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ESTHETIC CHECKLIST
Smile Form
1. PHYSICAL DIMENSION & SYMMETRY
size of one tooth to another
size in relation to face and mouth
size incisal edges overall and individual
arch position, shape and size
perspective
midline
Tooth Structure
2. LONG AXIS
mesial, straight, distal
lingual,
facial
3. INCISAL EDGE
perpendicular or slanted to long axis
characterized,
developmental youthful) or straight
4.
SURFACE CONTOURS
concave, convex, flat
5.
LINE ANGLES
placement of
transition distal-(facial)-mesial
6.
CONTACT AREAS
placement
broad, point
7.
EMBRASURE FORM (SILHOUETTE)
gingival,
incisal, lingual, facial
8.
HEIGHT OF CONTOUR
9.
SURFACE TEXTURE
general -
smooth, textured
characterization - lines, dimples, grooves
10.
TISSUE CONTOURS
for tipped, rotated, straight emergence profiles
COLOR
1.
BASE COLOR
2.
INTERPROXIMAL COLOR
3.
GINGIVAL 1/3 AND ROOT COLOR
4.
INCISAL EDGE
S.
CHARACTERIZATION
hypocalcification cemental-enamel junction developmental grooves
craze lines white
mottling
translucent incisal
tetracycline stain enamel cracks
stains
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Composite bonding and esthetic recontouring produce a nice smile. Composite diastema closure is performed on the mesial of the central incisors combined with esthetic recontouring of the distal embrasures and line angles. Composite is bonded to the mesial of the lateral incisors to form and improved silhouettes and faces of these teeth. Short broad teeth are proportionate to her broad smile.
ESTHETIC CHECKLIST
Aesthetic
dentistry is an art form which requires artistic ability. Artistic ability comes
naturally to some dentists while others must work hard to achieve it. In
addition, dentists with or without natural artistic abilities can have problems.
For dentists or support groups who lack artistic ability, analysis based on
anatomic criteria becomes important.
The
Esthetic CheckList is an organized method to analyze aesthetic results, define
terms and structure standards. It allows self analysis and improved
communication with both patients and support staff on a point by point system. A
knowledge of normal dental anatomy and how that anatomy may vary is critical to
success.
The
Aesthetic Check List is divided into two major categories:
SHAPE AND COLOR
Shape
includes both smile form and individual tooth structure. While individual teeth
require analysis, analysis of smile form may be necessary in more extensive
restorative cases.
SMILE
FORM
Smile
form sets standards for the relationship of the teeth to the facial form, lip
shape and mouth form. It includes
1.
GENERAL SIZE OF TEETH
Tooth
size is relative to face size and other teeth. Visual inspection and a rule of individual teeth
being one sixteenth the dimensions of the face is a good starting point.
2.
RELATIVE SIZE OF TEETH TO EACH OTHER
Average crown dimensions are
tooth
#
1 2
3
4 5
6 7
8
width
(mm) 8.6
9.2 10.7
6.8 7.2 7.6
6.4 9.0
length
6.3
7.2
7.7 7.5 8.2
9.5 8.8
10.0
tooth
#
17 18
19 20
21 22
23 24
width
(mm) 10.7 10.7
11.2 7.1 6.9
6.9 5.9
5.4
length
6.7
6.9
7.7 7.9
7.8 10.3 9.6
8.8
Establishing
proper curvature of the overall incisal line of the maxillary teeth follows the
lower lip lines. Central incisors are the lowest point of
the curve and each tooth gets a little shorter except for the cuspids. The
cuspids get shorter only in the "Hollywood Smile".
The
relation of incisal edges from tooth to tooth will vary primarily with age.
A
young smile has prominent centrals incisors. They appear longer in length and
often slightly more anterior in the mouth many times due to the laterals not
being completely erupted. There is very little incisal abrasion.
A
middle aged smile shows fully erupted teeth which exhibit a more even line of
incisal edges. There is often slight wear and rotation.
An
older smile exhibits pronounced incisal wear and drifting of the teeth.
4. POSITION, SHAPE AND SIZE OF THE ARCHES
The
position and size of one jaw in relation to the other may determine tooth
placement, tooth size and factors such as space management with use of
overlapping or diastemas.
The
shape. of arches can be. square, square tapering, tapering and ovoid.
The
square arch form gives a broad, straight line smile from cuspid to cuspid. There
tends to be very little overlapping, crowding or labial tipping.
The
tapering arch is narrow from cuspid to cuspid with the centrals being quite
anterior to the cuspids. A decrease in space usually means there is considerable
overlapping and crowding.
The
square tapering arch combines both square and tapering arch characteristics.
There is little crowding and overlapping of teeth. The incisors show their full
labial surfaces but the cuspids tend to have more distal rotation sometimes
referred to as turning the corner.
The
ovoid arch resembles the tapering arch form but is wider from cuspid to cuspid
forming an arc around the ridge.
The arch can vary in the anterior section or posterior areas separately. Factors such as tongue thrust or crossbite can influence development.
5.
PERSPECTIVE
Teeth
look larger in the anterior and appear smaller posteriorly creating
perspective. In addition, it is
desirable to have space between maxillary teeth and the lower lip continuing
back to the corners of the mouth ideally 1 to 3 millimeters. If teeth do
not flair into the corners of the
Center
teeth to the overall face form
TOOTH
STRUCTURE
Tooth
structure refers to overall and detailed shape of each teeth. These standards are
established as averages and altered in
particular instances.
1.
LONG AXIS
The
long axis of a tooth can have a mesial, straight, distal, lingual facial tilt. The long axis
varies from normal to accommodate
inadequate space, arch form or to match existing symmetry.
The maxillary incisors normally have mesial labial tilt and cuspids have pronounced lingual tilt with the gingival third appearing prominent.
2.
INCISAL EDGE
The
incisal edge is normally perpendicular to the long axis of the tooth. It is
altered to show wear, chips or notches as occurs with aging or youth.
3.
SURFACE CONTOURS
Surface
contours can be concave, convex or straight. Surface contours are viewed
as an overall or small detailed surfaces. Surface texturing is a general
pattern of small details.
4.
LINE ANGLES
Line
angles are defined as the transition from one surface to another. Altering the
degree of curvature and placement of line angles can change perception of tooth
width and length.
5.
CONTACT AREAS
Placement
of contact areas is a critical aesthetic results in anterior teeth. Contact establishes embrasures and tooth size. Normal placement in the maxillary
anterior would be the incisal third for the central incisor to central incisor, the
incisal to middle third for central incisors to lateral incisors and the middle
to gingival third for the lateral incisors to cuspids. Placement will be alter
with tipping, rotation and wear of teeth.
6.
EMBRASURE FORM
Embrasure
form defines the outline of a tooth. There are gingival, incisal, lingual, and
facial embrasures. The shape of embrasures alters the perception of tooth size
such that large embrasures make teeth look smaller and small embrasures make
teeth look larger. Embrasures, contacts, gingival, and incisal shape form
the silhouette of a tooth. Line angles, height of contour and incisal
areas form the face of a tooth. Unfortunately, the shape of the gingival papillae can be a
complicating factor for treatment when dark spaces occur from papillae loss.
Height
of contour is established by the contour of teeth. Knowledge of dental anatomy
is required to evaluate where is should be.
8.
SURFACE
TEXTURE
The
surface of teeth is textured or smooth. It determines light reflection and
blending into other teeth. Placement of lines as developmental grooves or craze
lines and dimples can affect perceptions of width and length and alter light
reflection patterns.
9.
TISSUE CONTOURS
The
shape of teeth at the gingival margin determine the gingival outline.
Tissue contours are different for teeth which are straight, rotated or tipped.
Periodontal disease will also have a profound effect on tissue contours.
COLOR
Selection,
analysis and communication of color is a more extensive science than can be
covered in this forum. The major
considerations to achieve excellent results are
1.
BASE COLOR
Color is selected and modified to achieve variations of color within a tooth if required. Composite color is modified by applying tints under them, tints mixed with them or trying to show through underlying composite or tooth color.
Interproximal
color provides a silhouette for the tooth. Dark colors makes teeth look smaller
while no change in color will give a broader appearance.
3.
GINGIVAL THIRD AND ROOT COLOR
Enamel
gets thinner in the gingival third of teeth so darker dentin shows through and
the area looks more yellow. Root
structure and cementum is a totally different color.
The
incisal edge is translucent enamel resulting in translucency, a halo effect, or no
change as it is worn away with age etc..
5.
CHARACTERIZATION
There
are many different colors which can occur within a tooth as might be seen with
crazelines or hypocalcifications. Evaluating hue, value
and chroma of color, with shape, size and position of characterizations is
challenging.
PERCEPTION OF SIZE
OBSERVE THE DIFFERENCE OF PERCEIVED SIZE FOR
THESE TEETH ALL THE SAME DIMENSIONS
EMBRASURES, INCISAL EDGE & INCISAL EDGE AND GINGIVAL BROWN ROOT STRUCTURE
GINGIVA FORM A SILHOUETTE EMBRASURE
BROWN ROOT STRUCTURE & LINES OF COLOR SURFACE TEXTURE, INCISAL EDGE
BROWN MESIAL AND DISTAL EMBRASURES, BROWN COLOR
IN
SUMMARY
The
Check List to Aesthetics combined with a knowledge of anatomy allows an
organized point by point method to analyze the aesthetic results of dental
restorative procedures. Combined they give excellent aesthetic results.
