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					    Normal Proportions of the Face
• The normal human face
  can be divided into thirds
• Average eye distance is
• Usually people show 2-
  3mm of tooth with
  relaxed lips

Julie Beegan       Source:
                Normal Gingival Contours
• Described as being either thin
  and scalloped, or thick and flatter
  in contour. The contour of the
  gingiva depends on the contour
  of the cementoenamel junction of
  the teeth, the amount of
  embrasure space, and the nature
  of the contact between teeth. The
  gingiva appears prominent over
  the tooth root and may have a
  slightly concave appearance in
  the interproximal area.

   Serio F.G, Hawley C.E, Manual of Clinical Periodontics   A.Tujios
                   Smile Line Analysis
                                      JessicaL. Rainey

• Subjective- patient’s perception of their smile
• Objective- measurements to quantify data
   –  tooth shade
   – distribution of color
   – defects and discoloration of the tooth structure
   – crowding, spacing
   – visible fillings or crowns
   – shape and size of teeth
   – amount of gum tissue shown when smiling
•   Prior to a smile analysis, a thorough exam, including appropriate radiographs, should be
    completed to ensure that more pressing concerns such as decay and infection are not present.
    Depending upon the results of your smile analysis, you may wish to take impressions of the teeth
    to create study models. These models can be used to help plan treatment and create a diagnostic
    wax-up of possible treatment results.
               Smile Analysis con’t
Lip formation
•    the lip may come up high and reveal some of your gum tissue
•    lower lip may be either rounded or straight across What to aim for: No
    excessive gums showing. The lower lip should be rounded. How to get it: The
    height of the gum can be altered.
Edge/line of teeth
•    Edge or line of the teeth goes straight across or is curved.
•    The line of the upper teeth should mimic the line of the lower lip.
•    Teeth can be reshaped to give flattering lines and edges.
Color of teeth
•    Whiter teeth are brighter and more youthful looking.
Broken Teeth
•    Bonding, crowns and veneers can fix decaying and broken teeth.
     Short Lip vs. Hyperactive Lip
•Average length of the
maxillary lip (measured in
repose from subnasale to
its inferior border)
      20-22mm in young
      adult female
      22-24mm in young
      adult male

•Short lip = maxillary lip
fails to achieve the
prescribed norms
               Short lip vs. Hyperactive lip
     • Hyperactive lip –
       excessive gingival display
       when the face height,
       gingival levels, lip length,
       and length of the central
       incisors are all within
       acceptable limits
            – Average translate
              approximately 6-8mm from
              repose to full smile
            – Hyperactive lip translates
              1.5-2x more

Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodont Aesthet Dent 1999; 11(2): 265-272.
               Diagnostic Wax-Up
1. Patient profile (age, sex, oral hygiene
   status, smoker, systemic, etc.)
2. Smile analysis with clinical photos
3. Determine biologic width as well as
   clinical attachment.
4. Study model fabrication
5. Model surgery (determine loss of
   supporting structures and incorporate
   into model)

                                     Gyula Takacs
              Diagnostic Wax-Up
7. Wax to new restorative
   margin with the lower
   incisors being 1mm lingual
   to and 1mm inferior to the
   upper incisors.
8. Make a surgical template to
   aide in the surgery.

                                 Gyula Takacs
                         Diagnostic Wax-Up
Shillingburg, Herbert. Fundamentals of Fixed Prosthodontics, 3rd Edittion.
Quintessence, 1996.

Scutella F, Ladi L, Stellino G, and Morgano S (1999)
Surgical template for crown lengthening: Aclinical report.

Journal of Prosthetic Dentistry. 82(3): 253- 256.

Columbia Dental Review 2000: 5:21-24..

Surgical Crown Lengthening: A 12-Month Clinical Wound Healing Study. J. of
Periodontology. July 2001 (Volume 72, No. 7)

J Can Dent Assoc 2001; 67(10):600-3

                                            Gyula Takacs
                      Evaluation of Patient Desire
        Evaluating the patient’s desire can only be achieved by
   understanding the components which contribute to the esthetics of the
   smile. These components include:

         facial - facial features (nasolabial groove, etc), tooth visibility, lip line,
                    smile line, upper lip curvature, symmetry, negative space
         dental - midline, alignment, arrangement, gradation, shape,
         gingival - morphology, contour, health
         physical - illusion effects of artificial teeth

         Only with a thorough background in the rules of esthetics can a
   detailed evaluation of what the patient desires be achieved. This is
   critical because the patient may be unable to accurately describe their
   own desire. Of course, take pre-op photographs, formulate a treatment
   plan and prepare to moderate the patient’s expectations.

Michael Kim
Ref: CR Rufenacht. Fundamentals of Esthetics. Quintessence. 1990. p.67-132.
 Altered Passive Eruption: Definition
• Altered Passive Eruption is an aberration in normal
  development where a large portion of the anatomic
  crown remains covered by the gingiva

This complicates dentofacial harmony for two dominant
   1. Usually results in a square tooth shape
   2. The excess soft tissue displayed makes a potentially
      medium lipline into a high lipline

Garber, D. A., Salama, M.A. The Aesthetic Smile: Diagnosis and Treatment.
  Periodontology 2000. Vol. 11. 1996. 18-28.        Jonathan Chiang
                        Black Triangles

• Defintion: “Black triangles”
  occur when the interdental
  papilla fails to fill completely
  the interdental space.

• Diagnosis: May exist due to:
  Gingival recession
  Highly tapered triangular
  tooth form
  Previous periodontal surgery
               Black Triangles
• Treatment options:
  Restorative recontouring (crowns, veneers)
  Periodontal surgery- Free gingival graft

                                           Nick Ferri

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