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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
50 — issue 1/2015 Aesthetic and Restorative Dentistry Article SMILE ANALYSIS: — Photoshop smile design technique — Professor Dr. Edward A. McLaren, DDS, is the director of the University of California, Los Angeles Center for Esthetic Dentistry in California, U.S. He maintains a private prac- tice in Los Angeles. — Lee Culp, CDT, is an adjunct faculty member at the University of North Carolina at Chapel Hill School of Dentistry in the U.S. and an accredited member of the American Academy of Cosmetic Den- tistry. He practices in Dublin, California, and Raleigh, North Carolina. Table 1: Components of smile analysis and esthetic design. Introduction: Smile analysis and esthetic design Dental facial esthetics can be defined in three ways: Traditionally, dental and facial esthetics have been defined in terms of macro- and micro-elements. Macro-esthetics encompasses the interrelationships be- tween the face, lips, gingiva, and teeth and the perception that these relation- ships are pleasing. Micro-esthetics in- volves the esthetics of an individual tooth and the perception that the color and form are pleasing. Historically, accepted smile design con- cepts and smile parameters have helped to design esthetic treatments. These specific measurements of form, color, and tooth/esthetic elements aid in transferring smile design information between the dentist, ceramist, and patient. Esthetics in dentistry can encompass a broad area—known as the esthetic zone.1 Rufenacht delineated smile analysis into facial esthetics, dentofacial esthetics, and dental esthetics, encompassing the macro- and micro-elements described in the first definition above.2 Further classification identifies five levels of esthetics: facial, orofacial, oral, dentogingival, and dental (Table 1).1, 3 Initiating smile analysis: Evaluating facial and orofacial esthetics The smile analysis/design process begins atthemacrolevel,examiningthepatient’s face first, progressing to an evaluation of the individual teeth, and finally moving to material selection considerations. Multi- ple photographic views (e.g., facial and sagittal) facilitate this analysis. At the macrolevel, facial elements are evaluated for form and balance, with an emphasis on how they may be affected by dental treatment.3, 4 During the macro- analysis, the balance of the facial thirds is examined (Fig. 1). If something appears unbalanced in any one of those zones, the face and/or smile will appear unesthetic. Such evaluations help determine the extentandtypeoftreatmentnecessaryto affect the esthetic changes desired. De- pendingonthecomplexityanduniqueness of a given case, orthodontics could be considered when restorative treatment alone would not produce the desired re- sults (Fig. 2), such as when facial height is an issue and the lower third is affected. In othercases—butnotall—restorativetreat- ment could alterthe vertical dimension of occlusion to open the bite and enhance estheticswhenapatientpresentswithrel- atively even facial thirds (Fig. 3). Evaluating oral esthetics The dentolabial gingival relationship, whichisconsideredoralesthetics,hastra- ditionallybeenthestartingpointfortreat- ment planning. This process begins by de- termining the ideal maxillary incisal edge placement (Fig. 4). This is accomplished byunderstandingtheincisaledgeposition relative to several different landmarks. Thefollowingquestionscanbeusedtode- termine the ideal incisal edge position: Where in the face should the maxillary incisal edges be placed? What is the proper tooth display, both statically and dynamically? What is the proper intra- and inter- tooth relationship (e.g., length and size of teeth, arch form)? Can the ideal position be achieved with restorative dentistry alone, or is orthodontics needed? In order to facilitate smile evaluation based on these landmarks, the rule of 4.2.2—whichreferstotheamountofmax- illary central display when the lips are at rest, the amount of gingival tissue re- Facial esthetics Total facial form and balance Orofacial esthetics Maxillomandibular relationship to the face and the dental midline relationship to the face pertaining to the teeth, mouth and gingiva Oral esthetics Labial, dental, gingival; the relationships of the lips to the arches, gingiva, and teeth Dentogingival esthetics Relationship of the gingiva to the teeth collectively and individually Dental esthetics Macro- and micro-esthetics, both inter- and intra-tooth