Smile Design Daniel H Ward DDS 1080 Polaris Pkwy Ste 130 Columbus OH 43240 614-430-8990 dward@columbus.rr.com
Incisal Placement Incisal plane parallel to the interpupillary line Vertical midline in the center of the face perpendicular to the interpupillary line centered with the philtrum Determinants of incisal edge position 1. esthetics 2. phonetics: f, v, th (Pound) 3. anterior guidance/occlusion Incisal edges follow curvature of the lower lip Clinical crown outlined by upper and lower lip, marginal gingiva display confined to interdental papilla Curve of Spee
Tooth Positions & Relationships (Rufenacht, Morley) Roots of anterior teeth diverge apically as you move distally Incisal embrasures become larger as you move distally Contact points move apically and incisal embrasures become larger as you move distally Connector area Incisal and cervical length of lateral incisors may be slightly shorter than central incisors and cuspids Cervical of central incisors and cuspids are parallel
Buccal Corridor 1. Visual area of buccal surfaces of posterior teeth 2. Ideally space is visually filled in 3. Negative space is when visual area contains vacancies between buccal surfaces of teeth and buccal mucosa Apical Zenith distal to midline of long axis of the tooth Individual Max Tooth Characteristics (Frush & Fisher, Lombardi, Morley) Central Incisors-mirror images-dominance 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 Tooth form may mimic face form (square, square tapering, tapering, ovoid)
Lateral Incisors-variations-gender-shorter than central incisors 0.5-1mm 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 Cuspids- aggressiveness Cusp tip mesial to 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 SPA factor (sex=lateral incisor, personality=cuspid, age=central incisor) Creating Illusions(Rufenacht, Gurel) Wider tooth-increase distance between developmental grooves Narrow tooth-decrease distance between developmental grooves Taller tooth-flat facial profile from cervical to incisal Shorter tooth-curved facial profile from cervical to incisal Aging of a Smile (Gurel, Vig & Brundo) Flattened Incisal edges Smaller incisal embrasures Smoother facial anatomy Prominent mandibular display Increased chroma Anterior Splaying
Common Facial Proportions Head Proportions Rule of Fifths Rule of Thirds Tooth Proportions Width of anterior six teeth in golden proportion to intercommisural width Central Incisor is 1/16 the width of inter-zygomatic width (House) Central Incisor is 1/16 the length from ideal hairline to the chin(house) Dentsply Tooth Size Indicator-combines 1/16 with Rule of Thirds
Smile Design Tooth Width Proportion Theories Golden Proportion (Levin) Golden Mean (Snow) Naturally occurring (Preston) RED Proportion (Ward)
Ideal Width/Height Ratio of CI =78% Relationship of tooth length and RED Proportion (Rosenstiel, Ward, Rashid) 75-78% w/h ratio of maxillary central incisor preferred by dentists Normal length teeth-70% RED Very tall teeth-62% RED (Golden Proportion) Very short & short teeth-80% RED Using RED Proportion to determine size of maxillary anterior teeth(ward) Calculating RED & anterior total widths from inter-canine width(icw) Tooth Height RED Central Incisor Width Lateral Incisor Width Canine Width Very Tall 62% RED ICW/ 4.0 CIW *.62 LIW *.62 Tall 66% RED ICW/ 4.2 CIW *.66 LIW *.66 Normal 70% RED ICW/ 4.4 CIW *.7 LIW *.7 Short 75% RED ICW/4.6 CIW *.75 LIW *.75 Very Short 80% RED ICW/4.8 CIW *.8 LIW *.8
Using ICW & CIH to determine size of maxillary anterior teeth(ward) Calculating RED & Individual tooth widths from ICW& CIH ICW/CIH RED Central Incisor Width Lateral Incisor Width Canine Width 3.1 62% RED ICW/ 4.00 ICW/6.47 ICW/10.43 3.2 65% RED ICW/4.15 ICW/6.38 ICW/9.81 3.3 67% RED ICW/ 4.24 ICW/6.33 ICW/9.44 3.4 70% RED ICW/4.38 ICW/6.26 ICW/8.94 3.5 73% RED ICW/4.53 ICW/6.20 ICW/8.49 3.6 75% RED ICW/4.63 ICW/6.17 ICW/8.22 3.7 78% RED ICW/4.78 ICW/ 6.12 ICW/7.85 3.8 80% RED ICW/4.88 ICW/6.10 ICW/7.63 Esthetic Periodontal Surgery(Gargiulo, Wentz & Orban, Kois) Biological Width-1mm sulcus, 1mm epithelial attachment, 1mm ct FGM 3mm coronal to osseous crest Communication with periodontist 1. Guide Incisal Edge 2. Desired length from guide incisal edge to free gingival margin 3. Teeth to be treated
Smile Design References Dickerson, W. The Smile Catalog. Las Vegas:The Ultimate Practice. Dorfman W. The Smile Guide. Culver City, CA:Discus Enterprises. Frush JP, Fisher RD. Introduction to dentogenic restorations. J Prosthet Dent 1955;5:586-595. Frush JP, Fisher RD. How dentogenic restorations interpret the sex factor. J Prosthet Dent 1956;6:160-172. Frush JP, Fisher RD. How dentogenic restorations interpret the personality factor. J Prosthet Dent 1956;6:441-449. Frush JP, Fisher RD. The age factor in dentogenics. J Prosthet Dent 1957;7:5-13. Gargiulo A, Wentz F, Orban B: Dimmensions and relations of the dentogingival junction in humans. J Periodontol 1961;32:261-67. Gürel G. The Science and Art of Porcelain Laminate Veneers. Chicago: Quintessence Publishing Co;2003. House MM, Loop JL. Form and Color Harmony in the Dental Art. Whittier, CA:Monograph;1937. Kois J. Altering gingival levels: the restorative connection, Part 1: Biologic variables. J Esthet Dent 1994; 6:3-9. Levin EI.Dental esthetics and the golden proportion. J Prosthet Dent 1978;40:244-252. Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973;29:358-382. Morley J. Smile designer s workshop Part 1:Design Theory of Maxillary Central Incisors. Dent Today 1990; 9(8):24. Morley J. Smile designer s workshop Part 2:Design Theory of Maxillary Lateral Incisors. Dent Today 1990; 9(9):36-37. Morley J. Smile designer s workshop Part 3:Design Theory of Maxillary Cuspids. Dent Today 1990; 10(1):42-43. Morley J, Eubank J. Macroesthetic elements of smile design. JADA 2001;132:39-45. Powell N, Humphreys N. Proportions of the Aesthetic Face. New York:Thieme-Stratton;1984. Pound E. Utilizing speech to simplify a personalized denture service. J Prosthet Dent 1976;24:586-600. Preston JD. The golden proportion revisited. J Esthetic Dent 1993;5:247-251. Romano, R. The Art of the Smile: Integrating Prosthodontics, Orthodontics, Periodontics, Dental Technology, and Plastic Surgery in Esthetic Dental Treatment. Chicago: Quintessence Publishing Co;2004. Rosenstiel SF, Ward DH, Rashid RG. Dentists Preferences of Anterior Tooth Proportion-A Web-based Study. J Prosthodont 2000;9:123-136. Rufenacht CR. Fundamentals of Esthetics. Chicago:Quintessence Publishing Co;1990. Snow SR. Esthetic smile analysis of anterior tooth width: The golden percentage. J Esthet Dent 1999;11:177-184. Vig R, Brundo G. The kinetics of anterior tooth display. J Prosthet Dent 1978;39:502-504. Ward DH. Proportional Smile Design using the Recurring Esthetic Dental (RED) Proportion. Dent Clin North Am 2001;45(1):143-154. Ward DH. A Study of Dentists Preferred Maxillary Anterior Tooth Width Proportions: Comparing the Recurring Esthetic Dental Proportion to Other Mathematical and Naturally Occurring Proportions. J Esthet Restor Dent 2007;19:323-336. Ward DH. Using the RED Proportion to Engineer the Perfect Smile. Dent Today 2008;27(5):112-117.