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Dental Tribune Pakistan Edition No. 5, 2015

removed. Drag the layer of the teeth to the trash, leaving only the layer with the tracing of the teeth (Fig. 21). In the file menu, click “save as” and choose “.png” or “.psd” (Photoshop) as the file type. This will preserve the transparency. You do not want to save it as a JPEG, since this would create a white background around the tracing. Name the file appropriately (e.g., 75% W/L central). . By tracing several patients’teeth that have tooth size and proportion in the aesthetic zone and saving them, you can create a library of tooth grids to custom design new teeth for your patients who require smile designs. The Photoshop smile design technique The Photoshop Smile Design (PSD) technique can be done on any image, and images can be combined to show the full face or the lower third with lips on or lips off. This article demonstrates how to perform the technique on the cheek-retracted view. The first step in the PSD technique is to create a digital conversion of the actual tooth length and width, and then digitally determine the proposed new length and proportion of the teeth. Determining digital tooth size To determine digital tooth size, follow these steps: . Create a conversion factor by dividing the proposed length (developed from the smile analysis) by the existing length of the tooth. . The patient’s tooth can be measured in the mouth or on the cast (Fig. 22). If the length measures 8.5mm but needs to be at 11 mm for an aesthetic smile, divide 11 by 8.5. The conversion factor equals 1.29, a 29% digital increase lengthwise. . Open the full-arch cheek-retracted view in Photoshop, and zoom in on the central incisor. Select the eyedropper palette. A new menu will appear. Select the ruler tool (Fig. 23). . Click and drag the ruler tool from the top to the bottom of the tooth to generate a vertical number, in this case 170 pixels (Fig. 24). Multiply the number of pixels by the conversion factor. In this case, 170 x 1.29 = 219 pixels; 219 pixels is digitally equivalent to 11 mm (Fig. 25). Determine the digital tooth width using the same formula. . Create a new layer, leave it transparent, and mark the measurement with the pencil tool (Fig. 26). Applying a new proposed tooth form Next, follow these steps: . After performing the smile analysis and digital measurements, choose a custom tooth grid appropriate for the patient. Select a tooth grid based on the width-to-length ratio of the planned teeth (e.g., 80/70/90 or 80/65/80). Open the image of the chosen tooth grid in Photoshop and drag the grid on to the image of teeth to be smile designed (Fig. 27). . If the shape or length is deemed inappropriate, press the command button (control button for PCs) and “z” to delete and select a suitable choice. . Depending on the original image size, the tooth grid may be proportionally too big or too small. To enlarge or shrink the tooth grid created (with the layer activated), press command (or control) and “t” to bring up the free transform function. While holding the shift key (holding the shift key allows you to transform the object proportionally), click and drag a corner left or right to expand or contract the custom tooth grid. . Adjust the size of the grid so that the outlines of the central incisors have the new proposed length. Move the grid as necessary using the move tool so that the incisal edge of the tooth grid lines up with the new proposed length (Fig. 28). . Areas of the grid can be individually altered using the liquify tool (Fig. 29). Digitally creating new aesthetic teeth Next, follow these suggested steps: . With the new tooth grid layer and the magic wand tool both activated, click on each tooth to select all of the teeth in the grid (Fig. 30). . Expand the selection by two pixels in the expand menu; click “select > modify > expand” (Fig. 31). Note that the selection better approximates the grid. You can expand the selection or contract as necessary using the same menu. Activate the layer of the teeth (cheek- retracted view) by clicking on it (Fig. 32). . Next, activate the liquify filter (you will see a red mask around the shapes of the proposed teeth). The mask creates a digital limit that the teeth cannot be altered beyond. This is similar to creating a mask with tape for painting a shape (Fig. 33). . Use the forward warp tool by clicking on an area of the existing tooth and dragging to mold/shape the tooth into the shape of the new proposed outline form (Fig. 34). Repeat this for each tooth. If you make a mistake or do not like something, click command (or control) and “z” to go back to the previous edit (Fig. 35). Adjusting tooth brightness The following steps are recommended next: . Select the whitening tool (dodge tool) to brighten the teeth. In the dodge tool palate, click on “midtones” and set the exposure to approximately 20%. Click on the areas of the tooth you want brightened (Figs. 36 & 37). . Alternatively, with the teeth selected, you can use the brightness adjustment in the brightness/contrast menu; click “image > adjustments > brightness/ contrast”. Performing the changes on only one side of the mouth allows the patient to compare the new smile design to his/her original teeth before agreeing to treatment. Create a copy To save the information you have created for presentation to the patient, follow these tips: . Go to “file” and select “save as.” . When the menu appears, click on the “copy” box. . Name the file at that step. Save it as a JPEG file type. . Designate where you want it saved. . Click “save.” A file of the current state of the image will be created in the designated area. You can now continue working on the image and save again at any point you want. Conclusion Knowledge of smile design, coupled with new and innovative dental technologies, allows dentists to diagnose, plan, create, and deliver aesthetically pleasing new smiles. Simultaneously, digital dentistry is enabling dentists to provide what patients demand: quick, comfortable, and predictable dental restorations that satisfy their aesthetic needs. Editorial note: A complete list of references is available from the publisher. This article was originally published in the Journal of Cosmetic Dentistry, spring issue, No 1/2013, Vol. 29, and the Clinical Masters Magazine No 1/2015. Prof. EdwardA. McLaren is the director ofthe University ofCalifornia, Los Angeles Center for Esthetic Dentistry. He can be contacted at emclaren@dentistry.ucla .edu. Authors Info Lee Culp, CDT, is an adjunct faculty member at the University of North Carolina at Chapel Hill School of Dentistry. He can be contacted at lee_culp@microdental. com. Continued from page 05 Thailand's first dental museum opens in Bangkok ANGKOK, THAILAND - With the newly opened Sirindhorn Dental Museum, the Faculty of Dentistry at Mahidol University in Bangkok has introduced the first dental museum of its kind in Asia. By highlighting the history of dentistry and oral hygiene acrossAsia through fun and interactive exhibits, the museum hopes to raise awareness in the country about the importance of proper oral care. The 620 m2 museum, which is sponsored by the royal family, features five main exhibits, each aimed at improving understanding of the importance of good dental health. "We want to ensure that Thais will have a healthy smile in our 'Land of Smiles' for as long as possible," Dr Phira Sithiamnuai, assistant professor and Deputy Dean for Collaboration and Networking at the faculty, told the Bangkok Post last week. "Our goal for the museum is to encourage Thai children to understand the importance of oral health in an entertaining way. We hope that learning with fun will inspire people to make healthy choices about their oral health." A highlight for children is the giant model of a mouth. Assisted by the staff, visitors are encouraged to practise their toothbrushing skills on the huge teeth with equally giant toothbrushes. Other interactive items are a 3-D human model that shows how oral health can affect the overall well-being, as well as several multimedia displays on dental science. Furthermore, the exhibition takes a closer look at the history of dentistry throughout China, India and Thailand, including collections of dental materials and tools, as well as information on dental statistics, and even a prehistoric human skeleton that features traces of unnaturally modified teeth. Many Thais, especially people in remote areas, lack access to basic oral health care. As reported online by the Bangkok Post, Sithiamnuai remarked that the dentist per capita ratio in the capital is 14 times higher than in the north-east of the country, for example. According to figures from the Bureau of Dental Health, Thailand has just 11,607 dentists. This translates to a dentist-population ratio of approximately 1:5,533, compared with an average of 1:2,000 in most developed countries. The Sirindhorn Dental Museum is located at the HRH Princess Maha Chakri Sirindhorn 50th Anniversary Building at the university's Phayathai campus and is free of admission. B DT International 24 partner varsities attend training session SLAMABAD - Higher Education Commission (HEC) in collaboration with the United States Agency for International Development (USAID) organised a two- day training session on 'Effective Financial Aid Offices for USAID' - both for merit and need-based scholarship programme. Over 35 representatives of the financial aid offices of 24 partner universities of the USAID attended the training, which was aimed at improving effectiveness and efficiency of these offices in various facets such as communication skills, coordination and interaction with aspiring students regarding scholarships and procedure involving execution of the programme. USAID Merit and Needs-Based Scholarship Programme (MNBSP) is a $37 million scholarship programme, offering graduate and undergraduate degrees in 31 public and private universities in Pakistan. Fifty per cent of scholarships are reserved for meritorious and deserving female students. Speaking at the concluding ceremony, HEC executive director Dr G Raza Bhatti highlighted local and overseas scholarship projects, faculty and infrastructure development Continued on page 13 I DT Pakistan Report HEC-USAID SCHOLARSHIPS 10 DENTAL TRIBUNE Pakistan Edition September 2015

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