Dynamic smile /certified fixed orthodontic courses by Indian dental academy


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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

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Dynamic smile /certified fixed orthodontic courses by Indian dental academy

  1. 1. Evolution of the concept and dynamic records of smile capture INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. PART - I Evolution of the concept and dynamic records of smile capture : Esthetics in orthodontics mainly defined in terms of profile enhancement – tend to drift away from clinical examination &the art of physical diagnosis Angle 1899 – once ideal tooth-jaw positions were achieved , then soft tissues would fall in line. Recent focus – multifactorial nature of smile , combined with a shift towards patient driven esthetic diagnosis and treatment planning www.indiandentalacademy.com
  3. 3. In contemporary orthodontics ,patients are examined in 3 spatial dimensions (static and dynamic ) –attempt to harmonise lip – tooth – jaw relationships (anatomic &physiologic ) and esthetic and functional desires www.indiandentalacademy.com
  4. 4. To treat smile : 1. Identify & quantify which element of smile needs correction, improvement or enhancement 2. Identify the positive elements of smile to be maintained or protected during our treatment 2. Visualized treatment strategy to address patient’s chief concerns www.indiandentalacademy.com
  5. 5. 3 spatial dimensions in profile frontal vertical 2 dynamic factors to be considered: 1. Soft tissue repose and animation 2. Facial changes with aging Disadvantages of cephalometric evaluation : 1. Scammon’s growth curve www.indiandentalacademy.com 2. Stable dento-skeletal relationships.
  6. 6. RECORDS FOR TREATMENT OF SMILE : 1. STATIC RECORDS : • Photographs – frontal rest ,smile - profile rest , smile - oblique smile - smile close-ups (frontal ,oblique) • Radiographs •Study models www.indiandentalacademy.com
  7. 7. Profile -smile Close-up frontal Close-up oblique www.indiandentalacademy.com
  8. 8. 2. Dynamic records Digital videography : records ant. tooth display during speech & smile. 2 segments of video – frontal & oblique dimension 30 frames /sec.- in standardized fashion “Chelsea eats cheese cake on Chesapeake” – video clip is taken (5 sec ) ---the smile that best represents patient’s www.indiandentalacademy.com unstrained social smile selected.
  9. 9. 1. 2. 3. 6. 5. 4. www.indiandentalacademy.com
  10. 10. 3 smile styles : 1. Commisure smile 2. Cuspid smile 3. Complex smile 3. DIRECT MEASUREMENT AS A BIOMETRIC TOOL Allows quantification of resting & dynamic lip –tooth relationships. ADVANTAGES: 1. Information translated to meaningful treatment plan 2. Visualize time related changes & repeatability www.indiandentalacademy.com
  11. 11. STATIC 1. Commisure height 2. Philtrum height 3. Inter labial gap 4. Incisor show at rest DYNAMIC 1. Crown height 2. Gingival display 3. Smile arc www.indiandentalacademy.com 4. Incisor show at smile
  12. 12. PHILTRUM HEIGHT : sub spinale to vermilion border -relation to max. incisor & commissure height is more important - In adolescence , philtrum height is shorter than commissure height COMMISURE HEIGHT : Construct line from alar bases thru subspinale & from the commisures perpendicular to this line GINGIVAL DISPLAY : Relation with incisor show at rest is important . It is BETTER to treat gummy smile less aggressively –more esthetic than a smile with less tooth display www.indiandentalacademy.com
  13. 13. SMILE ARC : From frontal view : curvature of incisal edges of incisors & canines to curvature of lower lip in posed social smile Ideal smile arc /consonant – Flat smile / nonconsonant – Reverse smile arc – www.indiandentalacademy.com
  14. 14. Case illustration: Excessive gingival display due to Short philtrum height Excessive curtain on smile Short max. incisor crown height www.indiandentalacademy.com Mild vertical max. excess
  15. 15. www.indiandentalacademy.com
  16. 16. PART II : SMILE ANALYSIS AND TREATMENT STRATEGIES 3 dimensions – 1. Frontal 2. Oblique 3. Sagittal 4 th dimension – “TIME “ www.indiandentalacademy.com
  17. 17. www.indiandentalacademy.com
  18. 18. FRONTAL DIMENSION: Vertical and transverse characteristics Smile index : “ACKERMAN AND ACKERMAN ” Area framed by vermilion border during social smile Intercommissure width Inter labial gap -enables comparison ofwww.indiandentalacademy.com smiles
  19. 19. Vertical characteristics of the smile : 1. Incisor display – 2. Gingival display – 3. Smile arc – 4. Relation between gingival margins & u.lip – -gingival margins of canines should coincide with upper lip & lateral incisors slightly inferior. -gingival margins should coincide with upper lip in the social smile. - age factor. www.indiandentalacademy.com
  20. 20. Transverse characteristics of smile 1. Arch formuse of broad square arch forms in collapsed arch improves transverse smile dimensions -denture smile -flattening of smile arc www.indiandentalacademy.com
  21. 21. www.indiandentalacademy.com
  22. 22. 2. Buccal corridorFrom mesial line angle of I p.m. to interior portion of commissure www.indiandentalacademy.com
  23. 23. 3. Transverse cant of maxillary occ. plane • Differential eruption • Skeletal mandibular asymmetry •Asymmetric smile curtain Only frontal smile visualization allows visualization of any dental /skeletal asymmetry transversely. Frontal full face /close up smile mandatory. www.indiandentalacademy.com
  24. 24. OBLIQUE DIMENSIONS Characterizes smile as not obtainable with frontal view / ceph. Analysis molars to the curvature of lower lip on posed smile. Consonant /parallel Nonconsonant /flat www.indiandentalacademy.com
  25. 25. Occlusal cant Oblique- smile arc www.indiandentalacademy.com
  26. 26. SAGITTAL DIMENSIONS 1.Overjet In cl.II / cl.III patients , frontal smile appears esthetic. Oblique & sagittal views shows underlying skeletal pattern & dental compensation www.indiandentalacademy.com
  27. 27. SAGITTAL MAXILLARY POSITION –influences smile in frontal view ( transverse smile dimensions ) Transverse smile dimension is a function of both arch width and A-P position of max. & mnd. arches www.indiandentalacademy.com
  28. 28. 2. INCISOR PROCLINATION: Flaring of incisors – decreased incisor show www.indiandentalacademy.com
  29. 29. THE FOURTH DIMENSION – “TIME” 1. Growth 2. Maturation 3. Aging Preadolescent Adolescent Adult www.indiandentalacademy.com
  30. 30. Effects of maturation & aging on soft tissues Profiles flattens over time Rate of philtrum lengthening is greater than that of commisures Flattening of ‘M’ characteristic of vermilion border of upperlip Decrease in turgor Decreased incisor display at rest Decreased gingivalwww.indiandentalacademy.com display on smile
  31. 31. TREATMENT PLANNING Identify problems and plan correction Identify &quantify positive esthetic arrangement Example : “Consonant smile arc” www.indiandentalacademy.com
  32. 32. Treatment strategy : 1. Maintain vertical incisor position 2. Extrude max. canines to level 3. Finish with periodontal crown lengthening www.indiandentalacademy.com
  33. 33. ALTERING SMILE ARC : strategies to be used. Treating occlusal plane: 1. Preadolescents – growth modification appliance 2. Adolescents &adults – surgical modification Bracket placement Difference in incisal edge-bracket slot distance between max. central and lateral incisors should be 1-1.5mm to preserve / create consonant smile arcs. Cosmetic porcelain laminates /composite bonding Enamel odontoplasty www.indiandentalacademy.com
  34. 34. www.indiandentalacademy.com Leader in continuing dental education www.indiandentalacademy.com