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Clinical Master Magazine

52 — issue 1/2015 Aesthetic and Restorative Dentistry Article Themidlineonlyshouldbemovedtoes- tablishanestheticintra-andinter-tooth relationship, with the two central inci- sors being most important. The midline only should be moved restoratively up to the root of the ad- jacent tooth. Ifthe midline is within 4mm ofthe cen- ter of the face, it will be esthetically pleasing. Themidlineshouldbeverticalwhenthe head is in the postural rest position. Evaluating dental esthetics Part of evaluating dental esthetics for smile design is choosing tooth shapes for patients based on their facial characteris- tics (e.g., long and dolichocephalic, or squarish and brachycephalic). When pa- tients present with a longer face, a more rectangular tooth within the esthetic range is appropriate. For someone with a square face, a tooth with an 80% width- to-length ratio would be more appropri- ate. The width-to-length ratio most often discussed in the literature is between 75% and 80%, but esthetic smiles could demonstrateratiosbetween70%and75% or between 80% and 85% (Figs. 8–10).1 The length of teeth also affects esthet- ics. Maxillary central incisors average be- tween10mmand11mminlength.Accord- ing to Magne, the average length of an unworn maxillary central to the cemen- toenamel junction is slightly over 11mm.10 The esthetic zone for central incisor length, according to the authors, is be- tween 10.5mm and 12mm, with 11mm be- ing a good starting point. Lateral incisors arebetween1mmandamaximumof2mm shorter than the central incisors, with the canines slightly shorter than the central incisors by between 0.5mm and 1mm (Fig. 11). The inter-tooth relationship, or arch form, involves the golden proportion and position of tooth width. Although it is a goodbeginning,itdoesnotreflectnatural tooth proportions. Natural portions demonstrate a lateral incisor between 60% and 70% of the width of the central incisor, and this is larger than the golden proportion.11 However, a rule guiding pro- portionsisthatthecanineandallteethdis- tal should be perceived to occupy less visual space (Fig. 12). Another rule to help maintain proportions throughout the archis1-2-3-4-5;thelateralincisoristwo- thirdsofthecentralincisorandthecanine is four-fifths of the lateral incisor, with somelatitudewithinthosespaces(Fig.13). Finally, contact areas can be moved restorativelyuptotherootoftheadjacent tooth. Beyond that, orthodontics is re- quired (Fig. 14). Creating a digital smile designed in Photoshop Although there are digital smile design services available to dentists for a fee, it ispossibletousePhotoshopCS5software (Adobe Systems) to create and demon- strate for patients the proposed smile de- signtreatments.Itstartsbycreatingtooth grids—predesignedtoothtemplatesindif- ferent width-to-length ratios (e.g., 75% central, 80% central)that can be incorpo- rated into a custom smile design based on patient characteristics. You can create as manydifferenttooth grids as you like with differenttoothproportionsintheesthetic zone. Once completed, you will not have to do this step again, since you will save the created tooth grids and use them to create a new desired outline form for the desiredteeth.Followtheserecommended steps: Figs. 8–10 Acceptable width-to-length ratios fall between 70% and 85%, with the ideal range between 80% and 85%. Fig. 11 An acceptable starting point for central incisors is 11 mm in length, with lateral incisors 1–2mm shorter than the central incisors, and canines 0.5–1mm shorter than the central incisors for an esthetic smile display. Fig. 12 The canines and other teeth distally located are visually perceived as occupying less space in an esthetically pleasing smile. Fig. 13 A general rule for achieving proportionate smile design is that lateral incisors should measure two-thirds of the central incisors and canines four-fifths of the lateral incisors. Fig. 14 If feasible, the contact areas can be restoratively moved up to the root of the adjacent tooth. Fig.8 Fig.9 Fig.10 Fig.11 Fig.12 Fig.13 Fig.14

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