Smile design semenar

SMILE DESIGNDR. FEBEL HUDA, M.D.S,DICOI,FICOI,FAD,DLD.

ORAL MAXILLOFACIAL PROSTHODONTIST AND IMPLANTOLOGIST

DIPLOMATE FROM THE INTERNATIONAL CONGRESS OF ORAL IMPLANTOLOGYFELLOW FROM THE INTERNATIONAL CONGRESS OF ORAL IMPLANTOLOGYDIPLOMATE IN LASER DENTISTRY (UNIVERSITY OF GENOVA - ITALY)FELLOW IN AESTHETIC DENTISTRY (UNIVERSITY OF GREIFSWALD - GERMANY)

INTRODUCTION

SMILE DESIGN

ESTHETIC DIAGNOSIS AND TREATMENT PLANNING

METHOD OF ANALYSIS FOR DIAGNOSIS AND TREATMENT

PLANNING• Total Smile Analysisa. Space Analysisb.Profile analysis c. Computer Analysis

TOTAL SMILE ANALYSIS

• FACIAL ANALYSIS (Examination of Lips at rest)

TOTAL SMILE ANALYSISProfile analysis

• Profile:


• Dentofacial Analysis:


• Dentofacial Analysis:

• Incisal edge to lower lip


Dentofacial Analysis• Midline

• Midline skewing to the right


• Dentofacial Analysis:• Tooth lower lip position

• Full smile. No of teeth exposed


• Dentofacial Analysis:• Bilateral Negative Space

• Central incisor proportion

TOTAL SMILE ANALYSISSpace Analysis

• Dentofacial Analysis:• Anterior teeth proportion


• Computer Analysis

Mc laren’s analysis for Smile Design

• Facial analysis (general facial balance).• Dento-facial analysis (maxillomandibular

relationships to the face, and the dental midline relationship to the face).• Dento-labial analysis (the relationship of the

teeth to the lips).• Dento-gingival analysis (the relationship of the

teeth to the gingiva, and• Dental analysis (the intertooth& intratooth

relationships, ie, form & position along with color).

Anatomy of the Smile: - Ackerman

The normal curvature of the lips Proper exposure of the red zone of the lips

An undistorted philtrum

Undisturbed naso-labial grooves.

Anatomy of the Smile: - Ackerman

Classification of Smile: According to Solomon E.G.R.1)Depending on the nature of labial mucous

membrane a) Papilla smile b) Gingival smile c) Mucosa smile 2) Dependant on the lip component a) Straight smile b) Convex smile c) Concave smile

Classification of Smile:According to Ackerman & Ackerman There are two basic types of smiles; i). The social smile ii). The enjoyment smile. Each type involves a different anatomic

presentation of the elements of the display zone.

Classification of Smile:According to RUBIN L R- He identified the following neuromuscular smile pattern• The commissure smile• The cuspid smile and • The complex smile.

The commissure smile:• Most common pattern, 67% of the population.• Lips contracting to show the upper teeth.• Lowest incisal edge of max teeth seen is central incissors• maximum movement of the commissure from 7 to 22 mm.

The cuspid smile:• Found in 31% of the population.• Shape of the lips is visualized as a diamond• Dominance of the levator labii superioris, exposing the cuspid teeth. • Inferior turn of lips in the maxillary premolars region.

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.

Classification of Smile:

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.

Classification of Smile:

The complex smile:• Found in 2% of population.

• The shapes of the lips are typically parallel.

• Simultaneous contraction of the levators of the upper lip & depressors of the lower lip showing

all the upper and lower teeth concurrently.

• The key characteristic of this smile is the strong muscular pull and retraction of the lower lip

downward and back.

• Smile pattern shows maxillary & mandibular incisal flat and parallel.

Requirements of an ideal smile

COMPONENTS OF AN ATTRACTIVE SMILE

AND THEIR ANALYSIS:

• Facial components

• Dental components

• Gingival components

• Physical components

FACIAL COMPONENTS:

• Smile analysis evaluation should begin with the observation of the

facial elements.

• Facial beauty is based on standard esthetic principles of proper

alignment, symmetry, and proportions of the face.

Facial features in smile design include,

– Facial height

– Facial shape

– Facial profile

– Gender, and age.

• FACE HEIGHT is divided into three equal thirds:

– From forehead to brow line

– From brow line to the base of the nose

– From the base of the nose to the base of the chin.

• The width of the face is typically the width of five ‘‘eyes’’.

FACIAL COMPONENTS

• Four Basic FACIAL SHAPES, Trubyte guide are square, tapering, square tapering,

and ovoid.

• LATERAL FACIAL PROFILES -straight, convex, or concave.

• FACIAL FEATURES RELATED TO GENDER AND AGE - soft tissue texture, complexion,

and tissue integrity of the epithelial tissues.

FACIAL COMPONENTS

Geometric Facial analysis:

• Creates horizontal symmetry and act as cohesive forces to unify the facial

composition.

• Cohesive force – to achieve pleasing aesthetics.

• The facial midline is perpendicular to these lines act as segregative

forces.• Interpupillary line-Incisal Plane - Facial midline.

FACIAL COMPONENTS

A tilt in the incisal plane may be attributed to;

• Dental factors - Attrition, Different Patterns of Eruption, and Periodontal Disease

• Skeletal factors - slanted maxilla.

FROM THE SAGITTAL ASPECT,

SOFT TISSUE ANALYSIS,

• Contour of upper& lower lips

• Lip support

• Lip protrusion

• Prominence of chin

• Recession or prominence of nose and its degree

• Nasolabial angle

• Rickett’s E-plane

Evaluation helps in diagnosis & treatment planning.

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 2

mm.

The protrusion or retrusion of the maxilla can be assessed.

Prominent maxilla - nasolabial angle < 90° & upper lip < 4 mm to the E-plane -

convex profile.

Concave profile - nasolabial angle > 90°and upper lip > 4 mm to the E-plane.

Spear has termed as “facially generated treatment planning”.

Steiner line - midpoint of the nose to the chin, and touches lips.

Burstone line - subnasale point to pogonion point.

The patient’s profile angle extends through the glabella, subnasale, and soft tissue pogonion,

and should be approximately 165° to 175° for Class I occlusion.

LIPS ANALYSIS

Lips analysis

• Boundaries of the smile design.

Lips analysis

• Genetic traits - position of the teeth, alveolar bone, and jaws; and their relationships influence the

shape of the lips.

Width:

• Wide lips make for a wide smile.

• Esthetic smile – smile atleast half the width of the face.

• The upper lip - more arched and wider than the lower lip.

• Lower lip is recessed beneath the upper lip approximately 300.

• The fullness of the lip, or lip volume, can be categorized as full, average, or thin.

FULLNESS:

Lip symmetry:

• Mirror image appearance of each lip when smiling & on both sides of midline.

• Independent evaluation of the upper and lower lip is essential when analyzing both symmetry and

fullness.

Lip position:

STATIC POSITION

• Static position - Tranquil position and ‘M’.

LARS - Lip Length, Age, Race And Sex

Influence tooth exposure in this tranquil position.

• 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.

Inference:

Before the amount of tooth exposure at rest is prescribed for the proposed

prostheses,each patient should be assessed according to the LARS factor.

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

Rufenacht’s morphopsychological concepts:

• Thin & taut lips – provide teeth which confer delicacy and fragility.

• Thick or voluptuous lips – provide teeth which display dominance and boldness.

Lip line:

• Relation of the inferior border of the upper lip to the teeth & gingiva.

• Upper lip line - to evaluate the max incisor display & the vertical position of the gingival margins during

smile.

• Lower lip line - to evaluate the buccolingual position of the incisal edge of the maxillary incisors and the

curvature of the incisal plane.

upper lip line:

• Classified as - low, average or high.

• Acceptable if it is within a range of 2 mm apical to the height of the gingiva on the

maxillary centrals.

Extremes:

• Shorter maxillary lips

• Longer maxillary lips

corrective options for gummy smile:

• Vertical maxillary excess - Cephalometric analysis. Skeletal displasias - Orthognathic surgery

(Horizontal le fort I osteotomy) to impact the maxilla.

• Altered passive eruption - diminished tooth size in combination with a high lip line creates a gummy

smile - corrective periodontal procedures are an option.

• Cosmetic crown lengthening – improve normal tooth height and tooth proportions. Creates pleasing

emergence profile, symmetry, positive radicular architecture, and proper zenith points of the gingival

margins.

• Cosmetic dental procedures.

• Exostosies - ledging appearance of the gingival tissues. Re-contouring the alveolar bone is necessary

to recreate & define normal architecture.

Before (top) and after (bottom) crown lengthening, frenectomy and application of 10 maxillary porcelain veneers.

• Frenum attachment can also affect the upper-lip shape and the amount of tooth exposure. A

frenectomy, can free up the lip for normal lip movement.

• Broad attachment of frenum creates a redundant flap of tissue, termed as a ‘‘lip curtain’’, is

visible hanging beneath the upper lip when smiling.

• These procedures, used in combination with cosmetic dental procedures,can reduce gummy

smiles and produce a more esthetic smile.

Smile zone:

• The exposed portion of teeth & gums within the oral frame formed by lips during a smile.

• Six basic smile-zone shapes:

Negative space:

• 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.

• Lateral negative space

• Buccal negative spaces.

• Obliteration of these essential spaces by dental elements lead to an unattractive smile.

• Excessive negative space also appear unesthetic.

Smile line:

• 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.

Smile line:

• 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.

Intercommissure line and lower lip framing:

• 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 the

patient’s age. In a youthful smile, approximately 75 percent to 100 percent of the maxillary

teeth would show below this line.

Facial and Dental midline:

• The starting point of the esthetic treatment plan is the facial midline.

• Anatomical landmarks as locating guides - midline of the nose, forehead, interpupillary

plane, philtrum, and chin.

• Variations in genetic structures undermines these landmarks as indicators of the facial

midline.

Two reliable anatomical landmarks to locate facial midline:

• The first is point nasion.

• The second is the base of the philtrum - cupid’s bow in the center of the upper lip, it matches

the papilla between the centrals directly over the dental midline.

• Connecting line locates the position & direction of the facial midline.

• Philtrum of the lip - most accurate. The exceptions are surgical, accident, and cleft-lip cases.

• The dental midline refers to a vertical line formed by the contact of the maxillary central

incisors.

• 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.

• Midline discrepancies of up to 4 mm off-centre to facial midline will generally not be perceived

as unesthetic or not noticeable.

• Alignment of the maxillary and mandibular dental midlines is desirable.

• Canted midline – a major design flaw in any natural or restored dentition.

Controversies in the placement of the dental midline:

• One school of thought states that the maxillary dental midline should coincide exactly with the labial

frenum and the facial midline, as it does in 70% of the population.

• The opposing view is that placing the midline exactly in the centre may contribute to a sense of artificiality.

• Choice is determined after aesthetic appraisal.

• Midline in centre - To detract attention from asymmetries & disharmonies of the face.

• The mandibular midline should not be used as a reference point, because in 75% of the population this

does not coincide with the maxillary midline

• Restorative dentistry - Slight corrections of midlines if maxillary centrals are made relatively symmetric and

correct intertooth relationships are maintained.

• Large midline discrepancy - orthodontics.

Axial inclination of teeth:

• Anterior teeth tends to incline mesially toward the midline & become more pronounced from the central

incisors to the canines.

• Overall esthetic impact - one of a harmonious relationship with the framing of the lower lip.

• Posterior teeth exhibits mesial inclination toward the midline as the cuspid.

• Creates a natural visual gradation - appear to diminish in size as they progress posteriorly.

Contact points / connectors:

• The connector is the zone in which two adjacent teeth appear to touch.

• 50-40-30 connector zone rule – establish esthetic reation.

• Coincidence of incisal edges to curvature of the lower lips enhance the cohesiveness of the

dentofacial composition.

Intratooth Relationships:

• The intratooth relationships refer to the morphology of maxillary anterior teeth.

• Shape & Size.

Shape:

• The morphology of maxillary anterior teeth is a fusion of the three basic shapes circle,

square and triangle.

• Teeth have inimitable shapes based on only three variables.

• Studies by Williams' and Frush and Fisher.

• Williams - shape of the central incisor is inverted frontal view of the face – invalidated.

• Frush and Fisher suggested that sex, age and personality related to the contour of the

anterior dental segment.

• Chronological age and dental age.

• Genetically determined factor – relatives records as guides.

• Morphopsychology - The concept of transposing the gender variations onto the shape of the

teeth.

• Females - curvaceous features, Males - ruggedness and sharp line angles.

Size:

• Tooth size - mesio-distal width divided by the inciso-gingival length - yields the width/length (w/l) ratio.

• Sizing with 1 to 16 theory, postulated by House and Loop.

• Height of C.I - 1/16th of the distance from the inferior border of the chin to the inter pupillary line.

• Width is 1/16th of the distance measured from either zygomatic prominence.

TWO SCHOOLS OF THOUGHT ON SIZE OF CENTRAL INCISORS

• Rufenacht suggested that the width and length of the central incisor should be constant

throughout life based on morpho-psychological determination of an ideal proportion.

• The second theory states that our bodies are in perpetual change throughout life. The dentition is

no exception to this transformation. Creating teeth with a youthful appearance in an older person

and creates a sense of artificiality.

Inter-tooth relationships

Tooth proportions:

Golden proportion:

• Greek’s mathematical concept of beauty.

• Pythagoras - Golden Proportion - (1/1.618 = 0.618)

• Plato - Beautiful Proportion (1/1.733 = 0.577).

• Kepler called it the “DIVINE PROPORTION”.

• The application of golden no. to dentistry was first mentioned by LOMBARDI(1973) and

developed by LEVIN(1978).

• Levin used the golden proportion to relate the successive widths of the anterior teeth as

viewed from the frontal.

• Width of the central incisor 0.618, or approximately 62% width of the lateral incisor.

Repeated Ratio:

• Lombardi described the use of a "continuous proportion or repeated ratio which

has been established between the width of central and lateral incisor and is

continued in the ratio of the placement of the remaining teeth and spaces."

• Eg. A lateral incisor should be 80% the width of central incisor and a canine should

be 80% width of the lateral incisors.

Recurring esthetic dental (RED) proportion:

• The 62% golden proportion is used, the lateral incisor appears too narrow, and the resulting

canine is not prevalent enough.

• Preston reported the golden proportion only 17%.

• Using continuous proportion or repeated ratio is not convincing.

• By combining elements of concepts Daniel.H.Ward has defined as the recurring esthetic

dental (RED) proportion.

• The RED proportion states that the proportion of the successive widths of teeth as viewed

from the frontal should remain constant as one move distally.

Physical attributes of the elements of the dento-facial composition :

• Fundamental principles of esthetics - artistic parameters.

• Co-relating them to the dento-facial complex to scale esthetics of the dento-facial composition.

Various physical attributes of elements of a composition impart the esthetic value:

• Contrast

• Unity

• Cohesive & segregate force

• Symmetry

• Proportion

o Dominance

o Balance

o Visual tension

o Progressive abating in dental composition

o Shade progression & selection

GINGIVAL COMPONENT:

• A feature of smile design that is often overlooked yet very significant is the health, symmetry, and

architecture of the gingival tissues. These tissues frame the teeth and add to the symmetry of the smile.

HEALTH, COLOR AND TEXTURE :

• Paramount for long-term success & the esthetic value of the treatment.

• Pale pink, vary in degree of vascularity, epithelial kertinization, and pigmentation, in the thickness of the

epithelium.

• Pointed papillary contour and should fill the interdental spaces to the contact point.

• Black triangles - makes a smile less attractive.

• Managing the soft tissues in this area improves the smile.

• Firm in consistency and the attached part should be firmly anchored.

• A normal, healthy gingival sulcus should not exceed 3 mm in depth.

• The texture - stippled (orange-peel–like appearance) in most cases. Fine or coarse. Younger

females has more finely textured & finer stippling when compared with that of males.

ARCHITECTURE & SYMMETRY:

• Positive radicular shape forming a scalloped appearance should be symmetric on both

sides of the midline.

• The marginal contour of the gingival should be sloped coronally to the end in a thin edge.

• Marginal gingival line extending from cuspid to cuspid. Ideally, the laterals reach slightly

short of that line.

Gingival zenith:

• The most apical point of the free gingival margin along the long axis of the tooth. Their position are

dictated by:

• Root form anatomy.

• CEJ.

• Osseous crest, where gingiva is scalloped the most.

• Located distal to the long axis on the maxillary centrals and cuspids.

• Zenith point of max.lat & mand.incisors is coincident with the long axis of these teeth.

• The compromised zenith can be reestablished by replacing the defective restoration.

Importance of zenith point

o When closing diastemas or changing the mesial or distal tilt position of the tooth i.e., moving

zenith points horizontally.

o 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 Biotype :

• The gingival biotype is classified as thin or thick.

• Prevalence - thick biotype is 85% & thin biotype is 15%.

Thin periodontal biotypes:

• Gingiva – delicate, almost translucent, appears friable with a minimal zone of attached gingiva.

• Escalates the risk of recession following crown preparation, periodontal or implant surgery.

Thick periodontal biotype

• Dense fibrotic and resilient, making it resistant to surgical procedures

• Reacts with pocket formation & during disease.

• Favorable esthetic outcomes with restorations.

• Relatively large amount of attached gingiva.

• Thick underlying osseous form.

• Relatively resistant to acute trauma.

TISSUE BIOTYPE IN PROSTHODONTIC TREATMENT

Tooth preparation:

• Thin biotypes – supra-gingival margins.

• Subgingival for PFM - grayish discoloration - esthetic failure.

• Thick biotypes - subgingivally in esthetic zones.

• Over contoured restorations will lead to gingival recession in thin biotypes. Pocket formation is

seen in thick biotype.

Gingival retraction:

• Thin biotypes - Thin retraction cord to avoid injury

• > 15 minutes - chances of recession are more.

• Thick biotype – comfortable retraction.

Gingival aesthetic line (GAL):

• The GAL

• The 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 2

mm) 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 the

GAL.

• Class IV —The GAL angle can be acute or obtuse. Gingival asymmetries due to recession,

altered patterns of eruption, loss of interdental papillae, clefts, and high frenal insertions.

• 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.Mclaren, inside dentistry—july/august 2009

PHYSIOLOGICAL COMPONENT:

Perceptual aspects – the art of illusion:

• Illusion is a figment of imagination where a perception of an object is created.

Fundamentals and Principles:

• The art of creating illusions consists of changing perception, to cause an object to

appear different from what it actually is.

• When an object is subjected to light it exhibits two dimensions, that is, length and

width. True natural light is multi-directional and on striking the surface of the

object, also reveals texture and shadows, this adds the third life like dimension of

depth.

Illusion works on two basic principles;

• the principle of illumination

• the principle of line.

• ‘Principle of Illumination” is based on the perception that light approaches and dark recedes. The

artistic predilection exhibited in the principle of illumination can be maintained to change the size,

shape and the overall form of the tooth through illusions.

• The second artistic predilection of great importance in dentistry is the use of horizontal and vertical

lines and ridges. Horizontal lines make the object appear wider and vertical lines make the object

appear longer. This is termed as the “Principle of Line”.

Esthetic treatment planning and sequencing :

An ideal esthetic treatment plan should be;

• Minimally invasive

• Preserve as much of the natural structures as possible.

• Realign the ideal form and function of the teeth and tissues.

• Enhance the esthetics.

• Never compromise the patient’s oral health or the stability of his or her teeth.

• Attempts to achieve perfection in every way.

• Patient interview – treatment options mock-ups.

• Treatment sequencing - phase wise distribution of treatment procedures, execution.

Esthetic treatment options:

• Cosmetic contouring – the reshaphing of anterior teeth for esthetic purposes involving

mesial, distal, labial and lingual surfaces.

• Bleaching discoloured teeth

• Composite resin bonding – to change the shape of the teeth as well as their colour

• Etched porcelain restorations- inlays, onlays, veneers – discoloured teeth, attrition,

erosion, abfraction, tooth chipping, endodontically treated teeth.

• Crown restoration

• Periodontal theraphy – in altered passive eruptions, crown lengthening, esthethic

gingival recontouring, frenectomies, flap surgeries, osseous recontouring.

• Orthodontic and surgical orthodontical interventions – in diastema, crowded

teeth, surgical orthodontic corrections of dento-facial deformities such as vertical

maxillary insufficiency, vertical maxillary excess etc.,

Role of Technology in Changing Smile:

Extra oral video camera:

• Record of the patient's face while moving and talking.

• It can record the patient in various moods and gestures

• Computer imaging .

Intraoral video camera:

• Reliability, performance and image quality.

• Smallest details of tooth can be viewed as close as 2mm.

• Pt education & treatment options

• Application wit computer imaging system.

T- Scan and Digital Radiography

• Buccolingual width of the jaws as well as the

• Location of anatomic features for placing an implant in the esthetic position.

CAD/CAM

• To design veneers and crowns to enhance smile while the patient waits.

• “Mock- up" of a planned cosmetic teatment

• Solve potential problems before providing treatment to the patient.

Lasers

• Delicate gum surgery and crown lengthening/ gingivectomy and gingivoplasty.

• Controlled bleeding - dry operating field - excellent visibility - Reduced operating time - reduced post

operative swelling, pain and scarring.

Abrasive Technology

• Jet air stream with micro abrasive particles.

• Stain removal, decay removal.

• Painless & faster.

• Repairing existing composite, ceramics.

Conclusion

“A well designed smile is a product of

consolidated efforts accomplished by accurate

diagnosis, methodical treatment planning, use of

advanced materials and contemporary

techniques rendered by the skilled dentist”.

References• Goldstein, RE: Change your Smile, ed 3 Chicago, Quintessence, 1997.• Nicholas C. Davis, Smile Design, Dent Clin N Am 51 (2007) 299–318• Ahmed I. anterior dental esthetics: dentofacial perspective. BDJ 2005 198:81-88• Levin El. Dental esthetics and the golden proportion. J Prosthet Dent 1978; 40:

244–252.• Ackermann JL et al. smile analysis and design in digital era, Am J Orthod

Dentofacial Orthop 2007;131:305-10• Kamal Shigli, Swaraj Bharati: Role of technology in designing a confident smile. J.

IPS Dec. 2001, vol.1, no.4.6) • Vig RG Brundo GC. The kinetics of anterior tooth display. J ProsthetDent

1978;39:502-4.• Jeff.morley et al., macroesthetic elements of smile design, JADA, Vol. 132, January

2001.• T.G.Mathews, anatomy of the smile, J ProsthetDent 1978;39:2 128-135.

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Smile design semenar