Smile Designing – In a Digital

Age

Presented By - Dr Akshat Waran

1st Year PG
Department of Conservative and
Endodontics
Himachal Dental College
So it all begins with the smile
• A charming smile can open doors and knock down
barriers that stand between you and fuller richer life.

• On the other hand, you are dissatisfied with your

smile, it may be holding you back from fully
embracing life and its opportunities

• When planning treatment for esthetic cases, smile

design cannot be isolated from a comprehensive
approach to patient care

• Esthetic dentistry demands attention to patient’s

desires and treatment of patient’s individual
problems.
HISTORICAL BACKGROUND
• The search for beauty can be
traced to the earliest
civilizations.

• The First instance can be seen

both the Phoenicians
(approximately 800 BC) and
Etruscans (approximately 900
BC) carefully carved animal
tusks to simulate the shape,
form, and hue of natural teeth
for use as pontics.
• The Central and South American
Mayan’s
(approximately 1000 AD) beautified
themselves by filing the incisal
edges of their anterior teeth
into various shapes and designs.
During the Roman Empire
dental cosmetic treatment
was available only to the
affluent classes. Oral
hygiene was practiced
primarily by women for
reasons of beauty rather
than dental health.
 GOAL
• The main goal of an esthetic makeover is to develop a peaceful
and stable masticatory system, where the teeth, tissues, muscles,
skeletal structures and joints all function in harmony.

• Achieving a successful, healthy and functional result requires an

understanding of the interrelationship among all the supporting oral
structures, including the muscles, bones, joints, gingival tissues and
occlusion.

• “HARMONY IS THE KEY”

• Tooth Color essential in the final result but esthetic treatment

planning should never be devised around shading improvements
alone.

• Our ultimate goal should be to achieve a pleasing composition in

the smile .
 Classification of Smiles
• Smiles are classified by many authors some
of which are
- Ackerman and Ackerman
- Tjan et al
- Rubin

• Classification of Smile ( Akerman and

Akerman)
According to this there are two types of Smile
a) Social Smile
b) Joyous Smile
 Social Smile - typically used as a
greeting - a voluntary, unstrained,
static facial expression.
The lips part due to moderate muscular
contraction of the lip elevator muscles,
and the teeth and sometimes the gingival
scaffold are displayed.
The enjoyment smile - elicited by
laughter or great pleasure - involuntary.
It results from maximal contraction of the
upper and lower lip elevator and
depressor muscles, respectively.
This causes full expansion of the lips,
with maximum anterior tooth display and
gingival show.
Classification of Smile
(Tjan et al)
They classified the Smile as
1) High
High smile shows complete display of
cervico-incisal length of the maxillary incisors
along with contiguous band of gingiva

2) Average
75–100% of upper incisors and inter dental
papilla is displayed.
maxillary incisors with the incisal curvature
of the maxillary anterior teeth are parallel
to the inner curvature of the lower lip and
may be slightly or totally touching the lower lip
3) Low
In low smile line, <75% of the maxillary incisors in the full smile is displayed
Classification of Smile
by Rubin
• He classified styles of smile depending on the
direction of elevation and depression of the lips
and the predominant muscle groups involved :

1. Mona Lisa smile – Commissure smile, the

zygomaticus major muscles pull the upper-lip like a
Cupid's bow.
2. Canine smile - The upper-lip is
elevated uniformly like a diamond
without the corners of the mouth
turning upward.

3. Complex smile/full denture

smile - The upper-lip moves
superiorly as in the canine smile,
but the lower-lip also moves
inferiorly.
 Requirements of an ideal
smile
• The ideal Smile has the following components :
• Facial components

• Dental components

• Gingival components

• Physical components
• Smile analysis evaluation should begin with the observation of the
facial elements.

• Facial beauty is based on standard esthetic principles of proper

alignment, symmetry, and proportions of the face.

Facial features in smile design include,

– Facial height

– Facial shape

– Facial profile

– Gender, and age.

 Facial Height of an ideal face can be measured by
both vertical as well as horizontal

Horizontal Vertical
Dimensions Dimensions

Basic Facial
Shapes

Lateral Profiles
 Smile Zone
• The exposed portion of teeth &
gums within the oral frame
formed by lips during a smile.

Six basic smile-zone shapes:

 Smile Line
The smile line can be defined as an imaginary line
running along the incisal edges of the maxillary anterior
teeth and coinciding the curvature of the lower lip

An attractive smile line is one of the most important

features of a pleasing smile.
 Dental Component
Inter-tooth relationships

Tooth proportions:

Golden proportion:

• Greek’s mathematical concept of beauty.

• Pythagoras - Golden Proportion - (1/1.618 = 0.618)

• Plato - Beautiful Proportion (1/1.733 = 0.577).

• Kepler called it the “DIVINE PROPORTION”.

• The application of golden no. to dentistry was

first mentioned by LOMBARDI(1973) and

developed by LEVIN(1978).

• Levin used the golden proportion to relate the

successive widths of the anterior teeth as viewed

from the frontal.

• Width of the central incisor is 0.618, or

approximately 62% width of the lateral incisor.

 Gingival Component
• A feature of smile design that is often overlooked yet very significant is the health,
symmetry, and architecture of the gingival tissues. These tissues frame the teeth and add to
the symmetry of the smile.

 HEALTH, COLOR AND TEXTURE :

• Pale pink, vary in degree of vascularity, epithelial kertinization, and pigmentation, in the

thickness of the epithelium.

• Pointed papillary contour and should fill the interdental spaces to the contact point.

• Firm in consistency and the attached part should be firmly anchored.

• A normal, healthy gingival sulcus should not exceed 3 mm in depth.

• The texture - stippled (orange-peel–like appearance) in most cases. Fine or coarse. Younger

females has more finely textured & finer stippling when compared with that of males.
 Gingival Zenith
• The most apical point of the free gingival margin along the long axis of the
tooth. Their position are dictated by:
• Root form anatomy.
• CEJ.
• Osseous crest, where gingiva is scalloped the most.

Importance of zenith point

o When closing diastemas or changing the mesial or distal tilt position of

the tooth i.e., moving zenith points horizontally.

o In cases where teeth needs to be shown longer or more taper at the

gingival 1/3rd Zenith point can be moved apically.

 Recent Technology in
Smile Designing
Extra oral video camera:
• Record of the patient's face while moving and talking.

• It can record the patient in various moods and gestures

• Computer imaging .
Intraoral video camera:

• Reliability, performance and image quality.

• Smallest details of tooth can be viewed as close as 2mm.

• Pt education & treatment options

• Application with computer imaging system.

T- Scan and Digital Radiography

• Buccolingual width of the jaws as well as the

• Location of anatomic features for placing an implant in the

esthetic position.
CAD/CAM

• To design veneers and crowns to enhance smile while the patient waits.

• “Mock- up" of a planned cosmetic teatment

• Solve potential problems before providing treatment to the patient.

Lasers

• Delicate gum surgery and crown lengthening/ gingivectomy and gingivoplasty.

• Controlled bleeding - dry operating field - excellent visibility - Reduced operating time - reduced post

operative swelling, pain and scarring.

Abrasive Technology

• Jet air stream with micro abrasive particles.

• Stain removal, decay removal.

• Painless & faster.

• Repairing existing composite, ceramics.

 Conclusion

“A well designed smile is a product of consolidated

efforts accomplished by accurate diagnosis,

methodical treatment planning, use of advanced

materials and contemporary techniques rendered

by the skilled dentist”.

THANK YU