Esthetic

Dentistry

Charles Wakefield, DDS, MAGD, ABGD

Lewisville, Texas

• Central Incisor Proportion

• Golden Proportion

• Midline and Canting of Arches

• Axial Inclination

• Incisal Edge and Lower Lip Alignment

• Gradation and Contact Points

• Arch Form, Buccal Corridors

• Gingival Symmetry, Contour and Zenith

Fundamentals

Incisal Edge Location - First • Incisor has two planes to allow for

lip closure

• Neutral zone – inner vermillion border

• Too far facial – hard to close lip

• Too far lingual – occlusal problem

• Say “F” and “V” sounds – inner

vermillion border

• Confirm with provisional restorations –

communicate with lab

“M” or

“Emma”

3 – 4 mm of incisal edges of

maxillary centrals are displayed

in a youthful female smile

50% – 70% of space between upper

and lower lip occupied by the

maxillary centrals.

“E”

Smile Planning Intercommissure Line

• Youthful Smile: 75% - 100%

of teeth below line

• Older Smile: 40% or less of

teeth below line

Morley

JADA

Aug 1999

Golden Proportion

Axial Inclination

Golden Percentage

“Pleasing proportions for the

anterior segment are

12% : 16% : 22% : 22% : 16% : 12%

for the relative widths.”

Snow, SR

Esthetics

Sept 2006

Midline and Canting of Arches

Axial Inclination

Incisal Edge

Lower Lip Alignment

Gradation

Contact Points

Gingival Symmetry

Face Height Measurements • Midface and Lower Face heights

equal • Maxillary lip length -

- Males: 22 mm - 24 mm - Females: 20 mm - 22 mm

• Altered Passive Eruption • Dentoalveolar Extrusion • Vertical Maxillary Excess

Robbins

UTSA

Smile Planning 50 / 40 / 30 Rule

The progressive decrease in

connector / contact length

between maxillary anterior

teeth as one moves distal to

the midline. Morley, Eubank

JADA

Jan 2001

50 / 40 / 30 Accuracy

“The average apparent contact

length of maxillary anteriors was

49 / 38 / 27, consistent with the

ideal proportions of 50 / 40 / 30.

Raj, V., et al

J Esth and Rest Dent

April 2009

Patients’ Idea of Dental Esthetics

“Tooth color was a major factor with

regard to dental esthetics. Most

patients were interested in improving

appearance through whitening teeth.”

Samorodnitzky-Navah, G.R., et al

JADA

June 2007

Shade Guide Color Stability

“Surface disinfectants cause significant

change in value and chroma after 2 years

of use. Set aside one shade guide to

compare against those in clinical use to

determine when replacement is needed.”

Pohjola, R.M., et al

Quint Intl

September 2007

D Don’t Believe the Lab… “Contamination of the etched, silanated

ceramic with die stone produces the

weakest bond strength. Always re-etch

the ceramic surface with hydrofluoric

acid to recreate the microporous layer

in porcelain free of contaminants.” Kim, T., et al

Calif Dent Assn Jnl

February 2006