Esthetics and Smile Design

Question 1

how symmetrical are central’/ lateral incisors in reality

Answer 1

central; discrepancies of .2mm or less in 63% of the population (14% totally identical)

lateral incisors: differ significantly in size, shape, rotation and length!!!!!!!!!

Question 2

esthetic ideal for profile of face: what are class i, ii, iii

Answer 2

class i: angle from chin to tip of nose is up and away= normal

class ii: convex

class III; concave face (chin sticks out)

Question 3

phonetics; what do M, E, F, V, S sounds result in for teeth positioning

Answer 3

M = teeth at rest

E = maxillary incisal edge should be 1/2 way between upper and lower lip during this sound

F and V= maxillary incisors should touch wet-dry line of lower lip

S sound = lower incisors should be 1 mm below and 1mm behind maxillary incisal edge

Question 4

round vs flat teeth what they do aesthetically

Answer 4

round: feminine, youthfull

flat : masculine, mature

Question 5

what are the facial landmarks to consider for smiel design

Answer 5

facial midline, horizontal restorative plane

Question 6

how much shift in positoning of midline is required to notice? what do we notice?

Answer 6

a dental midline shift of 4 mm IS NOT noitcable to the lay person!!!!
-its easier to detect deviations in dental midline angulation!

Question 7

what is a commissure smile, how common is it?

Answer 7

67% of the population!!

-corners of the mouth are pulled up and outwards followed by the upper lip contracting to show the upper teeth.

Question 8

what is a cuspid smile, what % of population

Answer 8

31% of population!
-levator labii superioris is dominant, exposing the canines first , followed by the corners of the mouth (kinda heart shaped..)

Question 9

what is a complex smile? what % of pop

Answer 9

2% of population!
simultaneously exposing ALL of the upper and lower teeth!!!!
restorative challenge..

Question 10

tissue display percentages : 1. gingiva showing (large amount) on maxilla teeth to molars, 2. just embrasures showing 3. NO gingiva showing on maxillary

Answer 10

1. 32% of population
2. 42% of population
3. 26% of population

Question 11

whats thin biotype? whats an issue with it regarding restorations

Answer 11

probe VISIBLE under gumline

tissue recedes more easily when irritated
-occurs in presence of PGMs or rough/open crown margins!!!

Question 12

whats thick biotype?

Answer 12

thick band of attached gingiva. tissue is more resilient. tendency toward inflammation rather than recession

Question 13

when would veneers be appropraite?

Answer 13

• teeth are RESISTANT to bleaching (whens that?!?!)
• require significant morphologic change (peg lateral)
• have lost extensive tooth structure

Question 14

why should you be cautious about canine veneers

Answer 14

can appear overbulked, causing a dark buccal corridor behind them when smiling

Question 15

what are alternative treatments to veneers?

Answer 15

• composite
• enameloplasty
• orthodontics

Question 16

what records are needed for smile changes

Answer 16

• full photographic series; range of emotions
• high quality impressions
• current shade and patients desired shade
• kois dento facial analyzer for midline & horizontal restorative plane!

(photos, take alginates, mount models, wax up, duplicate cast)

Question 17

wax up for smile design; rules, what should u never do

Answer 17

never take stone away. its additive only. if you must for misaligned teeth, use duplicate models !

Question 18

what should you do after placing the smile design in a patients mouth

Answer 18

• clean excess from gingiva and embrasures with a tree top bur
• polish in the mouth
• show patient in mirror, adjust contour as needed until the patients happy
• if you make adjustments, capture changes with alginate impression (this will become new duplicate cast)

important time to establish what is and what is not possible

record photos with a range of movement/emotion (should be done with AND without try on)