Smile Design

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
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Vertical midline in the center of the face perpendicular to the interpupillary
line centered with the philtrum
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Determinants of incisal edge position
1. esthetics
2. phonetics:”f, v, th” (Pound)
3. anterior guidance/occlusion
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Incisal edges follow curvature of the lower lip
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Clinical crown outlined by upper and lower lip, marginal gingiva display
confined to interdental papilla
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Curve of Spee
Tooth Positions & Relationships (Rufenacht, Morley)
 Roots of anterior teeth diverge apically as you move distally
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Incisal embrasures become larger as you move distally
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Contact points move apically and incisal embrasures become larger as
you move distally
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Connector area
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Incisal and cervical length of lateral incisors may be slightly shorter than
central incisors and cuspids
Cervical of central incisors and cuspids are parallel
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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
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Apical Zenith distal to midline of long axis of the tooth
Individual Max Tooth Characteristics (Frush & Fisher, Lombardi, Morley)
Central Incisors-mirror images-dominance
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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
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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
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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
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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)
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Dentsply Tooth Size Indicator-combines 1/16 with Rule of Thirds
Smile Design Tooth Width Proportion Theories
 Golden Proportion (Levin)
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Golden Mean (Snow)
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Naturally occurring (Preston)
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RED Proportion (Ward)
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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
75% RED
78% RED
80% RED
ICW/4.53
ICW/4.63
ICW/4.78
ICW/4.88
ICW/6.20
ICW/6.17
ICW/ 6.12
ICW/6.10
ICW/8.49
ICW/8.22
ICW/7.85
ICW/7.63
3.6
3.7
3.8
Esthetic Periodontal Surgery(Gargiulo, Wentz & Orban, Kois)
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Biological Width-1mm sulcus, 1mm epithelial attachment, 1mm ct
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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
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Dorfman W. The Smile Guide. Culver City, CA:Discus Enterprises.
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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.
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1973;29:358-382.
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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.
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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.