American Society using the Aesthetics in 1976 for Dental ... · (Tooth-to-Tooth Width) Levin EI...

Daniel H Ward DDS

Proportional Smile DesignProportional Smile Design

REDProportion

using the

Dr. Irwin Smigel

Pioneer in Aesthetic Dentistry

Founded the American Society

for Dental Aesthetics in 1976

Subjective Smile Evaluation

TLAR Principle

Smile Design Methods

Objective Smile Evaluation

Proportional Smile Design

Smile Design Methods

Proportion

The relation between one part to another or to the wholeHarmonious relation of parts to each other or to the whole: BALANCE, SYMMETRY

Definition

62%

UNIQUE Proportion with interesting mathematical

properties

Ancient GreeksRecognized Proportions

Daniel H Ward DDS

Phidias

Ancient GreeksRecognized Proportions

Correlation exists between “beauty, nature and

mathematics”

Ancient Mathematician Phidias

Illustrated human anatomy with the Golden Proportion

ArtistLeonardo da Vinci

Proportions and angles are carefully analyzed

Facial Plastic Surgeons

Powell and Humphreys

Facial Plastic Surgery Textbook

Powell N, Humphreys B. Proportions of the Aesthetic Face. New York. Thieme-Stratton, 1984.

• Divide face into equal fifths

• Each fifth is an eye width

Rule of Fifths


Daniel H Ward DDS

• Forehead - from Trichion to Nasion

• Cheek - Nasion to Subnasale

• Mouth - Subnasaleto Menton

Trichion

Nasion

Subnasale

Menton

Rule of Thirds


• Divide subnasaleand menton into equal Thirds

• Incisal edge at junction of Superior and Middle Thirds

Incisal Edge

Rule of Thirds


• Central Incisor is 1/16th the Width of Inter-Zygomatic Width

“House” Proportion

House MM, Loop JL: Form and Color Harmony in the Dental Art. Whittier, California, Monograph, 1937, pp3-33.

• Central Incisor is 1/16th the Length from Ideal Hairline to Chin

“House” Proportion

House MM, Loop JL: Form and Color Harmony in the Dental Art. Whittier, California, Monograph, 1937, pp3-33.

• Use Trubyte indicator to determine WIDTH proportions

1/16 Inter-zygomaticwidth

Trubyte Proportion Guide

• Use Trubyte indicator to determine LENGTH proportions

Rule of Thirds combined with 1/16 trichion-

menton length

Trubyte Proportion Guide

Daniel H Ward DDS

• Width of central incisor is 1/7 inter-pupillary width

Isa ZM, Tawfiq OF, Noor NM. Shamsudheen MI, Rijal OM. Regression methods to investigate the relationship between facial measurements and widths of the maxillary anterior teeth. J Prosthet Dent 2010; 103:182-188.

Using Inter-pupillary width for width of central incisor

• Width of Anterior Teeth in Golden Proportion to the Inter-commissural Width

Proportion of Anterior Teeth to the Face

Rufenacht CR. Fundamentals of Esthetics. Chicago. Quintessence. 1990:67-134.

Anterior 6 too wide


Anterior 6 too narrow


Levin - JPD 1978“Dental Esthetics and the

Golden Proportion”

“The widths of the maxillary central incisors are in golden proportion to the lateral incisors as seen from the frontal”

1.618 X 62%=1

1 X 62%=0.618

Golden Proportion(Tooth-to-Tooth Width)

Levin EI Dental esthetics and the golden proportion. J Prosthet Dent 1978;40:244-252.

Snow - JED 1999“Esthetic Smile Analysis of

Anterior Tooth Width: The Golden Percentage”“The widths of the maxillary central incisors, lateral incisors, & canines should be 25%, 15%, & 10% of the total frontal view width of the anterior 6 teeth ”

CI=25% ICW

LI=15% ICW

C=10% ICW

Golden Mean(Tooth-to-Tooth Width)

Snow SR, Esthetic smile analysis of anterior tooth width:thegolden percentage. J Esthet Dent 1999;11:177-184.

Daniel H Ward DDS

Lombardi - JPD 1973“The principles of visual

perception and their clinical application to denture esthetics”

“The existing proportion between the width of the maxillary central incisor and lateral incisor should be consistent as you progress distally”

Repeated Ratio(Tooth-to-Tooth Width)

Lombardi RE. The principles of visual perception and their clinical application to denture esthetics. J Prosthet Dent 1973:29:358-382.

Preston Proportion(Tooth-to-Tooth Width)

Preston - JED 1993“The golden proportion revisited”

“The golden proportion was found in the relationship between the perceived width of the maxillary central and lateral incisors in only 17% of observed images” LI=CI * 66%

C=LI * 84%Preston JD. The golden proportion revisited. J Esthetic Dent 1993;5:247-251.

Tooth to ToothWidth Proportions

Problem is none relate tooth width proportions with

tooth height

Golden

Proportion

GoldenMeanPres

ton

Proportion

Repeated Ratio……

RED Proportion

Ward DH. Proportional smile design using the RED proportion. Dent Clin North Am 2001;45:143-154.

“The proportion between the successive widths of the teeth as viewed from the frontal should remain

constant as you move distally”

RED Proportion


Without pre-existing constraints

Sample RED Proportions


x 0.8x 0.64x

x 0.7x 0.49x

x 0.62x

0.38x

Same size Central Incisors

Daniel H Ward DDS

Sample RED Proportions


Same Inter-Canine Width

Same Tooth Heights

DifferentCentral

Incisor W/H Ratios

Orthodontics-Treatment Planning-Missing Laterals

“Is the space alright?”

(Speak now or forever hold your peace)

6.6mm

8.5 mm

= 0.78 = 78%W/L Ratio

6.6mm=Central Incisor Width8.5mm=Central Incisor Length

6.6 8.5



4.6 4.6

Lateral Incisor Width = 4.6 mm

CIW * 0.7 = LIW6.6mm * 0.7 = 4.6mm




4.6 4.6


CIW * 0.7 = LIW6.6mm * 0.7 = 4.6mm




4.6 4.6


CIW * 0.7 = LIW6.6mm * 0.7 = 4.6mm


4.6 4.6

…to determine how dentists rate anterior tooth arrangements with different tooth-to-tooth width proportions and whether the best-ranked tooth proportions are affected by inciso-gingival tooth length.

Rosenstiel SF, Ward DH, Rashid RG. Dentists’ Preferences of Anterior Tooth Proportion-A Web-based Study. J Prosthodont 2000;9:123-136.

Smile Research Study

Daniel H Ward DDS


Results-TALL Teeth

62% RED ProportionRosenstiel SF, Ward DH, Rashid RG. Dentists’ Preferences of Anterior Tooth Proportion-A Web-based Study. J Prosthodont 2000;9:123-136.

Results-Average Teeth

70% RED Proportion


Results-Short Teeth

80% RED Proportion

“The majority (of 430 North American dentists surveyed) chose central incisors that were as close to 0.75-0.78 width/length ratio as possible.”


Results

86% W/L Ratio

Width/Length Ratio of Central IncisorsWidth/Length Ratio of Central IncisorsNaturally Observed

Sterret JD, Robinson F, Fortson W, Knaak B, Russell CM. Width/length ratios of normal clinical crowns of the maxillary anterior dimension in man. J Clin Periodontol1999;26:153-7.

Gillen RJ, Schwartz RS, Hilton TJ, Evans DB. An analysis of selected normative tooth proportions. Int J Prosthodont 1994;7:410-7.

Hasanreisoglu U, Berksun S, Aras K, ArslanI. An analysis of maxillary anterior teeth: facial and dental proportions. J ProsthodontDent 2005;94:530-8.

78% W/L Ratio

Width/Length Ratio of Central IncisorsWidth/Length Ratio of Central IncisorsYoung Patients & Dentist Preferred

Magne P, Gallucci GO, Belser UC. Anatomic crown width/length ratios of unworn and worn maxillary teeth in white suspects. J ProsthodontDent 2003;89(5):453-61.

Orozco-Varo A, Arroyo-Cruz G, Martinez-de-Fuentes R, Jiminez-Castellanos E. Biometric analysis of the clinical crown and the width/length ratio in the maxillary anterior region. CNaylor CK. Esthetic Treatment Planning: The Grid Analysis System. J Esthet Restor Dent 2002;14:76-84. Wolfart S. Thormann H, Freitag S, Kern M. Assessment of dental appearance following changes in incisor proportions. J Oral Rehabil2006;33:489-495.

Daniel H Ward DDS

Patients seeking Aesthetic Treatment desire a MORE Youthful Appearance

Width/Length Ratio of Central IncisorsWidth/Length Ratio of Central Incisors

78% W/L86% W/L

86% W/L 78% W/L

Preferred RED Proportions78% w/hratio

78% w/hratio

78% w/hratio

Very Short

Average

Very Tall

Same Inter-canine tooth width

Relative Tooth heights

Rosenstiel SF, Ward DH, Rashid RG. Dentists’ Preferences of Anterior Tooth Proportion-A Web-based Study. J Prosthodont2000;9:123-136.

•Central Incisor should maintain 78% width/height ratio

•The taller the central incisor the wider it should be

•The taller the central incisor the smaller the RED Proportion used

•The taller the central incisor the more dominant it becomes in the arch

•The wider the central incisor the narrower the resulting lateral incisor and canine

RED Proportion Principles

•The shorter the central incisor the narrower it should be

•The shorter the central incisor the larger the RED Proportion used

•The shorter the central incisor the more similar the relative individual tooth widths

•The narrower the central incisor the wider the resulting lateral incisor and canine

•Clinical judgment is paramount

RED Proportion Principles

15 Year Old

Minimally Invasive Dentistry

RED Proportion Template

Treatment Planning

Daniel H Ward DDS

RED Proportion Template

Treatment Planning

Dr. Paul Belvedere

A Pioneer in Direct Composite Dentistry

Restore opposite teeth

Pre-Operative

Finished Restorations

Observed Proportions

Ali Fayyad MA, Jamani KD, Aqrabawi J. Geometric and Mathematical Proportions and their Relations to Maxillary Anterior Teeth. J Contemp Dent Pract 2006;5:62-70.

“The Golden Proportion and Recurring Esthetic Dental (RED) Proportion were not found to exist between the maxillary anterior teeth of the natural dentition.”

(Photos of 376 Jordanian dental students)

The RED Proportion is a mathematical tool to aid in the diagnosis and treatment planning of a smile. It is not a study of what was observed in nature, but a model that can create balance and symmetry pleasing to dentists and patients.

RED Proportion

Daniel H Ward DDS

Study of Preferred Proportions

…to determine if North American dentists surveyed prefer the Recurring Esthetic Dental (RED) proportion, other mathematical-defined proportions or naturally occurring tooth-to-tooth width proportions

Ward DH. A Study of Dentists’ Preferred Anterior Tooth Proportions:Comparing the RED Proportion to other mathematical and naturally occurring proportions. J Esthet Restor Dent 2007;19:323-336.

NatureScience

Preston Natural Proportion

#2a

Average Height

Golden Proportion

#2b

Average Height

Preston Natural Proportion70% Preference over Golden

#2a

Average Height

Golden Proportion

#3a

Average Height

Daniel H Ward DDS

70% RED Proportion

#3b

Average Height

70% RED Proportion75% Preference over Golden

#3b

Average Height


#4a

Average Height

70% RED Proportion

#4b

Average Height

Daniel H Ward DDS

70% RED Proportion57% Preference over Natural

#4b

Average Height


Tall#5a

Golden (62% RED) Proportion

Tall#5b

Tall

Golden (62% RED) Proportion58% Preference over Natural

#5b

Conclusions• With average length teeth Natural and 70%

RED Proportion smiles were preferred significantly over Golden Proportion >2:1

• Smiles created using the principles of the RED Proportion where preferred by a majority of North American dentists surveyed.

• Use of Golden Proportion (62% RED Proportion) was only preferred with tall teeth

Daniel H Ward DDS

Average Length Teeth

CIx66% RED LI-0.33mm

Average Length TeethAverage Length Teeth

Identical Size

CIx66% RED LI-0.33mm

Average Length Teeth Simple Equation to use the Inter-canine Width (ICW) and the RED Proportion to

calculate the Central Incisor Width (CIW)

Ward DH. Using the RED Proportion to Engineer the Perfect Smile. Dent Today 2008;27(8):112-117.

62% RED70% RED80% RED

ICW RED CIW

Simplified Chart to use the Inter-canine Width (ICW) and the RED Proportion to

calculate the Central Incisor Width (CIW)


Clinical Use

Using the Inter-canine Width (ICW) and the RED Proportion to calculate the Central

Incisor Width (CIW)


Daniel H Ward DDS

VERY SHORT

AVERAGE

VERY TALL

STEP 1-Determine Tooth Height

TALL

SHORT


STEP 2-Measure Inter-Canine Width

Lookup Tooth Length in Chart


Using RED to determine individual tooth widths

Average Length


70% RED

If average length ICW Width

4.4

STEP 3a-Divide Inter-Canine Width by factor for CIW


Central Incisor Width* 0.7

STEP 3b-Multiply CIW* 70% for Lateral Incisor WidthIf average length

70% REDWard DH. Using the RED Proportion to Engineer the Perfect Smile. Dent Today 2008;27(8):112-117.

Daniel H Ward DDS

Canine Width *07

STEP 3c-Multiply LIW * 70% for CW

70% RED

If average length


VERY SHORT

AVERAGE

VERY TALL

STEP 1-Determine Tooth Height

TALL


SHORT

STEP 2-Measure Inter-Canine Width


Lookup Tooth Length in Chart




ICW

4.0

STEP 3a-Divide Inter-Canine Width by factor

62% RED

If very tall length


Daniel H Ward DDS

Central Incisor Width * 0.62

STEP 3b-Multiply CIW* 62% for Lateral Incisor Width

62% RED

If very tall length




Inquiring about laminates

“I don’t like the spaces between my front teeth”

Smile Analysis

Teeth not centered with philtrum

Smile Analysis

Canted midline

Daniel H Ward DDS

Determining ideal width of central incisor

Constant 78% W/H Ratio

ICW

4.8

ICW

4.4

ICW

4.0

Short

Average

Tall

Use 70% RED Proportion

Calculating Tooth Widths

35.6------ = 8.1mm CI4.4

8.1*0.7= 5.7mm LI

5.7*0.7= 4.0mm C

35.6mm

Use 78% W/L Ratio

Calculating Central Incisor Length

35.6------ = 8.1mm CI4.4

8.1/0.78= 10.4mm CI

35.6mm

8.1mm10.4m

m

Post-Treatment

Short Average Tall

80% RED 70% RED 62% RED

Relating the Size of the Teeth to the FaceRelating the Size of the Teeth to the Face

Short Average Tall

80% RED 70% RED 62% RED

Relating the Size of the Teeth to the Face

Daniel H Ward DDS

Different RED Proportions can be used according to desired tooth length

Different RED Proportions can be used according to desired tooth length

Methods to Gain Favorable Width/Length Ratio in Short Teeth

Methods to Gain Favorable Width/Length Ratio in Short Teeth

Adding Length to Central Incisor allows Smaller RED Proportion

Adding Length to Central Incisor allows Smaller RED Proportion

Missing Lateral Incisors Replaced by Maryland bridges

“My bridges are loose and my front teeth hurt.”

Tooth size is too small

Lateral Smile Views

Radiographic Evaluation revealed that #8-9 require endodontic root canal therapy

De-Bonded Metal Abutments to Centrals

Daniel H Ward DDS

DETERMINE DESIRED RELATIVE TOOTH HEIGHT

Patient exhibits Short Tooth Length

…BUT Average Facial Height

PRE-OPERATIVE MEASUREMENTS

MEASURE INTERCANINE WIDTH (ICW)

Measure available ICW space

37.6 mm

CALCULATE CENTRAL INCISOR WIDTH (CIW)

Divide ICW by divisor for average tooth height to determine CIW

ICW/divisor=CIW37.6/4.4=CIW8.5=CIW

37.6 mm

CALCULATE LATERAL INCISOR WIDTH (LIW)

Multiply CIW X RED Proportion for average length teeth-70% RED (0.7)

CIW*RED=LIW8.5*0.7=LIW6.0=LIW

CALCULATE CANINE WIDTH (CW)

Multiply LIW X RED Proportion for average length teeth-70% RED (0.7)

LIW*RED=CW6.0*0.7=LIW4.2=CW

Daniel H Ward DDS

CALCULATE CENTRAL INCISOR WIDTH (CIL)

Divide CIW by Desired W/L Ratio (0.78) to determine CIL

CIW/0.78=CIL8.6/0.78=CIL11.0=CIL

Incisal Edge Determinants

• Esthetics

• Phonetics

• Anterior guidance / Occlusion

Lengthen incisal edge #9 -0.5mm

Incisal Edge Determinants

• Esthetics

• Phonetics

• Anterior guidance / Occlusion

Lengthen #9 - 2.5mm (0.5mm on incisal & 2.0mm at cervical

Ideal Tooth Proportions Using the RED proportion

Pre-Operative Measurements

Desired Measurements

No Periodontal Surgery Original Proportions Periodontal Surgery RED Proportions

• Lengthen #9 2.5mm to 11mm• Widen Central Incisors to allow

70% RED Proportion• Shift midline slightly to left

Daniel H Ward DDS

AfterPost Perio Surgery“I want a Model Smile”

CALCULATE W/H RATIOOF CENTRAL INCISORS

7.4 / 9.0 = 0.82 or 82%

CALCULATERED PROPORTIONS

1.0 / 4.5 = 0.22 or 22%

CALCULATERED PROPORTIONS

4.5 / 5.0 = 0.9 or 90%

• Esthetics

• Phonetics

• Anterior guidance Occlusion

DESIRED INCISAL EDGE POSITION

Daniel H Ward DDS

Determine ideal Central Incisor Width for 70% RED Proportion

33.4CENTRAL INCISOR WIDTH = -------------------------

4.4

CENTRAL INCISOR WIDTH = 7.6mm

Determining ideal Central Incisor Length for 78% W/L Ratio

7.6CENTRAL INCISOR LENGTH = -------------------------

0.78

CENTRAL INCISOR LENGTH = 9.8mm

Determining Maxillary Anterior Tooth Widths for 70% RED Proportion

CIW*RED=LIW

7.6*0.7=5.3=LIW

LIW*RED=CW

5.3*0.7=3.7=CW

FIVE

Pre-Treatment and Desired Tooth Dimensions

FIVE

Pre-Treatment and Desired Tooth Dimensions Treatment & Blueprint

Imaged without Perio Surgery

Daniel H Ward DDS

Treatment & Blueprint

Imaged with Perio Surgery


1 Month Post Perio Surgery


2 Weeks post-treatment

AfterBefore

REMEMBERREMEMBER

The Math is Important

American Society using the Aesthetics in 1976 for Dental ... · (Tooth-to-Tooth Width) Levin EI...

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