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Cosmetic Dentistry
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There are 10 scientific principles of smile design.
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| Artistic and Scientific Principles of Smile Design in Cosmetic Dentistry |
| 1. |
The Smile Line |
| 2. |
Relative Dental Proportions |
| 3. |
Dominance of Maxillary Central Incisors |
| 4. |
Silhouettes |
| 5. |
Progression of Maxillary Incisal Embrasures |
| 6. |
Progression of Contacts |
| 7. |
Axial Alignment |
| 8. |
Gingival Zenith |
| 9. |
Occlusion |
| 10. |
Colour |
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1. Smile Line |
| The shape of your teeth should follow your Smile Pattern. For a Commissure Smile the convex curve through the six upper anterior teeth should follow the curve of the lower lip. |
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2. Relative Dental Proportion |
| Three measurements must be symmetrical with regard to the top 6 teeth, known as the "social six". Combined width of 2 front teeth should be same length from midpoint to either 3rd tooth cuspid. Front 2 teeth should have combined width to height ratio, Golden in proportions, being 1 in height and 1.6 in width. |
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3. Dominance of the Central Incisors |
| Your two maxillary incisors (2 front teeth) should be symmetrical and their width should be 80% of their height with a perpendicular midline |
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4. Silhouettes |
| The curve of your maxillary incisors (2 front teeth) should match or silhouette the curve of the laterals (teeth beside front teeth). The laterals should silhouette the cuspids (eye-teeth) and so on. |
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5. Progression of Maxillary Incisal Embrasures |
| The embrasures between the maxillary centrals (2 front teeth) should be the smallest with the respective embrasures gradually getting larger to the cuspid (eye-teeth). This creates the illusion of delicate laterals. |
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6. Progression of Contacts |
| The contact points should follow the smile line and silhouette the lower lip. |
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7. Axial Alignments |
| The vertical axis should be perpendicular and begin to angle mesially (toward the centre) from midline to posterior teeth. |
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8. Gingival Zenith |
| When you are smiling we should see no more than 3mm of gum tissue. Also the gum crests between teeth should follow the smile line. |
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9. Occlusion |
| The vertical axis should be perpendicular and begin to angle mesially (toward the centre) from midline to posterior teeth. |
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10. Colour |
| When you are smiling we should see no more than 3mm of gum tissue. Also the gum crests between teeth should follow the smile line. |
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1. The Smile Line
 The first aspect of a patient’s smile that we look at is the smile line. The smile line is essentially the smile pattern. While there are as many different smiles as there are people, they can generally be classified as one of three basic smile patterns: the Commissure smile, the Cuspid smile, or the Complex smile.
The patient is graded on whether their smile line is right for their particular smile pattern. The teeth should mirror the smile pattern of the lips. In other words, the imaginary line created by the teeth should mirror the line of the mouth.
By looking at these three aspects of a smile, we can objectively describe a patient’s smile.
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| 2. Relative Dental Proportions
 The concept behind relative dental proportions is the belief that there is an ideal set of proportions, not only in dentistry, but in nature as a whole. When these ‘golden proportions’ occur, they are found to be naturally and universally pleasing. Applying them to dentistry, the width of the front two teeth together should be double that of the height of these two teeth. The width of the two front teeth, if the proportions are to be considered ideal, should also be the same as the width of the first three teeth to either side of the midline. How closely a patient meets these ideal proportions determines their score for this principle of smile design in the mDAI.
There has been considerable debate as to the validity of these ‘golden proportions’ in the field of dentistry. The ‘golden proportion’ was usually judged using three teeth to each side of the midline. There is however, a compromise position. As a profession it is agreed that the front two teeth should be viewed as a single unit, and as the ideal width to height proportion is 80%, when we look at front two teeth we see that they have a 160% width to height ratio, which is the ‘golden proportion.’ Therefore, there are three areas where the Golden proportion can be applied – to the front two teeth, and the three teeth to either side of the midline. The measurement of these should all be a 1.6 ratio.
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| 3. Dominance of Central Incisors
 Under this principle we look at the width to height proportions of the maxillary central incisors. Ideally, the width should be 75% to 80% of the height of the individual teeth. We also judge how symmetrical they are, and whether the midline runs perpendicular. Finally, we look at whether the incisal edges run parallel to the inter pupillary and the incisal display. The vast majority of the population have incisors between 10 mm and 11.5 mm long. Again, how closely a patient meets these criteria determines their score for this principle of smile design in the mDAI.
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4. Silhouettes
 In looking at a patient’s silhouettes we look to see that the teeth have a consistent curve as they progress into the back of the mouth. Specifically, we look at three measurements:
1. Anterior – distal of central to distal of lateral
2. Posterior – cuspid to premolars and molars
3. Decreasing gradation
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5. Progression of Incisal Embrasures
 After analysing a patient’s silhouettes, we look at the progression of their incisal embrasures. As one of the elements that can make or break a smile, this progression should ideally be a gradual one. |
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| 6. Progression of Contacts
 To grade the progression of contacts, we judge how the upper and lower bites come together.
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7. Axial Alignment
 The pattern of axial alignment should be consistent, starting from the patient’s midline. They don’t necessarily have to be perpendicular, but should run parallel to each other. |
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8. Gingival contour
 Two aspects are examined when we look at a patient’s gingival contour, the GAL and the zenith. When we look at the GAL, we want to see that the lateral incisor is at or below the imaginary line between the height of the gingiva from the maxillary central incisor to the gingiva at the cuspid. The zenith should follow the patterns commonly recognized in texts. |
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9. Occlusion
 When we look for occlusion, we’re looking for any obvious smile irregularities. These can include a loss of vertical dimension, a vaulted narrow palate or an anterior open bite.
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| 10. Colour
 The final principle of smile design looks at the colour of a patient’s teeth from a number of different perspectives. First we look at the colour of the teeth relative to the patient’s overall skin tone. Does it complement their skin tone or contrast it to such an extent that it draws undue attention to the teeth. We also look at whether all of a patient’s teeth are a uniform colour, whether there are large disparities between individual teeth, and whether there is any obvious general discolouration of the teeth in general.
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Daytime Television host Anthony interviews Dr Ed Philips about his method to creating the winning smile for his patients. Dr Philips shows a sample of before and after photos of the smiles he has redone for his patients. |
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