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
Julie Beegan Source: http://www.ppsca.com/dentface.html
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
• 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
• 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.
• 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
22-24mm in young
•Short lip = maxillary lip
fails to achieve the
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
– Average translate
approximately 6-8mm from
repose to full smile
– Hyperactive lip translates
Robbins JW. Differential diagnosis and treatment of excess gingival display. Pract Periodont Aesthet Dent 1999; 11(2): 265-272.
1. Patient profile (age, sex, oral hygiene
status, smoker, systemic, etc.)
2. Smile analysis with clinical photos
3. Determine biologic width as well as
4. Study model fabrication
5. Model surgery (determine loss of
supporting structures and incorporate
7. Wax to new restorative
margin with the lower
incisors being 1mm lingual
to and 1mm inferior to the
8. Make a surgical template to
aide in the surgery.
Shillingburg, Herbert. Fundamentals of Fixed Prosthodontics, 3rd Edittion.
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
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.
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
• Defintion: “Black triangles”
occur when the interdental
papilla fails to fill completely
the interdental space.
• Diagnosis: May exist due to:
Highly tapered triangular
Previous periodontal surgery
• Treatment options:
Restorative recontouring (crowns, veneers)
Periodontal surgery- Free gingival graft