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ePaper created 2015-09-18, 13:26:18 | version 1.38.0
6 DENTAL TRIBUNE Pakistan Edition September 2015 Editor - Online Haseeb Uddin CLINICAL PRACTICE Smile analysis and photoshop smile design technique 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-elements. Macro-aesthetics encompasses the interrelationships between the face, lips, gingiva, and teeth and the perception that these relationships are pleasing. Micro-aesthetics involves the aesthetics of an individual tooth and the perception that the colour and form are pleasing. Historically, accepted smile design concepts and smile parameters have helped to design aesthetic treatments. These specific measurements of form, colour, and tooth/aesthetic elements aid in transferring smile design information between the dentist, ceramist, and patient. Aesthetics in dentistry can encompass a broad area— known as the aesthetic zone1. Rufenacht delineated smile analysis into facial aesthetics, dentofacial aesthetics, and dental aesthetics, encompassing the macro- and micro-elements described in the first definition above2. Further classification identifies five levels of aesthetics: facial, orofacial, oral, dentogingival, and dental (Table 1)1,3. Initiating smile analysis: Evaluating facial and orofacial aesthetics The smile analysis/design process begins at the macro level, examining the patient’s face first, progressing to an evaluation of the individual teeth, and finally moving to material selection considerations. Multiple photographic views (e.g., facial and sagittal) facilitate this analysis. At the macro level, facial elements are evaluated for form and balance, with an emphasis on how they may be affected by dental treatment3,4. 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 unaesthetic. Such evaluations help determine the extent and type of treatment necessary to affect the aesthetic changes desired. Depending on the complexity and uniqueness of a given case, orthodontics could be considered when restorative treatment alone would not produce the desired results (Fig. 2), such as when facial height is an issue and the lower third is affected. In other cases—but not all— restorative treatment could alter the vertical dimension of occlusion to open the bite and enhance aesthetics when a patient presents with relatively even facial thirds (Fig. 3). Evaluating oral aesthetics The dentolabial gingival relationship, which is considered oral aesthetics, has traditionally been the starting point for treatment planning. This process begins by determining the ideal maxillary incisal edge placement (Fig. 4). This is accomplished by understanding the incisal edge position relative to several different landmarks. The following questions can be used to determine 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—which refers to the amount of maxillary central display when the lips are at rest, the amount of gingival tissue revealed, and the proximity of the incisal line to the lower lip—is helpful (Fig. 5). At a time when patients perceive fuller and brighter smiles as most aesthetic, 4mm of maxillary central incisor display while the lips are at rest maybe ideal2,5. In an aesthetic By Prof. Edward A. McLaren, Lee Culp Lee Culp 1 2 3 Fig. 1: Three altered views of the same patient enable analysis of what can be accomplished to enhance facial and smile aesthetics.-Fig. 2: Sagittal views best demonstrate which specialists should be involved in treatment, whether orthodontists or maxillo facial surgeons, to best aesthetically alter the facial aesthetics.-Fig. 3: Drawing a line along the glabella, subnasale, and pogonion enables a quick evaluation of aesthetics without the need for radio graphs to determine alignment of ideal facial elements.-Fig. 4: Evaluating the maxillary incisal edge position is the starting point for establishing oral aesthetics.-Fig. 5:According to the 4.2.2 rule, this patient's smile is deficient in aesthetic elements, having only 1mm of tooth display at rest (left), minus 3mm of gingival display, and 4 mm of space between the incisal edge and the lower lip (right) 4 ORAL-ESTHETICS(dento-liabial-gingival)- has been called dento-facial aestheics 5 THE ROLE OF 42.2 minus 3 mm gingival dispaly 1 mm dispaly at rest 8 9 10 11 15 12 1413 16 17 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 1–2mm 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. Table I: Components of smile analysis and aesthetic design. 123 891011 14131617