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Cosmetic Tribune United Kingdom Edition | 4/201520 Introduction: Smile analysis and aesthetic design Dental facial aesthetics can be defined in three ways. Traditionally, dental and facial aesthetics have been defined in terms of macro- and micro-ele- ments. Macro-aesthetics encom- passes the interrelationships be- tween the face, lips, gingiva, and teethandtheperceptionthatthese relationships are pleasing. Micro- aesthetics involves the aesthetics of an individual tooth and the per- ception that the colour and form are pleasing. Historically, accepted smile de- sign concepts and smile parame- tershavehelpedtodesignaesthetic treatments. These specific meas- urements of form, colour, and tooth/aesthetic elements aid in transferring smile design informa- tion between the dentist, ceramist, andpatient.Aestheticsindentistry can encompass a broad area— known as the aesthetic zone.1 Rufenacht delineated smile analysis into facial aesthetics, dentofacial aesthetics, and den- tal aesthetics, encompassing the macro- and micro-elements de- scribed in the first definition above.2 Further classification iden- tifiesfivelevelsofaesthetics:facial, orofacial, oral, dentogingival, and dental (Tab.I).1, 3 Initiating smile analysis:Evaluating facial and orofacial aesthetics Thesmileanalysis/designprocess beginsatthemacrolevel,examining the patient’s face first, progressing to an evaluation of the individual teeth, and finally moving to mate- rial selection considerations. Multi- ple photographic views (e.g., facial andsagittal)facilitatethisanalysis. At the macro level, facial ele- ments 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 some- thing appears unbalanced in any one of those zones, the face and/or smile will appear unaesthetic. Suchevaluationshelpdetermine the extent and type of treatment necessary to affect the aesthetic changesdesired.Dependingonthe complexity and uniqueness of a given case, orthodontics could be considered when restorative treat- ment alone would not produce the desiredresults(Fig.2),suchaswhen facial height is an issue and the lower third is affected. In other cases—but not all—restorative treatment could alter the vertical dimensionofocclusiontoopenthe bite and enhance aesthetics when a patient presents with relatively even facial thirds (Fig.3). TRENDS&APPLICATIONS Smile analysis and photoshop smile design technique Prof.Edward A.McLaren & Lee Culp,USA Fig.1:Three altered views of the same pa- tient enable analysis of what can be ac- complished to enhance facial and smile aesthetics.—Fig. 2: Sagittal views best demonstrate which specialists should be involved in treatment, whether ortho- dontistsormaxillofacialsurgeons,tobest aesthetically alter the facial aesthetics.— Fig. 3: Drawing a line along the glabella, subnasale, and pogonion enables a quick evaluationofaestheticswithouttheneed forradiographstodeterminealignmentofidealfacialelements.—Fig.4:Evaluatingthemaxillaryincisaledgepositionisthestartingpointforestablishingoralaesthetics.—Fig.5:Accordingtothe4.2.2rule,thispatient’s smile is deficient in aesthetic elements,having only 1 mm of tooth display at rest (left),minus 3 mm of gingival display,and 4 mm of space between the incisal edge and the lower lip (right). 1 2 3 4 5 Facial aesthetics Total facial form and balance Orofacial aesthetics Maxillomandibular relationship to the face and the dental midline relationship to the face per- taining to the teeth, mouth and gingiva Oral aesthetics Labial, dental, gingival; the relationships of the lips to the arches, gingiva, and teeth Dentogingival aesthetics Relationship of the gingiva to the teeth collec- tively and individually Dental aesthetics Macro- and micro-aesthetics, both inter- and intra-tooth Table I: Components of smile analysis and aesthetic design. Fig.6: Gingival symmetry in relation to the central incisors,lateral incisors and canines is essential to aesthetics.Optimal aesthetics is achieved when the gingival line is relatively horizontal and symmetrical on both sides of the midline in relation to the central incisors and lateral incisors.—Fig. 7: The aesthetic ideal from the gingival scallop to the tip of the papilla is 4–5mm.—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 11mm in length, with lateral incisors 1–2 mm shorter than the central incisors, and canines 0.5–1mm shorter than the central incisors for an aesthetic smile display.—Fig. 12: The canines and other teeth distally located are visually perceived as occupying less space in an aesthetically 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. 15: Photoshop provides an effective and inexpensive way to design a digital smile with proper patient input. To start creating custom tooth grids, open an image of an attractive smile in Photoshop and create a separate transparent layer.—Fig. 16: The polygonal lasso tool is an effective way to select the teeth.— Fig.17: Click“edit > stroke,”then use a two-pixel stroke line (with colour set to black) to trace your selection.Make sure the transparent layer is the active working layer. 6 7 8 9 10 11 12 13 14 15 16 17 123 45 67 89101112 1314151617