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Evaluation of Dentolabial
Parameters As Part
of a Comprehensive
Esthetic Analysis
Mauro Fradeani, MD, DDS
Visiting Associate Professor, Department of Prosthodontics,
School of Dentistry, Louisiana State University, New Orleans;
and Private Practice, Pesaro and Milan, Italy

Correspondence to: Dr Mauro Fradeani

Corso XI Settembre, 92, 61100 Pesaro, Italy; fax: 39 0721 32796; e-mail: maurofradeani@netco.it.

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Abstract
Analysis of the facial features and lip move-
ments in relation to teeth, achieved by eval-
uating the facial, dentolabial, and phonetic
parameters, should be the first step in pros-
thetic rehabilitation. This article focuses on
dentolabial analysis, presenting a system-
atic approach to evaluating the relationship
between the teeth and the lips and lower
third of the face. The parameters evaluated
include tooth exposure, incisal edge posi-
tion, smile width, labial corridor, interincisal
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line vs midline, and occlusal plane vs com-
missural line. Here two parameters of dento-
labial analysis are explored in depth: incisal
edge position (with regard to both incisal
curve and incisal profile) and orientation of
the incisal plane, which is a portion of the
occlusal plane. Methods for identifying both
parameters are outlined, and their role in
the achieving successful esthetic results in
prosthetic treatment is discussed.
(Eur J Esthet Dent 2006;1:62–69.)

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Dentolabial analysis
There are some basic, universally recog-
nized principles that govern our ideas about
what is considered attractive. An expressive
smile is a highly salient form of nonverbal
communication, and possessing a smile
that leaves a pleasing impression is natural-
ly quite desirable. It is the clinician’s task to
balance the patient’s esthetic needs with
functional requirements, while maintaining
the individual characteristics unique to each
patient. Advances in technology and bioma-
terials have dramatically expanded the pos-
sibilities for esthetic optimization in restora-
tive dentistry.
Too often, however, such treatment focus-
es exclusively on the dental area and fails
to consider the overall facial composition.
An evaluation of the patient’s expectations
and understanding of the possible thera-
peutic solutions is crucial before embark-
ing upon any treatment plan.
Analysis of the facial features and lip
movements in relation to the teeth, achieved
by evaluating the facial, dentolabial, and
phonetic parameters, is an indispensable
1–4
first step in prosthetic rehabilitation.
Consideration of the dental and gingival
aspects complete the esthetic analysis,
providing the treating clinician with the in-
formation needed to make the most appro-
priate treatment choices in each individual
case. Careful evaluation of these parame-
ters allows clinicians, by means of a prac-
tical and rational approach, to improve the
quality of their work, helping them to create
restorations that are harmonious not only
with the smile, but also with the rest of the
patient’s face. To this end, the creation of a
suitable esthetic checklist that includes fa-
cial, dentolabial, phonetic, tooth, and gingi-
val analyses is invaluable for optimizing the
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esthetic appearance of the prosthetic re-
habilitation.
Before focusing attention on the teeth, it
is necessary to evaluate the facial compo-
sition. Frontal and lateral examination of
the subject, including analysis of the posi-
tion of the eyes, nose, chin, and lips, allows
identification of the reference points and
lines that are indispensable for orienting
the occlusal plane and the gingival outline
in esthetic rehabilitation.
Dentolabial analysis focuses attention on
the lower third of the face. The face and lips
together form a dynamic frame for the teeth,
with tooth exposure constantly changing
during speaking and smiling. A systematic
approach to dentolabial analysis evaluating
specific parameters (outlined in the box on
the next page) allows for an exhaustive as-
sessment that will help the clinician to
achieve good esthetic integration of the
prosthetic rehabilitation. This article will fo-
cus on two parameters: incisal edge posi-
tion and the orientation of the incisal plane,
which is a portion of the occlusal plane.
Incisal edge position
Identification of the position of the incisal
edge, in both the apicocoronal (incisal
curve) and anteroposterior (incisal profile)
directions, is a fundamental part of the es-
thetic diagnosis. Its location significantly af-
fects many of the procedural restorative
decisions that the clinician and the dental
technician will make; therefore, it is highly
important that it is done with accuracy.
Table 1 lists considerations for the analysis
of the incisal edge position; this article will
focus on just a few of these parameters.
Ideally, the incisal crest, when observed
from the front, has a convex curve that
follows the natural concavity of the lower
lip during smiling (Fig 1). A convex incisal
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Table 1 Analysis of incisal edge position

Type of analysis Parameter Objective

Dentolabial Exposure of maxillary teeth Reestablish a minimum exposure of 1 to 5 mm

at rest of the maxillary teeth, depending on age and sex

Incisal curve Reestablish an incisal curve that is parallel

with the lower lip

Phonetic S sound Limit the modification to the tooth position in the

buccolingual direction in the case of horizontal
mandibular movement

F and V sounds Position the incisal profile inside the vermilion border
of the lower lip

Tooth Overjet/overbite Restore an adequate amount of overjet/overbite

to allow disclusion of the posterior teeth through
correct incisal canine guidance

curve that closely follows the shape of the Parameters to examine during dentolabial
lower lip produces a radiating symmetry 5 analysis
that is increasingly evident the more dom- • Tooth exposure at rest
inant the central incisors are in relation to • Incisal edge position

the laterals. Radiating symmetry creates a • Smile width

• Labial corridor
pleasing smile and is normally found in
• Interincisal line vs facial midline
young people.
• Occlusal plane vs commissural line
Sometimes, abrasion of the incisal edges
can lead to a flat or even a reverse incisal
curve, producing unpleasant effects from
an esthetic point of view (Figs 2 to 4). These
effects include a negative anterior space,
created by the discrepancy between the
incisal plane and the curvature of the low-
er lip, and the reduction—or in some cases
even the disappearance—of the interincisal
angles, which are a significant factor in the
appearance of the smile.1

Fig 1 The incisal curve is normally convex, following

the concavity of the lower lip and producing a radiat-
ing symmetry.

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Fig 2 Abrasion of the incisal edge has produced a
reverse incisal curve with an unpleasing appearance.
Orientation of the incisal plane
In prosthetic rehabilitation, the occlusal
plane represents an important craniofacial
6,7
point of reference, the orientation of which
is fundamental for developing correct func-
tion and achieving ideal esthetics.8 It is es-
tablished by the incisal surfaces of the
anterior teeth and the occlusal surfaces of
9
the posterior teeth.
The incisal plane is the anterior portion of
the occlusal plane. When viewed from the
front, it should be parallel to the horizontal
reference lines, such as the interpupillary
line and the commissural line, to maintain
1–10
natural facial harmony. Overlooking this
parallelism during the esthetic facial exam-
ination is currently one of the most com-
mon diagnostic errors in dentistry. Some
11
investigators have found that a lateral in-
clination of the occlusal plane is immedi-
ately noticeable from the front, even by lay
observers; however, others12 have found a
lesser ability to recognize this inclination.
A marked lack of parallelism between
the occlusal plane, the commissural line,
and the interpupillary line can have differ-
ent etiologies; the particular cause must be
identified in each individual case. In some
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Fig 3 The reduced length also has produced a de-
crease in the overlap of the maxillary teeth over the
mandibular teeth, especially on the left side.
cases, the problem can be resolved using
orthognathic therapy, often in combination
with orthodontic treatment.13,14 In the case of
prosthetic rehabilitation, discrepancies be-
tween the occlusal plane and the other hor-
izontal reference lines can be corrected by
a variety of clinical approaches, which can
be adapted to the individual patient needs.
Prosthetic applications
and considerations
The ideal esthetic treatment involves re-
establishing an incisal curve that is in har-
mony with the concavity of the lower lip by
restoring adequate tooth shape and pro-
portion. An increasing number of patients
wish to rejuvenate their appearance5 and
therefore request teeth that are more
prominent. Whenever possible, the clini-
cian should test a new tooth length intra-
orally, either by means of an in-office rapid
composite mockup (Figs 5 to 9) or with an
indirect acrylic mockup, fabricated by the
laboratory. The in-office method is more
time- and cost-efficient, but either technique
can be used to simulate an increase in den-
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Fig 4 The lack of anterior guidance (due to the re- Fig 5 A composite mock-up was performed to ide-
duced maxillary incisal length) determines contact in alize tooth lengths and proportions. During the same
the molar areas during protrusive movements. appointment, selective grinding was performed in cen-
tric relation to ensure adequate occlusal stability.

Fig 6 From the frontal view, the incisal edge now has Fig 7 Adequate posterior disclusion is achieved dur-
a convex shape and follows the curve of the lower lip. ing excursive movements.

Fig 8 An alginate impression of the mock-up was Fig 9 A transparent stent was fabricated based on the
taken so that the ideal incisal edge position could be waxup to guide the clinician during tooth preparation.
communicated to the technician, who could then repli-
cate it in the provisional restorations.

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Figs 10 and 11 Six anterior veneers were fabricated to finalize the case. (Ceramist: Mr Giancarlo Barducci.)

Fig 12 The new tooth lengths and proportions now Fig 13 The incisal edge is in harmony with the low-
appear adequate. er lip.

tal volume without damaging the teeth. A

Fig 14 The frontal intraoral view of the final result
shows satisfactory esthetic, functional, and biologic in-
tegration of the restorations.
mockup is highly useful as a preview of es-
thetic results before any irreversible clinical
procedures are initiated, and also as a
method for evaluating phonetics and the
suitability of the anterior guidance. Phonet-
ic tests are a reliable aid in evaluating and
establishing the incisal edge position. Dur-
ing pronunciation of the F/V sounds, for ex-
ample, the maxillary incisal edge and the
lower lip should touch slightly, and, from the
incisal profile, the incisal margins of the
restorations should be positioned within the
vermillion border of the lower lip.

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When the final prosthetic rehabilitation
(Figs 10 and 11) has been created, it can
be considered to be well integrated when
(1) the occlusal plane is correctly correlat-
ed with the interpupillary and commissur-
al lines (from both the profile and frontal
views) and (2) the incisal curve is in har-
mony with the lower lip (Figs 12 to 14). This
is important not only for esthetic but also
for functional purposes, eg, the reestab-
lishment of appropriate anterior guidance
16
to allow disclusion of the posterior teeth.
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ysis before focusing on the teeth in order to
effectively determine what modifications are
necessary during the treatment planning
phase. The incisal edge position and the ori-
entation of the incisal plane play vital roles
in a successful prosthetic rehabilitation and
therefore are among the parameters that
should be carefully evaluated. Finally, it
must be remembered that to achieve a
predictable satisfactory esthetic result, the
accurate transfer of all information gathered
from the esthetic-functional analysis to the
laboratory is of utmost importance.

Conclusion
Acknowledgments
It is essential that the clinician concentrate Special thanks to dental ceramist Giancarlo Barducci,
on a meticulous facial and dentolabial anal- who fabricated the restorations shown in this article.

Se puede lograr en un paciente adulto corregir por medio del tto

protesico su habla? o eso solo le corresponde al fonoaudiologo?

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