SMILE DESIGNING sem 1.pptx

CONTENTS
INTRODUCTION
HISTORY
ARTISTIC ELEMENTS
PRINCIPLES OF SMILE DESIGN
STAGES OF SMILE
COMPONENTS OF SMILE DESIGN
SHADE SELECTION
CONCLUSION
REFERENCES

INTRODUCTION
 The clinical practice of dentistry no longer revolves only around
prevention and treatment of dental diseases. It also emphasizes on the
esthetic components too.
An attractive or pleasing smile clearly enhances the acceptance of the
individual in the society and the character of the smile influences to a
great extent the attractiveness and the personality of the individual.

Esthetics is an intellectual phenomenon which deals with scientific knowledge
, principles and perception of essential and natural beauty in nature and art.
Esthetic Dentistry can be defined as the art and science of dentistry applied to
create or enhance beauty of an individual within functional and physiological
limits.

 Cosmetic dentistry is the application of the principles of esthetics and certain
illusionary principles, performed to signify or enhance beauty of an
individual to suit the role he has to play in his day-to-day life .
 Smile designing is a process whereby the complete oral hard and soft tissues
are studied and evaluated and certain changes are brought about which will
have a positive influence on the overall esthetics of the face

HISTORY
Both the Phoenicians (app 800 BC) and Etruscians (app 900 BC) carefully
carved animal tusks to simulate the shape, form and hue of natural teeth.
The Central and South American Mayas (approximately 1000 AD)
beautified themselves by filing the incisal edges of their anterior teeth into
various shapes and designs .

They also placed plugs of iron pyrites, obsidian, and jade
into the labial surfaces of the maxillary anterior teeth.
Interest in dental esthetics was virtually absent during the
Middle Ages.
It was not until the eighteenth century that dentistry was
recognized as a separate discipline and its various
branches were established.
The leader of the movement to modernize and promote
dentistry was Pierre Fauchard (1678-1761) of France. He,
together with several colleagues, advocated such esthetic
practices as proper oral hygiene and the use of gold shell
crowns with enamel "veneers."

In the late nineteenth century, various techniques used in esthetic fixed
prosthodontics were introduced.
In 1930,Dr.Pincus designed the smiles of hollywood actors with the
help of thin porcelain veneers which are called as the ‘hollywood
facings’
Today esthetic dentistry has gained a lot of importance and reached
newer dimensions.
The open-faced crown was invented around 1880, the
interchangeable porcelain facing (a ridged facing that fitted into a
grooved pontic) was developed in the 1880s,and the porcelain jacket
crown came into vogue in the early 1900s. The three-quarter crown
was introduced in 1907.

ARTISTICELEMENTS
Regardless of the result desired, certain basic artistic elements must
be considered to ensure an optimally esthetic result.
In conservative esthetic dentistry these include:
 Shape or form
 Symmetry and proportionality
 Position and alignment
 Surface texture
 Color
 Translucency

SHAPEORFORM
The shape of teeth largely determines their esthetic appearance.
To achieve optimal dental esthetics, it is imperative that natural
anatomic forms be achieved. Therefore a basic knowledge of
normal tooth anatomy is fundamental to the success of any
conservative esthetic dental procedure.
 For example minor modification of existing tooth contours,
sometimes referred to as cosmetic contouring, can effect a
significant esthetic change. Reshaping enamel by rounding incisal
angles, opening incisal embrasures, and reducing prominent facial
line angles can produce a more youthful appearance

YOUTHFUL FEMININE SMILE
 ROUNDED INCISAL ANGLES
 OPEN INCISAL & FACIAL EMBRASURE
 SOFTENED FACIAL LINE ANGLES
MASCULINE SMILE
INCISAL EMBRASURES MORE CLOSED
PROMINENT INCISAL ANGLES

COSMETICCONTOURING
MINOR MODIFICATIONS ON EXISTING TOOTH
CONTOURS

 Illusions of shape also play a significant role in dental esthetics. The
border outline of an anterior tooth is primarily two-dimensional (i.e.,
length and width). However, the third dimension of depth is critical in
creating illusions, especially those of apparent width and length.
 Prominent areas of contour on a tooth typically are highlighted with
direct illumination, making them more noticeable, whereas areas of
depression or diminishing contour are shadowed and less conspicuous.
 By controlling the areas of light reflection and shadowing, full facial
coverage restorations (in particular) can be esthetically contoured to
achieve various desired illusions of form.

SYMMETRYANDPROPORTIONALITY
 The overall esthetic appearance of a human smile is largely governed
by the symmetry and proportionality of the teeth that constitute the
smile. Asymmetric teeth or teeth that are out of proportion to the
surrounding teeth disrupt the sense of balance and harmony essential or
optimal esthetics.
 Assuming the teeth are of normal alignment (i.e., rotations or
faciolingual positional defects are not present), dental symmetry can be
maintained if the sizes of the contralateral teeth are equivalent.

 In addition to being symmetric, anterior teeth must be in proper
proportion to one another to achieve maximum esthetics.
 One long-accepted theorem of the relative proportionality of maxillary
anterior teeth typically visible in a smile involves the concept of the
golden proportion .

POSITIONANDALIGNMENT
 The overall harmony and balance of a smile depend largely on proper
position of teeth and their alignment in the arch.
 Malposed or rotated teeth disrupt the arch form and may interfere with the
apparent relative proportions of the teeth. Orthodontic treatment of such
defects should always be considered, especially if other positional or
malocclusion problems exist in the mouth.

 However, if orthodontic treatment is either impractical or unaffordable,
minor positional defects often can be treated with composite augmentation
or full facial veneers indirectly made from composite or porcelain.
 It must be emphasized that only those problems that can be conservatively
treated without significant alteration of the occlusion or gingival contours of
the teeth should be treated in this manner

SURFACETEXTURE
 Young teeth characteristically exhibit significant surface
characterization, whereas teeth in older individuals tend to possess a
smoother surface texture caused by abrasional wear.
 The surfaces of natural teeth typically break up light and reflect it in
many directions .The restored areas of teeth should reflect light in a
similar manner to unrestored adjacent surfaces

TRANSLUCENCY
 Translucency also affects the esthetic quality of the restoration. The degree of
translucency is related to how deeply light penetrates into the tooth or restoration
before it is reflected outward.
 Normally light penetrates through the enamel into dentin before being reflected
outward. This affords the life like esthetic vitality characteristic of normal,
unrestored teeth.
 Shallow penetration of light often results in a loss of esthetic vitality

Illusions of translucency also can be created to enhance the realism of a restoration.
Color modifiers (also referred to as tints) can be used to achieve apparent
translucency and tone down bright stains or characterize a restoration

 The smile can be defined as a change in facial expression that involves a sparkle in
the eyes, an upper curvature in the corners of the lips, no sound emission, and less
distortion of muscle forms than with a laugh (Camara 2010)
 A facial expression characterized by turning up the corners of the mouth; usually
shows pleasure or amusement(Webster’s dictionary)

CLASSIFICATION OFSMILE:
 ACCORDING TO SOLOMON E.G.R
Depending on the nature of labial mucous membrane
 papilla smile
 Gingival smile
 Mucosa smile
Dependant on the lip component
 Straight smile
 Convex smile
 Concave smile

ACCORDING TO ACKERMAN & ACKERMAN
 The social smile
 The enjoyment smile.
 ACCORDING TO RUBIN L R
He identified the following neuromuscular smile pattern
 The commissure smile
 The cuspid smile and
 •The complex smile

ACCORDING TO EDWARD PHILIPS:
Smile styles
 The commissure smile
 The cuspid smile and
 The complex smile
Stages of a smile
 Stage I- lips closed
 Stage II- resting display
 Stage III- natural smile (three- quarters)
 Stage IV- expanded smile (full)
.

Types of smile
 Type I- maxillary only
 Type II- maxillary and over 3 mm gingival
 Type III- mandibular only
 Type IV- maxillary and mandibular
 Type V- neither maxillary nor mandibular

ACCORDING TO ANTHONY H.L.TJAN, GARY D.MILLER AND
JOSEPHINE G.P. –
open smiles were divided into 3 types-
 High smile- reveals the total cervicoincisal length of the maxillary anterior
teeth and a contiguous band of gingiva.
 Average smile- reveals 75% to 100% of the maxillary anterior teeth and the
interproximal gingiva only.
 Low smile- displays less than 75% of the anterior teeth.

Stages of smile
 There are two stages in smile formation:
the first (voluntary smile) elevates the upper lip towards the nasolabial
groove through the contraction of the elevator muscles that originate in this
groove and are inserted in the lip. The lip then find meets resistance due to
the adipose tissue in the cheeks.
The second stage (spontaneous smile) begins with higher elevation, both in
the lip and in the nasolabial groove.
.

 The half-shut look of eyes that accompanies the smile is a muscular trigger
of the face that activates the centers in the temporal anterior area of the brain,
which regulates the production of pleasant emotions

Smile design refers to the many scientific and artistic principles that
considered collectively can create a beautiful smile.
 These principles are established through data collected from patients,
diagnostic models, dental research, scientific measurements, and
basic artistic concepts of beauty

FACIAL
COMPOSITION
DENTOFACIAL
COMPOSITION
DENTAL
COMPOSITION

FACIALCOMPOSITION
 The facial composition is the one most important to the patient.
 This composition influences most patients’ preconceived ideas of a ‘perfect smile’
 From the frontal aspect, numerous landmarks are used as guides for aesthetic
appraisal.
 Horizontally, several imaginary reference lines are discernible, commencing from
the upper to lower part of the face including the hair, ophriac, interpupillary,
interalar and commissural lines.

These parallel lines create
horizontal symmetry, acting as
cohesive forces to unify the facial
composition.
The facial midline is perpendicular
to the horizontal lines and opposes
their cohesiveness.
These are termed segregative forces
and are essential in a composition to
add interest and harmony

 The interpupillary line is used as a
reference for the occlusal and incisal
plane orientations.
 The incisal edges of the anterior teeth
should be parallel to the interpupillary
line and perpendicular to the midline
 Canting of the incisal plane is attributed
to either dental or skeletal factors.
The dental factors include wear (attrition, erosion, abrasion),
altered patterns of eruption or periodontal disease.
If the dental factors are eliminated, the tilting could be
due to a slanted maxilla

From the sagittal aspect, the
horizontal lines also reinforce
the cohesiveness of the profile
In this aspect two
additional reference lines
require consideration:
the nasolabial angle Rickett’s E-plane

 Nasolabial angle – males 90° to 95°; in females 100° to 105°.
 Rickett’s E-plane - Upper lip 4mm behind this imaginary line, while lower
lip is 2mm
 The protrusion or retrusion of the maxilla can be assessed.

If the reverse, a
concave profile is
evident, i.e.
nasolabial angle is
>90°, and the
distance of the upper
lip to the E-plane is
<4mm, a prominent
maxillary anterior
dental sextant is
desirable.
Assuming 90° as the normal, if
the nasolabial angle is <90°,
and the distance of the upper
lip to the E-plane is greater
than 4mm, the maxilla is
prominent and the facial
profile is convex.
In these cases, less dominant
maxillary anterior restorations
should be considered.
Spear has termed this concept of facial profile to determine
the position and degree of dominance of the maxillary
anterior teeth as ‘facially generated treatment planning’.

Facial features
in smile design
 In classical terms, the face height is divided into
three equal thirds:
 from the fore head to the eyebrow line, from
the eyebrow line to the base of the nose and
from the base of the nose to the base of the
chin.
 The lower part of the face from the base of the
nose to the chin is divided into two parts, the
upper lip forms 1/3rd of it and the lower lip
and the chin 2/3rd of it.
includes facial height, facial shape,
facial profile, gender, and age.

The width of the
face should be the
width of five “eyes”.
The distance
between the
eyebrow to chin
should be equal to
the width of the face

The lateral profile of an
individual can be any one
of the following,
Straight
Convex
Concave
The basic shape of the
face when viewed from
the frontal aspect can
be one of the following,
1. Square
2. Tapering
3. Square tapering
4. Ovoid
FACIAL SHAPES
These factors play a role in determining the tooth size, shape and
the lateral profile, in short the tooth morphology is dependent on
the facial morphology

The facial features related to gender and age involve
the soft tissues and include the texture, complexion,
and tissue integrity of the epithelial tissues.

DENTOFACIAL COMPOSITION
The dental facial composition includes the lips and
the smile as they relate to the face
The lips play important role in that they create the
boundaries of the smile design’s influence.
 Understanding lip morphology and lip mobility can
often be helpful in meeting patients’ expectations
and determining the criteria for success

Genetic traits; the position of the teeth,
alveolar bone, and jaws; and their
relationships influence the shape of the
lips.
The upper lip is somewhat more arched
and wider than the lower lip.
Because the maxillary arch with the teeth
overlaps the mandibular arch, the upper
lip is the longer of the two.
The lower lip, therefore, is recessed
beneath the upper lip approximately 30°
in relation to the upper lip when the
arches are properly aligned

I. width --a smile that is at least half the width of the
face, at that level of the face, is considered esthetic.
II. The fullness of the lip, or lip volume, can be
categorized as full, average, or thin.
III.Lip symmetry -involves the mirror image appearance
of each lip when smiling.
The upper and lower lips should be analyzed separately
and independently of one another

Position of Lips
The position of the lips in
the rest position should
be evaluated for lip
contact as well as for the
range of lip mobility
when smiling.
These two determinants
establish how much tooth
structure and gingival
tissue are revealed when
comparing the repose
and full smile positions
four features influence tooth exposure in the
static/tranquil position:
LARS factor: lip length, age, race and sex

 Length of the upper lip varies from 10-36mm, long maxillary lips
show more mandibular rather than maxillary teeth.
 The amount of tooth exposure at rest is predominantly a muscle-
determined position.

Age - Maxillary and Mandibular tooth display.
Multi-factorial phenomenon described by the three Ps:
Programmed ageing
Pathological ageing
Psychological ageing.

RACE & SEX
 Decreasing amount of maxillary, & an increasing
amount of mandibular tooth visibility, is seen from
Caucasians to Asians to Blacks.
Males have longer maxillary lips than females.
 Maxillary tooth display - 1.91 mm for men & 3.40 mm
for women

DYNAMIC POSITION
Characterized by smile.
The extent of tooth exposure during a smile depends on:
Skeletal make-up
Degree of contraction of the facial muscles
Shape and size of the dental elements
Shape and size of the lips

Lip line
 When smiling, the inferior border of the
upper lip as it relates to the teeth and
gingival tissues is called the lip line.
 An average lip line exposes the maxillary
teeth and only the interdental papillae.
 A high lip line exposes the teeth in full
display as well as gingival tissues above
the gingival margins.
 A low lip line displays no gingival tissues
when smiling.
In most cases, the lip line is acceptable if it is
within a range of 2 mm apical to the height of the
gingiva on the maxillary centrals

The inferior border of the upper lip and the superior
border of the lower lip form an outline of the space
that is revealed when smiling.
 The space that includes the teeth and tissues is called
the smile zone

Negative space/buccal corridor
The dark space appearing b/w the jaws & the mouth
opening either at the corner of the mouth or around the
buccal aspect of the posterior teeth during active smile
and laugh.
Obliteration of these essential spaces by dental elements
lead to an unattractive smile.
Excessive negative space also appear unesthetic.

The smile line can be defined as an imaginary line
running along the incisal edges of the maxillary anterior
teeth and coinciding the curvature of the lower lip / gull-
wing course while smiling.
 An attractive smile line is one of the most important
features of a pleasing smile

 Slight to moderate deviations - esthetic recontouring
 Discrepancies to the smile line in situations where there is
ideal tooth form and color – orthodontics.
 Reverse smile line - centrals appear shorter than the cuspids
along the incisal plane & create an aged or worn appearance.
 Etiology: Abrasion, erosion or attrition,periodontitis, altered
patterns of eruption or poor quality dentistry.

Intercommissurelineandlowerlipframing
In broad smile position, the imaginary line through the
corners of the mouth is known as the intercommissure
line, or ICL.
 The amount of maxillary tooth reveal below the ICL
interacts with the viewer’s perception of thepatient’s age.
In a youthful smile, approximately 75 percent to 100
percent of the maxillary teeth would show below this
line.

The midline refers to the vertical contact interface between
two maxillary centrals.
 Ideal – coincidence b/w facial & dental the midline.
•Atleast- the central incisors should be parallel to the facial
midline and perpendicular to the incisal plane.
Maxillary and mandibular dental mid-lines do NOT
coincide in 75% of cases.

 Therefore, do NOT use the mandibular mid-line as a reference point for
establishing the maxillary mid line
 Mismatch between maxillary and mandibular midlines does not affect
aesthetics since mandibular teeth are not usually visible while smiling
 The maxillary dental mid-line and facial mid-line do NOT necessarily
coincide
 The maximum allowed discrepancy can be 2mm . Greater than
2 mm discrepancy is aesthetically acceptable so long as the dental
mid-line is perpendicular to the interpupillary line.
 Radiating symmetry: In the dental context, the maxillary dental midline
is the fulcrum or central point, and the right and left upper anterior teeth
are balanced mirror images.

 Various anatomical landmarks such as, midline of the nose, forehead,
chin, philtrum, interpupillary plane can be used as guides to the midline
assessment .
 The philtrum of the lip is one of the most accurate of these anatomical
guide posts.
 It is always in the centre of the face except in surgical, accident or cleft
cases.
 The centre of the philtrum is the center of the cupids bow and it should
match the papilla between the centrals.

 If these two structure match and the midline is incorrect then the
problem is usually incisal inclination. If the papilla and philtrum do
not match then the problem is a true midline deviation.
A midline that does not bisect the papilla is more noticeable than the
one that does not bisect the philtrum

1. parallel to the long axis of the face: the line angle that
forms the contact between the centrals should be parallel
to the long axis of the face
2. Perpendicular to the incisal plane: the line angle that
forms the contact between the centrals should be
perpendicular to the incisal plane.
3. Over the papilla: the midline should drop straight down
from the papilla.

Maxillary incisal edge position is the most important determinant in
smile creation because once set , it serves as a reference point to decide
the proper tooth proportion and gingival levels

Establishing the incisal lengths :
i.degree of tooth display
ii.phonetics
iii.patient input

Degree of tooth display
• When the mouth is relaxed and slightly open ,
-3.5 mm of incisal third of the maxillary central incisor is visible in a 20-year-old
patient
• As age increases, the decline in muscle tonus results in less tooth display

 Phonetic exercises for establishing the incisal edge position is an integral
part of restorative , prosthetic , and cosmetic dentistry
 In order to determine proper lip, tongue , and muscle support and tooth
position it is necessary that the patient sits either erect or stands during
the phonetic exercises

Thevariousphoneticsusedareasfollows
M – Sound: after pronunciation, the lips return to their normal rest
position, allowing evaluation of the amount of the tooth display in
rest position.
E- sound : the maxillary incisal edge position should be positioned
halfway between the upper and lower lip during the E sound.

 F & V sounds : fricative sounds are
produced by the interaction of the
maxillary incisal edge with the inner
edge of the lower lips vermilion border.
Thus fricative sounds help to determine
the labiolingual position and length of
the maxillary teeth
 S – sound : during pronunciation, the
mandibular central incisors are
positioned 1mm behind and 1mm below
the maxillary incisal edge.

Patientinput:
 Intraoral cosmetic preview and provisional restorations help to confirm proper
placement of the final incisal edge position.
 The patient desires must be met as best as possible, provided they do not
interfere with the parameters previously discussed.

Factors influencing the incisal
edge position

Correct dental proportion is related to facial morphology and is
essential in creating an esthetically pleasing smile.

Various guidelines for establishing correct
proportions in an esthetically pleasing smile are
i. Golden proportion ( Lombardi,1970)
ii. Preston's proportion
iii. Recurring esthetic dental proportions (Levin,1978)
iv. M – Proportions ( Methot)
v. Chu’s Esthetic Gauges
The important point to be noted here is that it is not the actual size, but
instead the perceived size, that these proportions are based on when
viewed from the facial aspect ( in short it is the distance between proximal
line angles of the teeth)

Golden proportion ( Lombardi)
 When viewed from the facial, the width of each anterior tooth is 62%
of the width of the adjacent tooth ( mathematical ratio being 1.6:1:0.6).
 It represents the ratio of visible part of central incisor to the visible
part of lateral incisor and also to that of visible part of canine

 It is difficult to apply as patients have different arch form, lip anatomy
and facial proportions.
 Strict adherence to golden proportions calculations limits creativity and
this may lead to cosmetic failure.
 Levine ,1978 said Golden rules are only rough guides and should be
never applied without taking account of the subject’s sex ,lip shape
&position ,age & general physique

Preston'sproportion
 Preston in 1993 studied the existence of Golden proportion in natural dentition
and found that only 17% of the maxillary lateral incisors’ width was in Golden
proportion with the width of maxillary central incisors and none of the canines’
width were in Golden proportion to the width of maxillary lateral incisor.
 He proposed Preston's proportion, that is, the width of maxillary lateral incisor
should be 66% the width of central incisors and the width of maxillary canines
should be 55% the width of maxillary central incisors in the frontal view

Recurring esthetic Dental Proportion ( Levin)
The successive width proportion when viewed from
the facial aspect should remain constant as we move
posteriorly from midline.
This offers great flexibility to match tooth properties
with facial proportions

Mproportions(Methot)
This method compares the tooth width with the facial
width using a software. The whole analysis is done in
the computer and hence involves more of mathematics
rather than artistic analysis

CHU’S ESTHETIC GAUGES:
Dr. Chu’s research supports
Levin’s concept and refutes the
golden proportion. A series of gauges
are available to make intraoral
analysis easier.

 The gauges allow for:
 Faster, simple analysis and diagnosis of tooth width problems, tooth
length problems and gingival length discrepancies.
 Color coding predefines desired tooth proportions , quicker and easier
to read than any other instrument
Used as reference guide between clinician and lab technician, hence
reduces the incidences of miscommunications errors

These principles
are used as a
guide rather than
a rigid
mathematical
formula.
Most authors
recommend
creating harmony
and balance by
eye via proper
adjustment and
evaluation of
provisionals
rather than any
formula

Central incisor
First , a dentist must establish the size of Central incisor
which is the key stone of smile.
Its measurements will be in proportion to facial width ,
width of dental arch , interpupillary distance and volume
of lips.
 The proportions of the centrals must be esthetically and
mathematically correct. The width to length ratio of the
centrals should be approximately 4:5 (0.8 to 1.0); a range
for their width of 75 % to 80% of their length is most
acceptable.

Ideallengthofcentralincisoris10-11mm
Rufenacht ,1990 prefers in determining
harmony and balance by eye rather than
mathematical formula
The shape and location of the centrals
influences or determines the appearance and
placement of the laterals and canines
Ciche and Pinauld ,1994 said that central
incisor should be predominant .

MAXILLARY CENTRAL INCISOR
Centrals are the focal point of an esthetic smile and
create the central dominance as described earlier.
 Approximate length of the central should be 10–11 mm
and the width is calculated accordingly so that the ratio
falls between 75 and 80%

These are the playful part of the smile.
They provide
- individuality,
-never symmetrical
-influence gender characterization.

They play a critical point in creating a pleasing smile as they are,
 The junction between the anterior and posterior dental segments. Hence
only the mesial half of the canine is visible from the frontal view when
the patient smiles.
 Support the frontal muscles – the size and characteristic of the buccal
corridor is determined by the size, shape and position of the canine.
 Canine depicts the personality characterization
; masculine – vigorous and aggressive
: feminine – delicate and soft

Also we have to keep in mind that,
 Central incisor is wider than the lateral by 2 to 3 mm and
canine by 1 to 1.5 mm.
 Canine is wider than the lateral by 1 to 1.5mm
 Canine and central are longer than lateral by 1 to 1.5 mm
 Maxillary bicuspids : they play a very important role for arch
design. They should fill the buccal corridor .

Archform
 Arch form has a direct influence on the buccal corridor
 The ideal arch is broad and conforms to a U shape.
 A narrow arch is generally unattractive. The unattractive, negative
space should be kept to a minimum.
 This problem can be solved or minimized by restoring the premolars.
 The buccal corridor should not be completely eliminated because a
hint of negative space imparts to the smile a suggestion of depth.

Zenithpoints:
 Zenith points are the most apical position of the cervical tooth
margin where the gingiva is most scalloped.
 Their position are dictated by:
• Root form anatomy.
• CEJ.
• Osseous crest, where gingiva is scalloped the most.
 It is located slightly distal to the vertical line drawn down the centre
of the tooth. The lateral is an exception as its zenith point may be
centrally located

IMPORTANCE OF ZENITH POINT
 When closing diastemas or changing
the mesial or distal tilt position of the
tooth i.e., moving zenith points
horizontally.
 In cases where teeth needs to be shown
longer or more taper at the gingival
1/3rd Zenith point can be moved
apically.
 By horizontal & vertical alterations,
zenith point can enhance:
 1. Perception of tooth axis.
 2. Length.
 3. Gingival shapes.

Gingival aesthetic line (GAL):
GAL is considered for creating pleasing gingival level
transition between the maxillary anterior teeth.
Four classes of GAL can be described:
• Class I — The GAL angle is between 45° and 90° and
the lateral incisor is touching or below (1 mm to 2mm) the
GAL .

 Class II — observed in Class II angles or pseudo-Class II conditions.
 • Class III — The GAL angle equals 90°, and the canine, lateral, and
central all lie below theGAL.
 • Class IV —The GAL angle can be acute or obtuse. GAL should be
relatively horizontal to the horizon and relatively symmetric on both
sides of the midline. It may radiate up slightly as it goes posterior.

Toothinclinations:
 Axial inclination compares the vertical alignment of maxillary teeth,
visible in the smile line, to central vertical midline.
 A tooth's axial inclination is indicated by a vertical line drawn from
its zenith point through the middle of its incisal edge.

 From the central to the canine there should be natural, progressive
increase in the mesial inclination of each subsequent anterior tooth
 It should be least noticeable with the centrals and more pronounced
with the laterals and slightly more so with the canines.

The evaluation of axial inclination can be done on a
photograph of the anterior teeth in a frontal view.
A line is sketched on each tooth from the middle of
the incisal edge through the midline of the tooth at
its gingival interface.
Axial inclination can also refer to the degree of
tipping in any plane of reference.

 The guide for labiolingual inclination is as follows.
I. Maxillary central incisor – positioned vertically or
slightly labial.
II. Maxillary lateral incisor – cervical are tucked in, incisal
edge inclined slightly labially.
III. Maxillary canine – cervical area positioned labially,
cusp tip lingually angulated

Interproximalcontactareas(ICA)
it is defined as the broad zone in which two
adjacent teeth touch
it follows the 50:40:30 rule in reference to the
maxillary central incisor
The increasing ICA helps to create the illusion of
longer teeth by wider and also extend apically to
eliminate black triangles.

Interproximalcontactpoints(ICP)
It is the most incisal aspect of the ICA
As a general rule, the ICP move apically the further
posteriorly one moves from the midline
If the ICP does not extend far enough gingivally ,an
open gingival embrassure ,or black triangle results.

 The incisal embrasures should display a natural, progressive
increase in size or depth from the central to the canine.
 This is a function of the anatomy of these teeth and as a result,
the contact point moves apically as we proceed from central to
canine.
 The contact points in their apical progression should mimic the
smile line .

 Also, if the incisal
embrasures are too deep it
will tend to make the
teeth look unnaturally
pointed.
 Failure to provide adequate depth
and variation to the incisal
embrasure will:
make the teeth appear too uniform
 make the contact areas too long
and will impart to the dentition a
box like appearance.

Interdental embrasure( cervical embrasure) :
 The darkness of the oral cavity should not
be visible in the interproximal triangle between the
gingiva and the contact area.
If the ICP does not extend far enough gingivally ,an
open gingival embrassure ,or black triangle results.

At times this will require long contact area that will be
extended towards the cervical.
This will encourage the formation of a healthy,
pointed papilla instead of the blunted tissue form that
often accomplishes a black triangle .
Conversely an improperly developed cervical
embrasure that involves overextended, bulky
restorations will result in an improper emergence
profile and swollen and inflamed gingival tissues

 A tooth’s Distal incisal corner is more rounded than its mesial incisal
corner
Rounding of the incisal corners will create the impression of longer
teeth

Youthful teeth-
unworn incisal edge,
defined incisal embrasure,
low chroma, high value.
Aged teeth –
shorter so less smile
display, minimal incisal
embrasure, high chroma and
low value.

Female form – round
smooth, soft delicate
Male form – cuboidal ,
hard vigorous

Aggressive, hostile angry
– pointed long “ fangy
“ cusp form
Passive, soft – blunt,
rounded, short cusp form

SymmetryandBalance:
 Symmetry is the harmonious arrangement of several elements with respect to each
other. Symmetrical length and width is most crucial for the centrals. It becomes less
absolute as we move further away from the midline
Static symmetry – mirror image, maxillary central incisors
Dynamic symmetry – two objects very similar but not identical. Playing with perfect
imperfection in the laterals and canines allow for a more vital, dynamic, unique and
natural smile .
 Balance is observed as the eyes move distally from the midline, that both the right and
left side of the smile are well balanced

Smile line refers to an imaginary line along
the incisal edges of the maxillary anterior teeth
which should mimic the curvature of the superior
border of the lower lip while smiling.

Another frame of reference for
the smile line suggests that the
centrals should appear slightly
longer or at the very least not
any shorter than the canines
along the incisal plane.
Reverse smile line or inverse
smile line occurs when the
centrals appear shorter than the
canines along the incisal plane.

Lip line should not be confused with the smile line, it
refers to the position of the inferior border of the
upper lip during smile formation and thereby
determines the display of tooth or gingiva at this hard
and soft tissue interface.

Above all, the appropriate shade selection has to be
done to bring out all the hard work of our smile
design.
Shade selection must be customized for each
individual. It should be natural and polychromatic.
The body of the tooth can be fairly
uniform in color but the gingival
third should be noticeably richer in
chroma.

Value (lightness) describes overall intensity to how
light or dark a color is. It is the only dimension of
color that may exist by itself.
Chroma (Saturation) may be defined as the strength
or dominance of the hue.
Hue is described with the words we normally think of
as describing color: red, purple, blue, etc

The chroma should also increase
from central to the canine,
canine having a higher chroma
The incisal portion of the tooth
typically exhibits a translucency
that can vary from bluish-white
to blue, gray, orange and other
variations.

Shadematching
There are several parameters that describe an ideal light
for shade matching in dentistry.
The first one is called correlated color temperature
(CCT).
Color‐corrected lights resembling standard daylight at
5500 and 6500 K (D55 and D65) are recommended.
Another key factor is termed the color rendering index
(CRI)—a light source that has CRI of 90 or greater is
appropriate.

Lighting of these characteristics would have a spectral
power distribution (SPD) that is similar to standard
daylight.
 Finally, the light needs to be of adequate intensity, which
is termed the illuminance, and measured in lux
(abbreviated to lx).
The level of illuminance at the color matching area should
be 1000 lx.
 More intense light, up to 1500 lx, might be used to
overcome other ambient lighting.

Color metamerism in teeth is a phenomenon that needs
to be taken into account in cosmetic dentistry, when
matching shades.
Teeth are made of hydroxyapatite. Composite bonding
materials are made of organic resins impregnated with
inorganic fillers. Porcelain and other ceramics are
composed of different materials. Each of these materials
has its color properties. It is not uncommon at all for a
tooth restored to a shade match under one lighting
situation to not match under different lighting.

If a crown or bonding material is created to match a tooth
under warm fluorescent lighting, or incandescent lighting,
the color metamerism properties of the restorative material
can easily mean that the color will not match under a
different light source, such as outdoor lighting.
 For best results, shade matching should be done either in
the natural light from a large window with a northern
exposure, or under color-correct fluorescent lighting.
There are several companies that sell full-spectrum
lighting. This lighting will be at a color temperature of
5500 Kelvin. The Durotest Vita-Lite is the original bulb
manufactured to these specifications

Color matching with a
Ritelite hand-held
light.

 Digital smile designing is an effective digital treatment
protocol which utilizes 2D clinical and lab images of the
patient and the proposed treatment plan including planes of
reference, facial and dental midlines, incisal edge position,
lip dynamics, basic tooth arrangement, and the incisal plane.
Advantages of Digital Smile Design
 Accurate esthetic analysis
 Increased communication among the interdisciplinary team
 Feedback at each phase of treatment
 Patient understanding and marketing tool
 Dynamic and effective treatment planning presentation
 Educational tool

 Ultimately there is NO formula for anterior esthetics;
instead the final esthetics is a combination of
I. tooth proportion guide lines
II. patients own perception
III. cultural and social influences
IV. dentist artistic influences
V. effective communication with laboratory

TREATMENTPLANNINGINESTHETIC
DENTISTRY
The restoration of a smile is one of the most appreciated and gratifying
services a dentist can render. In fact, the positive psychologic effects
of improving a patients smile often contribute to an improved self-
image and enhanced self-esteem.
These improvements make conservative esthetic dentistry particularly
gratifying for the dentist and represent a new dimension of dental
treatment for patients.

Treatment planning starts with evaluation of entire
stomatognathic system however following three
components are mandatory for planning esthetics.
 Evaluation of teeth and arch
 Evaluation of the periodontal status
 Analysis of facial structure

TREATMENT OPTIONS FOR VARIOUS ESTHETIC PROBLEMS
ESTHETIC PROBLEMS TREATMENT MODALITIES
Problems with tooth morphology Bleaching, microabrasion
and alignment Esthetic recontouring
Composite resin restorations
Composite / ceramic veneers
Esthetic inlays, onlays and crowns
Stomatognathic problems Orthodontic treatment
Orthognathic surgery
Post – core restorations
Color problems Bleaching
Veneers
Crowns
Traumatic injuries Splinting
Surgical corrections
Periodontal therapy
Veneers / Crowns
Gingival / periodontal esthetic problems Gingival recontouring , electrosurgery
Gingival grafting
Periodontal therapy, Frenectomy
Missing teeth Dentures
Implants
Dermatological Problems Cosmetic recontouring
Plastic surgery

CONCLUSION
The crafting of an ideal smile requires analyses and evaluations
of the face, lips, gingival tissues, and teeth and an appreciation
of how they appear collectively.
It is at this point that the eye of the artist becomes helpful for
developing the final shade ,shape, contour and incisal edge
configuration of the provisional restorations which will serve as
a blueprint for the definitive restorations.

 Smile forms the basis for our perception of others and ourselves. A pleasing appearance is the main objective in cases
of smile designing. The digitalization and advent of technology has provided us with numerous treatment options
such that smile designing can be done in a more patient friendly and efficient way. The various technological
advancements have revolutionized the way dentistry is practiced today. This article reviews the various digital
advancements in the field of smile designing
 Extraoral video camera
 Intraoral video camera
 T scan
 CAD CAM
 Lasers
 Abrasive technique
 Digital smile designing

REFERENCES
 Goldstein Esthetics in dentistry. 3rd edition.
 Fundamentals of operative dentistry –summit & schartz 3rd edition
 J conserv dent. 2010 oct-dec; 13(4): 225–232. Doi: PMCID:
PMC3010027
 Nicholas C. Davis, Smile Design, Dent Clin N Am 51 (2007) 299
 Ackermann JL et al. smile analysis and design in digital era, Am J
Orthod Dentofacial Orthop 2007;131:305-10–318

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