of the anterior six
teeth as viewed from the frontal
should be in golden proportion to the
intercommissural width.
: Levin used the
golden proportion to
relate the successive
widths of the anterior
teeth as viewed from the
 Levin
stated that “the width of
the central incisor should
be in golden proportion
to the width of the lateral
incisor and that the width
of the lateral incisor to
the width of the canine
should also be in golden
proportion as should the
width of the canine to the
first premolar.
 The width of the central incisor should be
multiplied by the value defined as the golden
proportion, which is 0.618,or approximately
62%.The resultant width of the lateral incisor
should be multiplied by 62% to give the width of
the canine as viewed from the frontal.

 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. This phenomenon has been combined
in a grid which can be used to assist us in
perfecting the aesthetics of the eight front teeth.
 Snow considered a bilateral analysis
of apparent individual tooth width as
a percentage of the total apparent
width of the six anterior teeth. He
proposed the golden percentage
wherein the proportional width of
each tooth should be: central 25%,
lateral 15%, and canine 10% of the
total distance across the anterior
segment in order to achieve an
 The RED proportion states that the
proportion of the successive widths of the
teeth as viewed from the frontal should
remain constant as one move distally.
Rather than being locked into using the
62% proportion, the dentist can use the
proportion of his or her own choosing as
long as the dentist is consistent while
moving distally. Instead of having to accept
the proportion already defined by the
widths of the central and lateral incisors,
the dentist can define his or her desired
RED proportion.
 The use of RED proportion gives greater
flexibility. Although an approximate 70%
RED proportion is preferred, the RED
proportion should be modified to fit the
 Dental photography is essential in
evaluating a smile. Photographs provide
unlimited time as well as the ability to
measure the dimensions and proportions
of the teeth.
 An image taken parallel to the facial
plane and at least 8 inches away from
the teeth should be used to minimize
 If the camera is located too close, the
teeth are distorted. A 35-mm camera
with a 100mm macro-lens set at 1:2
magnification is preferred.
 A digital camera with similar optical
capabilities also may be used. It is
important to use a high-quality camera,
 When working with the anterior six teeth,
mathematical formulas for calculating the ideal size of
the central incisors may be used. The equation used
to determine the ideal width of a central incisor from a
predetermined RED proportion is:
 {(FIVE width of the anterior 6 teeth) / 2(1+
RED + RED2)}
= width of central incisor
(The RED should be expressed as a decimal <1)
 Once the width of the central incisor has been
established, the height can be determined by using
the formula:
 (Width of central incisor / Width-to-height
ratio) = height of central incisor
 (The width-to-height ratio should be expressed as a
decimal <1)

 The anterior six teeth are the only teeth clinically in

which the individual mesial and distal FIVE dimensions
of the teeth can be altered significantly by making
 The interpupillary line is determined by a
straight line that passes through the
center of the eyes and represents, if
parallel to the horizontal plane, the most
suitable reference for carrying out
correct facial analysis.
 In most subjects in whom asymmetry is
found, the dimensional difference
between the left and right sides of the
face is less than 3%.This is therefore
considered the limit beyond which a
facial irregularity becomes evident to the
eye of the observer.
 A well- proportioned face can be divided
vertically into three portions of equal size.
The upper third of the face is the area
between the hairline and the ophriac line,
the middle third runs from the ophriac line
to the interalar line and the lower third
extends from the interalar line to the tip of
the chin.
 The lower third of the face plays a
significant role in determining the overall
esthetic appearance. The distance from the
bottom of the nose to the lower edge of the
upper lip should be approximately half the
length between the lower lip and the
Appropriate clinical evaluation of the lateral
view is a determining factor in successful
completion of an esthetic examination of
the patient.
 The profile is evaluated by measuring the
angle formed when three reference points
on the face are joined together: glabella,
subnasale and soft tissue pogonion. The
lines that join these three elements
normally form an angle of roughly 170
 In a patient with a convex profile, the angle
formed by joining the three reference points
 In patients with a concave profile, the
angle formed by joining the three
reference points is greater than 180
degrees, creating an anterior

 One useful element in determining the
profile type is an evaluation of the
position of the lips with reference to an
ideal line that joins the tip of the nose to
the tip of the chin. According to Ricketts,
in a normal profile, the upper lip is about
4 mm posterior to the E-line, while the
The lips
 Shape
 Labial philtrum
 Lip movements

 When the teeth are at maximum intercuspation,

the lips touch lightly and the incisal third of the
maxillary incisors is covered by the wet surface of
the lower lip.
 When the mandible is in the rest position, the
teeth do not come into contact, the lips are
slightly apart, and a portion of the incisal third of
the maxillary incisors is visible, this varies from 1-
5mm,depending on the height of the lips and the
patient’s age and sex

 Vig and Brundo reported that on average, the
maxillary incisors are exposed more in women
when at rest than in men (3.4 versus 1.91mm)
and that young patients show them much more
than middle-aged patients(3.37mm versus
 Identification of the position of the
incisal edge, in both the apico-coronal
(incisal curve) and anteroposterior
(incisal profile) directions, represents
a fundamental aspect of the esthetic
 Sometimes abrasion of the incisal
edges can lead to a flat or even a
reverse incisal curvature, producing
unpleasant effects from an esthetic
point of view.
 A flat incisal plane, with uniform tooth
length and the reduction or
disappearance of the interincisal
angles, gives the smile horizontal
symmetry. This causes the loss of the
so-called cohesive force in the
dentofacial composition, creating an
 The incisal profile is the position of the
incisal edge in the anteroposterior
direction and is contained within the
inner border of the lower lip. This allows
adequate closure of the lips, so they can
come together without any interference
from an incorrectly positioned incisor.

 The first step in this analysis is to
evaluate the exposure of the anterior
teeth during smiling. On the basis of the
amount of dental and gingival display in
the anterosuperior area, Tjan and
coworkers identified three types of smile
lines: low, average, high.
The various factors that can cause this
excessive visibility of the soft tissue
 A short upper lip
 Labial hyper motility
 Altered passive tooth eruption
 Anterior dento alveolar extrusion
 Excessive vertical development of the
upper maxilla

 a function that is closely affected by

the relationship between the teeth,
the lips, and the tongue, and it can be
significantly compromised by the
presence of inadequate restorations.
Pronunciation of the sounds of m, e,
f/v, and s can be a valuable aid in
identifying some of the functional and
esthetic parameters to be followed
when creating the treatment plan.
 When the patient is in the rest position, a space
between the arches exist, ranging on average
from 2 to 4 m, that is never completely occupied
by the teeth (i.e., the free space)

 In addition to helping establish the postural
interocclusal position, the m sound can also
provide useful information about incisal length.
 In the interval between one pronunciation and
the next, the clinician can evaluate the portion of
the central incisor that is visible in the rest
position, which will help to determine the
modifications that need to be made to the incisal
 The possibility of shortening or lengthening the
incisal third of the anterior teeth must be
assessed on the basis of the amount of tooth
exposure, the sex and the age of the patient,
 Prolonged pronunciation of the vowel sound e is another aid
in phonetic evaluation of the incisal length of the maxillary
 While pronouncing this sound a space can be seen between
the upper and lower lips that are occupied only partially by
the maxillary incisors. The size of this space varies from one
patient to another, depending on age.

 When young patients pronounce the letter ‘e’, the space
between the upper and lower lips is, as a rule, occupied
almost entirely by the maxillary incisors. The incisal edge is
therefore brought very close to the lower lip. If the maxillary
teeth occupy less than 50% of this space, they can normally
be lengthened to occupy as much as 80% of the space
between the lips.
 Because of the reduced tonicity of the perioral tissues in
elderly patients, the space between the upper and lower lips
is only partially occupied by the maxillary incisors. The
incisal edge may therefore be short of the lower lip. This
 Correct pronunciation of the sounds f and v is
produced by light contact between the maxillary
central incisor and the vermilion border of the lower
 Air compression that occurs when the hard surfaces of
the maxillary incisal margins meet the soft surface of
the lower lip during pronunciation of the letters f and v
produces the appropriate sounds. Fluent pronunciation
of these sounds means that the maxillary incisors are
the correct length and that their incisal profile is
positioned adequately.
 The vermilion border therefore represents the buccal
limit within which the incisal margins of the
restorations are to be positioned. When the incisal
margin just touches the lower lip, the incisal length
can be considered suitable. If there is any separation
between the teeth and the lip during pronunciation,
the suitability of the length of the anterior teeth must
be evaluated on the basis of the results of the other
phonetic tests (i.e., m and e) and analysis of the other
 Correct pronunciation of the s sound
is determined by the uniform passage
of a wide, flat band of air that is
forced between the hard surfaces of
the maxillary and mandibular anterior
 The different tooth forms can be
correlated invariably to sex or
personality and specific age
Certain aspects that can provide useful
indications for defining the most
appropriate tooth type are:
 Recreating correct tooth type lies in the
natural teeth adjacent to those being
restored or, in their absence, those in
the opposing arch.
 Use of old photos or models of the
patient is indispensable for determining
the original form of the teeth.
 The gingival architecture and the
 When observing the natural dentition, a
significant difference in colour can be seen
between the teeth in both arches. The maxillary
central incisors are the lightest teeth in the
mouth and therefore dominate the tooth
composition not only because of their size, but
also because of their brightness. In most
individuals, the lateral incisors appear to be the
same hue as the central incisors but slightly less
intense, and therefore they look much less bright.

 The canines, both maxillary and mandibular,

often show a much more intense chroma,
sometimes appearing much darker than the teeth
adjacent to them. The premolars are of a similar
color to the lateral incisors, therefore
distinguishing themselves from the canines. The
color of the tooth depends on the thickness of the
enamel and the level of saturation of the dentin.
 In the cervical area, the reduced
thickness of the enamel makes the color
of the dentin more evident, producing
greater chromatic saturation. Thicker
enamel, on the other hand, produces a
marked translucency in the incisal third,
where phenomena of fluorescence and
opalescence combine with those of total
light reflection caused by the inclination
of the incisal edge.

 When restoring anterior teeth, due

consideration must be given to re-
creating a natural color progression and
the color obtained in this way will
represent the new point of reference for
Other factors that influence in
smile design
 Tooth position and arrangement
 Arch shape
 Tooth crowding
Functional aspects

 Occlusal relationships
 Maximal intercuspal position
 Centric relation
 Centric occlusion
 Anteroir guidance
 Incisor guidance
 Canine guidance
 Overjet and overbite
 In the past, esthetics and function were
considered two separate aspects and
optimization of esthetics often involved
functional compromise.
 Nowadays, the functional aspect must
represent the starting point for achieving
esthetics. The re-establishment of a
natural appearance achieved by creating
restorations that are not only
increasingly difficult to distinguish from
natural dentition but also allow the
achievement of both correct function

 It is well recognized that the smile has

great influence on facial esthetics and
one’s general appearance. This new
emphasis on esthetics is changing the
focus of dental practice from restoring
carious teeth to treating healthy teeth
to making them more esthetic.

To be continued as…………………….