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Operative Dentistry - Best Practices

Smile Analyses: Considerations, Diagnosis and Treatment Planning

(last modified August 8, 2014)

Dental facial esthetics can be defined in different ways:

  • Traditionally, dental and facial esthetics has been defined in terms of macro and micro elements. Macro esthetics encompasses the interrelationships between the face, lips, gingiva, and teeth and the perception that these relationships are pleasing. Micro esthetics involves the esthetics of an individual tooth and the perception that the color and form are pleasing.
  • Historically, accepted smile design concepts and smile parameters help to design esthetic treatments. These specific measurements of form, color, and tooth/esthetic elements aid in transferring smile design information between the dentist, ceramist, and patient. However, esthetics in dentistry can encompass a broad area—known as “the esthetic zone.”
  • Rufenacht delineated smile analysis into facial esthetics, dentofacial esthetics, and dental esthetics, encompassing the macro and micro elements describe above. Further classification identifies five levels of esthetics: facial, oral-facial, oral, dentogingival, and dental.

Part of evaluating dental esthetics for smile design is choosing tooth shapes for patients based on their facial characteristics. Although there are digital smile design services available to dentists for a fee, it is possible to use basic software, such as: Powerpoint, Keynote, Photoshop to create and demonstrate for patients the proposed smile design treatments.

Digital smile design (DSD) is a multi-use conceptual tool that can strengthen diagnostic vision, improve communication, and enhance predictability throughout treatment. DSD allows for careful analysis of the patient’s facial and dental characteristics along with any critical factors that may have been overlooked during clinical, photographic, or diagnostic cast–based evaluation procedures. The drawing of reference lines and shapes over extra- and intraoral digital photographs in a predetermined sequence can widen diagnostic visualization and help the restorative team evaluate the limitations and risk factors of a given case, including asymmetries, disharmonies, and violations of esthetic principles.