Proportional Smile Design

Daniel H Ward DDS

1080 Polaris Pkwy Ste 130
Columbus OH 43240
614-430-8990
dward@columbus.rr.com

Incisal Placement
 Incisal plane parallel to the interpupillary line

 Vertical midline in the center of the face perpendicular to the interpupillary

line centered with the philtrum

 Determinants of incisal edge position

1. esthetics
2. phonetics:”f, v, th” (Pound)
3. anterior guidance/occlusion
 Incisal edges follow curvature of the lower lip

 Clinical crown outlined by upper and lower lip, marginal gingiva display
confined to interdental papilla

 Curve of Spee
Tooth Positions & Relationships (Rufenacht, Morley)
 Roots of anterior teeth diverge apically as you move distally

 Incisal embrasures become larger as you move distally

 Contact points move apically and incisal embrasures become larger as

you move distally

 Connector area

 Incisal and cervical length of lateral incisors may be slightly shorter than
central incisors and cuspids
 Cervical of central incisors and cuspids are parallel
  Buccal Corridor
1. Visual area of buccal surfaces of posterior teeth
2. Ideally space is visually filled in
3. “Negative space” is when visual area contains vacancies between
buccal surfaces of teeth and buccal mucosa

 Apical Zenith distal to midline of long axis of the tooth (feminine lateral
incisor may be at midline) (Chu, Morley)

Individual Max Tooth Characteristics (Frush & Fisher, Lombardi, Morley)

SPA Factor-(sex=lateral incisor, personality=cuspid, age=central incisor)
Central Incisors-mirror images-dominance

Lateral Incisors-variations-gender-shorter than central incisors 0.5-1mm

Cuspids- aggressiveness
Teeth May Mimic Inverted Face Form (Williams, Leon)

Aging of a Smile (Gurel, Vig & Brundo)

 Flattened Incisal edges
 Smaller incisal embrasures
 Smoother facial anatomy
 Prominent mandibular display
 Increased chroma
 Anterior Splaying

Common Facial Proportions

 Rule of Fifths

 Rule of Thirds
Tooth Proportions
 Width of anterior six teeth in golden proportion to intercommisural width

 Central Incisor is 1/16 the width of inter-zygomatic width (House)

 Central Incisor is 1/16 the length from ideal hairline to the chin(House)

 Dentsply Tooth Size Indicator-

Smile Design Tooth Width Proportion Theories
 Golden Proportion (Levin)

 Golden Mean (Snow)

 Naturally occurring (Preston)

 RED Proportion (Ward)

  Width/Height Ratio of Central Incisor (Sterrett, Wolfart)

Relationship of tooth length and RED Proportion (Rosenstiel, Ward, Rashid)

 75-78% w/h ratio of maxillary central incisor preferred by dentists
 Normal length teeth-70% RED
 Very tall teeth-62% RED (Golden Proportion)
 Very short & short teeth-80% RED

• Taller teeth gives more dominant Central Incisor

• Patient preferences (Carlssan Jørnung, Ker, Rosenstiel, Wagner Wolfart)

 Using RED Proportion to determine size of maxillary anterior teeth(Ward)
 Step 1 Determine Relative Tooth height (Very tall, Tall, Normal, Short,
Very Short)
 Step 2 Measure facial view Intercanine Width (ICW)

 Step 3 Divide ICW by appropriate tooth height column divisor

(After determining Central Incisor width multiple times appropriate RED
proportion)

Calculating RED & anterior total widths from inter-canine width(ICW)-Divisors

Tooth Height RED Central Incisor Width Lateral Incisor Width Canine Width
Very Tall 62% RED ICW/ 4.0 CIW *.62 LIW *.62
Tall 66% RED ICW/ 4.2 CIW *.66 LIW *.66
Average 70% RED ICW/ 4.4 CIW *.7 LIW *.7
Short 75% RED ICW/4.6 CIW *.75 LIW *.75
Very Short 80% RED ICW/4.8 CIW *.8 LIW *.8

 Step 4 Divide CIW by 0.78 (78%) for CIL

 Simplified Method Using ICW & CIL to determine size of maxillary anterior
teeth maintaining incisal length(Ward)
 Step 1 Measure frontal view Intercanine width (ICW) and Central
Incisor Length (ICL)

 Step 2 Divide (ICW) by Central Incisor Length (ICL) to obtain quotient

 Step 3 Lookup quotient in chart for appropriate divisors to divide
ICW by to obtain appropriate facial widths

Calculating RED & Individual tooth widths from ICW& CIH-Divisor chart
ICW/CIL=Quotient RED Central Incisor Width Lateral Incisor Width Canine Width
3.1 62% RED ICW/ 4.00 ICW/6.47 ICW/10.43
3.2 65% RED ICW/4.15 ICW/6.38 ICW/9.81
3.3 67% RED ICW/ 4.24 ICW/6.33 ICW/9.44
3.4 70% RED ICW/4.38 ICW/6.26 ICW/8.94
3.5 73% RED ICW/4.53 ICW/6.20 ICW/8.49
3.6 75% RED ICW/4.63 ICW/6.17 ICW/8.22
3.7 78% RED ICW/4.78 ICW/ 6.12 ICW/7.85
3.8 80% RED ICW/4.88 ICW/6.10 ICW/7.63

 Step 4 Divide CIW by 0.78 (78%) for CIL

 Simplified Method Using ICW & desired CIL to determine size of maxillary
central incisor & RED Proportion(Ward)
 Step 1 Measure frontal view Intercanine width (ICW)

 Step 2 Determine desired Central Incisor Length (DCIL)

 Step 3 Divide (ICW) by desired Central Incisor Length (ICL) to obtain
quotient
 Step 4 Lookup quotient in chart for appropriate divisors to divide
ICW by to obtain central incisor facial width and appropriate RED
Proportion

RED proportion for desired central incisor

length
ICW/DCIL=Quotient Tooth Height RED Proportion Central Incisor Width
3.1 Very Tall 62% RED ICW/4
3.25 Tall 66% RED ICW/4.2
3.4 Normal 70% RED ICW/4.4
3.6 Short 75% RED ICW/4.6
3.8 Very Short 80% RED ICW/4.8
Esthetic Periodontal Surgery(Gargiulo, Wentz & Orban, Kois)
 Adding length to Central Incisor allows a smaller RED Proportion

 Methods to gain length

 Biological Width-1mm sulcus, 1mm epithelial attachment, 1mm ct

 FGM 3mm coronal to osseous crest

 Communication with periodontist
1. Guide Incisal Edge
2. Desired length from guide incisal edge to free gingival margin
3. Teeth to be treated
 FACIAL SMILE EVALUATION

Name__________________________________________________________________
Date___________
Do you like your smile? Yes No
What would you like to change about your smile? _______________________________

________________________________________________________________________Would
you prefer?
Ideal Perfect Smile Natural Smile with individuality
10 9 8 7 6 5 4 3 2 1
How do you like the color of your teeth?_______________________________________

What shade would you like them to be? _______________________________________

Alignment-Draw lines

Cant Midline

Smile Curve Vertical Incisal Edge

Draw outlines

Gingival Heights Incisal Heights

Circle appropriate display

Inadequate Incisal Display Ideal Incisal Display Covered Incisal Edges

Filled Buccal Corridor Dark Buccal Corridor Excess Gingiva

Circle areas

Black Triangles

Major Areas of Concern____________________________________________________

________________________________________________________________________

Teeth to be Treated________________________________________________________

Periodontal Concerns______________________________________________________

________________________________________________________________________

Referrals Needed__________________________________________________________
 BLUEPRINT WORKSHEET
Patient_______________________________________
Cast Length Central Incisor ________mm

Photo Length Central Incisor ________mm

Ratio Cast length = ----------- (Conversion factor)

Photo Length
Pre Treatment
Photo Measurements
5 6 7 8 9 10 11 12
Width
Length

Converted Cast Measurements

(Photo measurements X Conversion Factor)
Conversion 5 6 7 8 9 10 11 12
Factor =
Width
Length

8 9
Width/Length Ratio

5/6 6/7 7/8 8/9 10/9 11/10 12/11

RED Proportion

Desired Post-Treatment(Cast Measurements)

5 6 7 8 9 10 11 12
Width
Length

Converted Photo Measurements

(Cast measurements/Conversion Factor)
Conversion 5 6 7 8 9 10 11 12
Factor =
Width
Length