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ePaper created 2015-03-10, 11:16:47 | version 1.33.01
issue 1/2015 — 51Aesthetic and Restorative Dentistry Article Fig.1 Fig.2 Fig. 2 Sagittal views best demon- strate which specialists should be involved in treat- ment, whether orthodon- tists or maxillofacial sur- geons, to best esthetically alter the facial esthetics. Fig. 3 Drawing a line along the glabella, subnasale, and pogonion enables a quick evaluation of esthetics without the need for radi- ographs to determine alignment of ideal facial elements. Fig. 4 Evaluating the maxillary incisal edge position is the starting point for establish- ing oral esthetics. Fig. 5 According to the 4.2.2 rule, this patient’s smile is defi- cient in esthetic elements, having only 1 mm of tooth display at rest (left), minus 3 mm of gingival display, and 4 mm of space be- tween the incisal edge and the lower lip (right). Fig. 6 Gingival symmetry in rela- tion to the central incisors, lateral incisors and canines is essential to esthetics. Optimal esthetics is achieved when the gingival line is relatively horizontal and symmetrical on both sides of the midline in rela- tion to the central incisors and lateral incisors. Fig. 7 The esthetic ideal from the gingival scallop to the tip of the papilla is 4–5 mm. vealed,andtheproximityoftheincisalline to the lower lip—is helpful (Fig. 5). At a time when patients perceive fuller and brighter smiles as most esthetic, 4mm of maxillary central incisor display while the lipsareatrestmaybeideal.2, 5Inanesthetic smile,seeingnomorethan2mmofgingiva when the patient is fully smiling is ideal.6 Finally, the incisal line should come very closetoandalmosttouchthelowerlip,be- ingnomorethan2mmaway.2Theseguide- lines are somewhat subjective and should beusedasastartingpointfordetermining proper incisal edge position. Dentogingival esthetics Gingival margin placement and the scal- loped shape, in particular, are well dis- cussedintheliterature.Asgingivalheights are measured, heights relative to the cen- tral incisor, lateral incisor, and canine in an up/down/up relationship are considered esthetic(Fig.6).However,thismaycreate a false perception that the lateral gingival line is incisaltothe central incisor. Rather, in most esthetic tooth relationships, the gingival line of the four incisors is approx- imatelythe same line (Fig. 6), withthe lat- eral incisor perhaps being slightly incisal.7 The gingival line should be relatively par- allel to the horizon forthe central incisors and the lateral incisors and symmetric on each side of the midline.2, 8 The gingival contours (i.e., gingival scallop) should fol- low a radiating arch similar to the incisal line. The gingival scallop shapes the teeth and should be between 4mm and 5mm (Fig. 7).9 Related to normal gingival form is midline placement.Althoughusuallythefirstissue addressed in smile design, it is not as sig- nificantastoothform,gingivalform,tooth shape, or smile line. Several rules can be applied when considering modifying the midlinetocreateanestheticsmiledesign: Fig.3 Fig.4 Fig.6 Fig. 7 Fig.5 Fig. 1 Three altered views of the same patient enable analy- sis of what can be accom- plished to enhance facial and smile esthetics.