An esthetic smile components and Digital smile design . Facial , Dental , Lip and gingival criterias for a balanced smile. by soheil shahbazi , SBMU dental student

1. Digital Smile Design
(DSD)
Soheil shahbazi

2. “Smile is our business card”
Primary Goal is ideal occlusion but esthetics is critical !
Stable masticatory system, where the teeth, tissues, muscles, skeletal
structures and joints all function in harmony
Multidisciplinary approach : orthodontics, orthognathic surgery,
periodontal therapy, cosmetic dentistry and plastic surgery
Be careful ! Trends change
Introduction

3. Types of Smile
• Social : posing for a photograph – static – moderate lip
elevation – reproductive
• Spontaneous : emotional – maximal lip elevation and
depression – maximum tooth display – base of design
• Comissure : people greetings – teeth may be shown or not

5. Depressor anguli oris
Risorius
Zygomaticus major
Zygomaticus minor
Levator labii superioris
Muscles of Smile

6. 1. Levator muscles raise upper lip a little
2. Levator labii superioris, zygomaticus major, and
buccinator muscles raise the lips even more
3. PeriOcular muscles (squinting)
Stages of Smile

7. Shapes of Smile
Straight Curved Elliptical Bow-shaped Rectangular Inverted

8. Smile Line
Imaginary line along the incisal
edges of the maxillary anterior
teeth which should mimic the
curvature of the superior border of
the lower lip while social smiling
(Consonant
Flat : the incisal edges of teeth in
the esthetic zone are nearly at the
same level
Non-Consonant : centrals appear
shorter than the cuspids
The most important factor of
dental esthetics !

10. The more arched , the younger the
smile looks (flattening in aging )
Convex smile arcs are more suitable
for women whereas convex or plane
arcs are acceptable for men
Clockwise maxillary rotation leads
to greater incisor exposure . As a
result, convex smile arcs are more
easily found
The broader the archform, the
greater the likelihood of a flat smile
arc
Smile Line

12. • Low : incisal 1/3 to 1/2 of the teeth
• Medium : Entire teeth and 1-2 mm of gingiva
• High : Gummy smile
Smile Line

14. a smile that is at least
half the width of the
face, at lower 1/3
level of the face, is
considered esthetic
Width of Smile

15. Vertical contact interface
between two maxillary centrals
Perpendicular to the incisal
plane
Drop straight down from the
papilla
Dental
Component
Midline

16. Maxillary and mandibular midlines do not coincide in 75% of cases.
midline deviations not greater than 3-4 mm are not identified by laypeople
Canted midline would be more
obvious, and therefore, less
acceptable
Minor discrepancies (2mm) between facial
and dental midlines are acceptable and, in
many instances, not noticeable
Midline

17. Philtrum is the most accurate guide (except in surgery , accicdent , cleft and …)
Philtrum should match the papilla between the centrals. If these two structures
match and the midline is incorrect, then the problem is usually incisal
inclination. If the papilla and philturm do not match, then the problem is a true
midline deviation.
Midline

18. The nearer the midline, the greater the need for
symmetry, and the further from the midline, the
higher the number of slight asymmetries clinically
acceptable

19. All midline diastemas must be closed
the greater the diastema and the nearer the midline,
the more unesthetic the smile is. The only exception
was for 0.5-mm diastemas in the distal surface of
lateral incisors, which were not identified by
laypeople
Diastema

20. 2-4 mm of the incisal third of the
maxillary central incisor should
be visible in a young individual
The average incisal display of
the maxillary centrals for males
is 1.91 mm and the average for
females is 3.40 mm
Dental
Component
Tooth Display
Relaxed

21. In a youthful smile, approximately 75 percent to 100
percent of the maxillary teeth would show below
intercommisural line
Maxillary anterior teeth should fill between 75 percent to
100 percent of the space between lips to create a
youthful look
Tooth Display
Smile

22. • Maxillary central incisors clinical crowns W/H ratio must be 75 to 85%
• Centrals must be the DOMINANT teeth in the smile
• Values tend towards 75%, will have a longer pattern widely accepted by
women, whereas in 85% ratios, incisors will have a wider pattern widely
accepted by men
• Canine ratio should be similar to incisor
• The step between maxillary central and lateral should be 0.5-1.5mm
from facial view
Anterior Teeth Specifications

24. Basic shape of the anterior teeth is the inverted frontal view of the face
Central incisor length is approximately one sixteenth of the facial height
Static symmetry in Centrals , Dynamic symmetry in others
In orther to increase tooth height in the event of proclined incisors (decreased
interincisal angle), extrusion is inhibited because retroclination will solve the problem
Edge line of central incisors must be parallel to the interpupillary line.
Anterior Teeth Specifications

26. S soundF & V soundE soundM sound
Anterior Teeth Specifications
Phonetics
Rest position
2-4 mm display
Incisal edge
halfway
between lips
Maximum
extension of lips
labiolingual
position and
length of the
maxillary teeth
mandibular central
incisors are
positioned 1 mm
behind and 1 mm
below the
maxillary incisal
edge

28. Golden proportion : When viewed from the facial, the
width of each anterior tooth is 62% of the width of the
adjacent tooth
Recurring esthetic dental (RED) proportion : The
successive width proportion when viewed from the
facial aspect should remain constant as we move
posteriorly
Anterior Teeth Specifications
Proportions

30. Buccal Corridor
• The space from the mesial line angle of maxillary first
premolar to the commissure of the lip
• width of the negative space is in golden proportion to
one-half of the width of the anterior segment
• the ideal BC width was 13% of the total width between the
two commissures

32. The buccal corridor should not be
completely eliminated because it
gives depth to the smile
BC is in relationship with arch
tranvsverse dimensions
BC can be reduced by uprighting
posterior teeth
It is not necessary to increase
narrow BC but wide BC should be
decreased
Dental
Component
Buccal Corridor

33. The environment light affects buccal corridor
Negative space is often accentuated when smile makeover is limited to the
maxillary six anterior teeth and the hue and value of newly restored teeth do
not blend with the untreated teeth .
Buccal Corridor

35. DVR
In patients who have square arch form and wide lip extension, tooth reveal
behind the canines can be in shadow or disappear completely.This
condition has been called deficient vestibular reveal

36. Axial Inclination
In frontal view , From the central to the canine, there
should be natural, progressive increase . The axial
inclination of the posterior teeth is similar to canine.

37. Contact Area
• The zone in which two adjacent teeth appear to touch
• It follows the 50:40:30 rule in reference to the maxillary
central incisor
• The increasing ICA helps to create the illusion of longer teeth
by wider and also extend apically to eliminate black triangles

39. • Most incisal point of contact area
• The contact points in their apical progression should mimic the smile line
Contact Point

40. progressive increase in size from
the central to the canine
Failure to provide will lead to
uniform teeth and box like
appearance
Dental
Component
Incisal Embrasures

41. Value(most critical) : middle > cervical > incisal
Gingival third has the richest chroma.
The chroma should also increase
from central to the canine
The goal is to have the color of the teeth the
same as the color of the sclera of the eye
Color

42. Basic Shapes of the face : square –
Tapering – Square tapering – Ovoid
Lateral Profile : straight – convex –
concave
Use Nasion and cupid’s bow for midline
tracing
The interpupillary line should be
perpendicular to the Facial midline and
parallel to the occlusal plane
Width of the face should be 5 eyes and
height of the face is divided into 3
equal parts
Facial
Component

43. complete state of health prior to
the initiation of any treatment
Inflammation & blunted papillae
decreases esthetic
The gingival height of the centrals
should be symmetrical(up to 2mm
unnoticed). It can also match that
of the canines. The gingival margin
of the lateral incisor is 0.5–2.0 mm
below .
White esthetics or Pink esthetics?
Gingival
Component

44. The gingival margin of central incisors is below
canines (0.5 - 1.0 mm) and the gingival margin of
lateral incisors is below central incisors (0.5 mm)
Modified Ginigval Design

46. Gingival Disharmony Treatment
ExtrusionIntrusionPeriodontal
intruding maxillary incisors so as to minimize gingival exposure in cases of normal
smile arc?

47. The gingival architecture of the central incisor teeth should
mirror one another
Maxillary lateral incisors and the mandibular incisors should
display a semicircular shape. The maxillary central incisors and
canines display a more elliptical gingival shape
Gingival Component

49. If the most apical point of the restoration is 5 mm or less from the crest of the bone,
then black triangles will be avoided. As this distance increases for every 1 mm >5 mm,
the chances of achieving complete fill is progressively reduced by 50%.
Cervical embrasure

50. Zenith Points
• Most apical position of the gingival margin
• This most apical point is located distal to the long axis on
the maxillary centrals and cuspids The zenith point of the
maxillary laterals and the mandibular incisors is coincident
with the long axis of these teeth

51. Frame of smile
Upper Lip Curvature : straight –
upward – downward
Retroclination of inscisors may
cause low lip volume
Upper lip length varies from 10 to
36 mm
Lip
Component

53. Technology has overpowered almost all our everyday chores. Almost
everything is a click away. So why not dentistry?
what will be the result of their treatment before even starting it?
a skeptical patient turn into a more philosophical
Through the use of videos, photographs, and temporary mock-ups
DSD

55. Evolution of DSD
By pen on
photograph
Digital 2D
drawing on
digital
photographs
Linked 2D
digital design to
3D waxup
Added motion
3D design
linked to 3D
waxup

56. Photography
Videos
DSLR/smartphone
Software
Intraoral scanner
Requirements

57. • Esthetic diagnosis
• Communication : with patient , Interdisciplinary , with Lab
• Feedback
• Patient management
• Education
• Marketing tool
 Expensive
 Requires training
DSD
Advantages and Disadvantages

58. Frontal view
• Full face with a wide smile and teeth apart
• Full face at rest
• Retracted view of maxillary arch with teeth apart
Profile view
• Rest
• Full smile
12 O, clock view with a wide smile
An intra occlusal view of maxillary arch
Protocol for
Photography

60. 1. A facial frontal video with retractor and without retractor smiling
2. A facial profile video with lips at rest and wide E smile
3. A 12 O'clock video,
4. An anterior occlusal video to record maxillary teeth
5. Four complementary videos should also be taken for facial, phonetic, functional
and structural analysis
Protocol for
Videography

61. Disadvantages of Videography
Lower quality of screenshots
Needs more storage
Needs specific knowledge

62. • Cerec
• Keynote
• Microsoft Powerpoint
• DSD by Dr Coachman
• Planmeca romnexis
• Visagi smile
• Photoshop C6
• Smile designer pro
Software criterias
To have needed parameters
Userfriendly
Case documentation
Cost time efficiency
Compatible with CAD/CAM
DSD Softwares

63. • Case selection : high esthetic needs …
• Capture pictures
• Make videos
• Upload shots to software
• Draw basic lines
• Calibration
• Proportion analysis
Steps of DSD

64. • Shape & size of the teeth template
• Show digital mock-up
• Temporaries
• Video with temporaries
Steps of DSD

65. “Beauty is in the eye of the beholder”
Achieving the ideal smile requires that the clinician combine the
scientific esthetic principles with artistic creativity to match the
individual personality
There is no universal “ideal” smile. The most important esthetic goal in
orthodontics is to achieve a “balanced” smile
Final Words

66. References:
Perception of Smile Esthetics by Orthodontists and Laypersons: Full Face and A Localized View of The
Social and Spontaneous Smiles
Peak into the Future – with Digital Smile Designing (DSD)
Principles of smile design
Benefits of Digital Smile Design (DSD) in the conception of a complex orthodontic treatment plan: A case report-proof of
concept
Smile Design Nicholas C. Davis
Smile Characteristics in Orthodontics: A Concept Review
Digital Smile Design-An innovative tool in aesthetic dentistry Zeba Jafria,
10 commandments of smile esthetics Andre Wilson Machado1
Macroesthetic elements of smile design JEFF MORLEY
Smile Attractiveness: Differences among the Perceptions of Dental Professionals and Laypersons
Perception of Buccal Corridor Space on Smile Aesthetics among Specialty Dentist and Layperson
Perception of Laypeople and Dental Professionals of Smile Esthetics
Dental Smile Esthetics: The Assessment and Creation of the Ideal Smile Pratik K. Sharma
Smile Analysis and Design in the Digital Era MARC B. ACKERMAN

67. Thanks!