Professional Documents
Culture Documents
Presented by
Dr. P. Baskar
PG student
Department of conservative dentistry and Endodontics
TNGDC
Guidelines in smile design
Shade selection and multidisciplinary
approach in smile design
Guidelines in smile
design
Introduction
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
appearance.
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
conservative.
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.
E-LINE
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
TOOTH EXPOSURE AT REST
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
INCISAL EDGE
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
diagnosis
FLAT OR REVERSE INCISAL CURVE
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.
HORIZONTAL SYMMETRY
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
INCISAL PROFILE
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.
SMILE LINE
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
are
A short upper lip
Labial hyper motility
Altered passive tooth eruption
Anterior dento alveolar extrusion
Excessive vertical development of the
upper maxilla
phonesis
LENGTH
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
length.
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,
THE ‘E’ SOUND
INCISAL LENGTH
Prolonged pronunciation of the vowel sound e is another aid
in phonetic evaluation of the incisal length of the maxillary
teeth.
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.
YOUNG PATIENTS:
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.
ELDERLY PATIENTS:
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
THE F/V SOUNDS
INCISAL LENGTH AND INCISAL PROFILE
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
lip
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
THE S SOUND
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
teeth.
TOOTH TYPE
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
COLOUR
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.
Occlusal relationships
Maximal intercuspal position
Centric relation
Centric occlusion
Anteroir guidance
Incisor guidance
Canine guidance
Overjet and overbite
ESTHETICS AND FUNCTION
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
CONCLUSION
To be continued as…………………….
SHADE
SELECTION AND
MULTIDISCIPLINARY APPROACH IN
SMILE DESIGN