Daniel H Ward DDS Private Practice- Columbus, Ohio Former Assistant Clinical Professor: The Ohio State University-13 years Daniel H Ward DDS Oh, I Get By With a Little Help from my friends.. Fellow Academy of General Dentistry Fellow American College of Dentists Fellow International College of Dentists Fellow American Society for Dental Aesthetics Associate Member American Academy of Esthetic Dentistry Dr Harry Albers Dr Paul Belvedere Dr John Burgess Dr Mark Canon Dr Gordon Christensen Dr George Freedman Dr Doug Lambert Dr Karl Leinfelder Dr Graeme Milicich Dr Buddy Mopper Dr Brian Novy Dr Jorge Perdagão Dr Robert Seghi Dr Irwin Smigel Dr Byong Suh Dr Ed Swift Phographic Disclosure Universal Language Some Images were: Cropped Rotated Levels adjusted No images were: Site adjusted Enhanced produce a better result Music 1
Universal Language Communication Smile Emotions The smile is a way of expressing on the outside our feelings on the inside Communication: Success Communication: Perception Congratulations, You re hired! Excessive gingival display negatively affected how attractive a person's smile is judged be. In addition, how friendly, trustworthy, intelligent, and self-confident a person was perceived be was inversely related the amount of gingival display. Laypeople were just as sensitive these differences as dental students. Equally Qualified Excess Gingival Display Malkinson S1, Waldrop TC, Gunsolley JC, Lanning SK, Sabatini R. The effect of esthetic crown lengthening on perceptions of a patient's attractiveness, friendliness, trustworthiness, intelligence, and self-confidence. J Periodonl. 2013 ;84:1126-33. According a recent survey: Why Do People Seek Cosmetic Dentistry? In 2014: Median US household yearly salary was $53,891* Plain looking individuals made 5-10% less per year Attractivepersonsmade 4-8% moreperyear (based on their own personal opinion of their appearance) *Sentier Research Group as cited http://money.cnn.com/2014/08/20/ news/economy/median-income/ AACD Survey 2013 2
Successful Attitude Who is This? Hilliary Duff So you don t think a smile is Important? The Stars know!! Cheryl Cole Catherine Zeta-Jones Smile What is a Smile? 1840 s Paris physician Applied electrodes guillotine patients Muscles contract in facial expressions First demonstrate mechanism of smiling Dr Guillaume Duchenne Guillaume-Benjamin Duchenne de Boulogne Mechanism of Human Physiognomy or Electro-physiological Analysis of the Expression of the Passions Smiling constitutes a universal language which neither fashions nor whims can change and is the same in all people Dr Guillaume Duchenne Guillaume-Benjamin Duchenne de Boulogne Mechanism of Human Physiognomy or Electro-physiological Analysis of the Expression of the Passions 3
Smile Muscles What is a Smile? Zygomatic Buccinar Obicularis Oris Triangularis Muscles of Facial Expression The smile offers a convenient shorthand for far-reaching assessments of character, behavior, and temperament. 2004 Angus Trumble A Brief Hisry of the Smile Angus Trimble What is a Smile? What is a Smile? Our facial expressions, and especially the smile, constitute a system of unconscious communication that got built in our biology long before language itself Richard Conniff Smithsonian 2007 What s behind a Smile? Smiles in fact are only the most visible part of an intimate melding between two minds New York Times 2011 Words Used Describe Smiles Words Used Describe Smiles Brittle Smile a brittle laugh or smile does not show real humor or happiness Cheesy Smile a cheesy smile is very obvious but looks false laugh or smile does not show real humor or happiness Humorless Smile a humorless smile expresses no pleasure http://www.macmillandictionary.com/us/thesauruscategory/american/words-used--describe-smiles http://www.macmillandictionary.com/us/thesauruscategory/american/words-used--describe-smiles Mirthless Smile a mirthless smile or laugh expresses feelings such as anger or sadness Mona Lisa Smile used for describing a mysterious smile or expression on a woman s face Sardonic Smile a sardonic smile, expression, or comment shows a lack of respect for what someone else has said or done 4
Words Used Describe Smiles Smiles are part of the FACE http://www.macmillandictionary.com/us/thesauruscategory/american/words-used--describe-smiles Set Smile a set smile or expression does not change, and often hides what someone is really thinking Sly Smile a sly smile shows that the person doing it knows something that other people do not know Thin Smile if someone gives a thin smile, their lips move but the feeling is not sincere FACIAL TRIANGLE Facially Generated Dental Esthetics Introduction Smile Design Multi-disciplinary Approach Orthodontics Periodontics Prosthodontics Facial Plastic Surgeon There are rules Rules are made be broken No one smile ever follows all the rules Dr. David Sarver Designing an Ideal Smile Incisal Placement Let s start with a blank canvas Where do we begin? Incisal plane parallel the interpupillary line Incisal edge is starting point! 5
Canted Incisal Plane Rule of Thirds Forehead - from Trichion Nasion Cheek - Nasion Subnasale Mouth - Subnasale Menn Trichion Nasion Subnasale Menn Rule of Thirds Incisal Plane o inferior Divide subnasale and menn in equal Thirds Incisal edge at junction of Superior and Middle Thirds Incisal Edge Incisal Plane o superior Determinents of Incisal Edge Placement: Appearance 6
Determinents of Incisal Edge Placement: Incisal Edge Position: Phonetics Appearance Phonetics Use words like these, those, fifty five, very fine Pound- JPD 1970 Using speech simplify denture service When the patient pronounces f and v sounds the length and labiolingual position of the incisal edges of the maxillary teeth can be determined. Determinants of Incisal Plane Placement: Incisal Placement Appearance Phonetics Occlusion Vertical midline in the center of the face perpendicular the interpupillary line Vertical midline centered with the philtum Reverse Smile Curve Incisal Placement Incisal edges follow curvature of the lower lip 7
Curve of Spee Curve of Spee-Flat The anterior-posterior curvature of the occlusal plane superiorly as you move distally Tooth Display Excess Gingival Display Clinical crown outlined by the upper and lower lip Marginal gingiva display confined interdental papilla Altered Passive Eruption Smile Display Smile Display Filling the Buccal Corridor Buccal Corridor Negative Space Display of posterior buccal teeth 8
Roots diverge apically as you move distally-anteriors Roots converge apically as you move distally-anteriors Incisal embrasures become larger as you move distally Roots Contact diverge points move apically as you apically move as distally you move distally Roots Connecr diverge Area apically as you move distally Apical Zenith located distal the long axis midline Connecr area is the perceived area where the two teeth appear uch Percentage is of height of oth Contact point is usually 2mm or less Morley J Prac Perio Aesth Dent 2000 A multidisciplinary approach complex aesthetic resration with diagnostic planning 50 % 40 % 30 % 9
Roots Cervical diverge of Central apically Incisors as you and move Cuspids distally are parallel Roots Incisal and diverge cervical apically length as you of laterals move distally may be 0.5-1mm shorter than Central Incisor Feminine Roots Incisal and diverge cervical apically length as you of laterals move distally may be 0.5-1mm shorter than Central Incisor Facrs affecting each oth in the smile Central Incisor: DOMINANCE Lateral Incisor: VARIABILITY Cuspid: AGGRESIVENESS Masculine Central Incisors Mirror Images Central Incisors SPA facr-age Morley Dentistry Today 1990 Design Theory of Central Incisors Frush & Fisher - JPD 1957 The Age Facr in Dengenics 10
Central Incisors Roots Relationship diverge of Face apically Form as you and move Tooth distally Form Geometric shape is trapezoidal Mesial crest of convexity is in the incisal third Distal profile is more convex and the crest of convexity is at the junction of the middle and incisal thirds Mesial incisal angle is almost a right angle, distal incisal line angle is rounded Denture teeth often recommend oth form mimic face form Relationship of Face Form and Tooth Form Lateral Incisors-Diversity SPA Facr Sex Correlating Face and Personality Dynamic Delicate Stability Feminine Masculine Dr.Galip Gurel Frush & Fisher - JPD 1956 How Dengenic Resrations Interpret the Sex Facr Lateral Incisors Roots Masculine diverge vs feminine apically as you move distally Smaller and more rounded than the central incisor Mesial crest of convexity is in the incisal third Distal crest of convexity is in the middle third The incisal edge and incisal angles are more curved than the central Feminine Rounded facial profile Shorter lateral incisor Apical zenith-lateral centered Narrow gingival width of LI Rounded incisal forms Lombardi - JPD 1973 The principles of visual perception and their clinical application denture esthetics Research show no difference in extracted teeth from male female; However 11
Masculine vs feminine Cuspids-Aggresiveness SPA Facr-Personality Masculine Feminine Passive Aggressive Frush & Fisher - JPD 1956 How Dengenics Interprets the Personality Facr Cuspids Whose smile is this? Cusp tip mesial crown center Mesial crest of convexity at the junction of middle and incisal thirds Distal crest of convexity-prominent bulge in the middle third of the crown Distinct developmental depressions Whose smile is this? Whose smile is this? 12
Whose smile is this? Whose smile is this? Whose smile is this? Roots Natural Aging diverge of apically the Faceas you move distally Powell N, Humphreys B. Proportions of the Aesthetic Face. New York. Thieme-Stratn, 1984. Roots Natural Aging diverge of apically a Smile as you move distally Roots Creating diverge a Younger apically Smileas you move distally Vig RG, Brundo GC. The kinetics of anterior oth display. J Prosthet Dent 1978; 39:502-504. Morley J. The Role of Cosmetic Dentistry in Resring a Youthful Appearance. JADA 1999; 130:1166-1172. 13
Roots Compensate diverge for apically as you Discrepancies move distally by Creating Illusions-Width Roots Compensate diverge for apically as you Discrepancies move distally by Creating Illusions-Height Narrow Wide Flat (Tall) Narrow Wide Curved (Short) Roots Smile Shapes diverge apically as you move distally Smile Shapes by Dr Bill Dickerson From The Smile Catalog TM The Ultimate Practice Inc Smile Shapes Smile Shape Guides From The Smile Guide TM Discus Enterprises From The Smile Catalog TM The Ultimate Practice Inc 14
Traditional Dentistry Traditional Dentistry Components Teeth Periodontium Occlusion Periodontal Architecture Objective Tooth Evaluation Cosmetic Dentistry Visual Exam Tactile Exam Diagnostic Casts Radiographs Aesthetic Dentistry Founding Father NYU and the curar for the Smithsonian Institute credit Dr. Irwin Smigel with being the Father of Aesthetic Dentistry 15
Cosmetic Dentistry Components Teeth Periodontium Occlusion Periodontal Architecture Lips Facial Muscles Skeletal structure Soul 16
How do we diagnose a smile? Evaluation Methods TLAR Principle Who has an ideal smile? Subjective Smile Evaluation Evaluation Methods Evaluation Methods Proportional Smile Design Objective Smile Evaluation Chair-side Smile Evaluation Objective Smile Evaluation Evaluation Methods Evaluate this smile Evaluate this smile 17
Describe this smile Chair-side Visual Evaluation? Evaluation Methods Objective Smile Evaluation Lips Facial Muscles Skeletal structure Soul Diagnostic Laborary Casts? Evaluation Waxup Objective Smile Evaluation Evaluate all smile components Unlimited Time Facr Measure relative oth dimensions Predictable Results CHALLENGE Objective Smile Evaluation Predictable Cosmetic Dentistry Cannot be achieved without the use of: PHOTOGRAPHY My wife wants me do a smile makeover 18
I just don t like the gray spots. I want whiter teeth! High Occlusion Implant # 10 Lingual composites # 9 & #11 Implant # 10 Crowns # 9 & #11 I just Treatment don t like Options the gray spots. I want whiter teeth! Treatment Options Implant # 10 Crowns # 9 & #11 Replace missing oth Change cant Whiten smile Treatment Options Challenges 19
All-porcelain bridge #9-11 Porcelain laminate veneers #5,6-8,12 All-porcelain bridge #9-11 Porcelain laminate veneers #6-8 Recommended Treatment Accepted Treatment Preparations Soft Tissue Model Seating Completed Case 20