Proportional 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 (feminine lateral

incisor may be at midline) (Chu, Morley)

Individual Max Tooth Characteristics (Frush & Fisher, Lombardi, Morley)

SPA Factor-(sex=lateral incisor, personality=cuspid, age=central incisor) Central Incisors-mirror images-dominance

Lateral Incisors-variations-gender-shorter than central incisors 0.5-1mm

Cuspids- aggressiveness

Teeth May Mimic Inverted Face Form (Williams, Leon)

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 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-

Smile Design Tooth Width Proportion Theories

Golden Proportion (Levin)

Golden Mean (Snow)

Naturally occurring (Preston)

RED Proportion (Ward)

Width/Height Ratio of Central Incisor (Sterrett, Wolfart)

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

• Taller teeth gives more dominant Central Incisor

• Patient preferences (Carlssan Jørnung, Ker, Rosenstiel, Wagner Wolfart)

Using RED Proportion to determine size of maxillary anterior teeth(Ward)

Step 1 Determine Relative Tooth height (Very tall, Tall, Normal, Short, Very Short)

Step 2 Measure facial view Intercanine Width (ICW)

Step 3 Divide ICW by appropriate tooth height column divisor (After determining Central Incisor width multiple times appropriate RED proportion)

Calculating RED & anterior total widths from inter-canine width(ICW)-Divisors

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 Average 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

Step 4 Divide CIW by 0.78 (78%) for CIL

Simplified Method Using ICW & CIL to determine size of maxillary anterior

teeth maintaining incisal length(Ward) Step 1 Measure frontal view Intercanine width (ICW) and Central

Incisor Length (ICL)

Step 2 Divide (ICW) by Central Incisor Length (ICL) to obtain quotient Step 3 Lookup quotient in chart for appropriate divisors to divide

ICW by to obtain appropriate facial widths

Calculating RED & Individual tooth widths from ICW& CIH-Divisor chart ICW/CIL=Quotient 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

Step 4 Divide CIW by 0.78 (78%) for CIL

Simplified Method Using ICW & desired CIL to determine size of maxillary

central incisor & RED Proportion(Ward) Step 1 Measure frontal view Intercanine width (ICW)

Step 2 Determine desired Central Incisor Length (DCIL) Step 3 Divide (ICW) by desired Central Incisor Length (ICL) to obtain

quotient Step 4 Lookup quotient in chart for appropriate divisors to divide

ICW by to obtain central incisor facial width and appropriate RED Proportion

RED proportion for desired central incisor

length

ICW/DCIL=Quotient Tooth Height RED Proportion Central Incisor Width 3.1 Very Tall 62% RED ICW/4

3.25 Tall 66% RED ICW/4.2 3.4 Normal 70% RED ICW/4.4 3.6 Short 75% RED ICW/4.6 3.8 Very Short 80% RED ICW/4.8

Esthetic Periodontal Surgery(Gargiulo, Wentz & Orban, Kois)

Adding length to Central Incisor allows a smaller RED Proportion

Methods to gain length

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

FACIAL SMILE EVALUATION Name__________________________________________________________________ Date___________ Do you like your smile? Yes No What would you like to change about your smile? _______________________________ ________________________________________________________________________Would you prefer? Ideal Perfect Smile Natural Smile with individuality 10 9 8 7 6 5 4 3 2 1 How do you like the color of your teeth?_______________________________________ What shade would you like them to be? _______________________________________ Alignment-Draw lines

Cant Midline

Smile Curve Vertical Incisal Edge

Draw outlines

Gingival Heights Incisal Heights Circle appropriate display

Inadequate Incisal Display Ideal Incisal Display Covered Incisal Edges

Filled Buccal Corridor Dark Buccal Corridor Excess Gingiva Circle areas

Black Triangles

Major Areas of Concern____________________________________________________ ________________________________________________________________________ Teeth to be Treated________________________________________________________ Periodontal Concerns______________________________________________________ ________________________________________________________________________ Referrals Needed__________________________________________________________

BLUEPRINT WORKSHEET

Patient_______________________________________ Cast Length Central Incisor ________mm Photo Length Central Incisor ________mm

Ratio Cast length = ----------- (Conversion factor)

Photo Length Pre Treatment

Photo Measurements

5 6 7 8 9 10 11 12

Width

Length

Converted Cast Measurements

(Photo measurements X Conversion Factor)

Conversion

Factor =

5 6 7 8 9 10 11 12

Width

Length

8 9

Width/Length Ratio

5/6 6/7 7/8 8/9 10/9 11/10 12/11

RED Proportion

Desired Post-Treatment(Cast Measurements)

5 6 7 8 9 10 11 12

Width

Length

Converted Photo Measurements

(Cast measurements/Conversion Factor)

Conversion

Factor =

5 6 7 8 9 10 11 12

Width

Length