Dynamic smile /certified fixed orthodontic courses by Indian dental academy

Evolution of the concept and dynamic records of smile
capture

INDIAN DENTAL ACADEMY
Leader in continuing dental education
www.indiandentalacademy.com

PART - I
Evolution of the concept and dynamic records of
smile capture :
Esthetics in orthodontics mainly defined in terms of profile
enhancement – tend to drift away from clinical examination
&the art of physical diagnosis
Angle 1899 – once ideal tooth-jaw positions were achieved ,
then soft tissues would fall in line.
Recent focus – multifactorial nature of smile , combined with a
shift towards patient driven esthetic diagnosis and treatment
planning

In contemporary orthodontics ,patients are examined in 3
spatial dimensions (static and dynamic ) –attempt to
harmonise lip – tooth – jaw relationships (anatomic
&physiologic ) and esthetic and functional desires


To treat smile :
1. Identify & quantify which element of smile needs
correction, improvement or enhancement
2. Identify the positive elements of smile to be maintained
or protected during our treatment
2. Visualized treatment strategy to address patient’s chief
concerns

3 spatial dimensions in profile
frontal
vertical

2 dynamic factors to be considered:
1. Soft tissue repose and animation 2. Facial changes with aging Disadvantages of cephalometric evaluation :
1. Scammon’s growth curve
2. Stable dento-skeletal relationships.

RECORDS FOR TREATMENT OF SMILE :
1. STATIC RECORDS :

• Photographs – frontal rest ,smile
- profile rest , smile
- oblique smile
- smile close-ups (frontal ,oblique)
• Radiographs
•Study models


Profile -smile

Close-up frontal

Close-up oblique


2. Dynamic records
Digital videography :
records ant. tooth display during speech &
smile.
2 segments of video – frontal & oblique dimension
30 frames /sec.- in standardized fashion
“Chelsea eats cheese cake on Chesapeake” –
video clip is taken (5 sec )
---the smile that best represents patient’s
unstrained social smile selected.

1.

2.

3.

6.

5.

4.


3 smile styles :

1. Commisure smile
2. Cuspid smile
3. Complex smile

3. DIRECT MEASUREMENT AS A BIOMETRIC TOOL
Allows quantification of resting & dynamic
lip –tooth relationships.
ADVANTAGES:
1. Information translated to meaningful treatment plan
2. Visualize time related changes & repeatability

STATIC
1. Commisure height
2. Philtrum height
3. Inter labial gap
4. Incisor show at rest
DYNAMIC
1. Crown height
2. Gingival display
3. Smile arc

4. Incisor show at smile

PHILTRUM HEIGHT :
sub spinale to vermilion border
-relation to max. incisor & commissure height is more important
- In adolescence , philtrum height is shorter than commissure height
COMMISURE HEIGHT :
Construct line from alar bases thru subspinale & from the
commisures perpendicular to this line
GINGIVAL DISPLAY :
Relation with incisor show at rest is important .
It is BETTER to treat gummy smile less aggressively –more esthetic than
a smile with less tooth display

SMILE ARC :
From frontal view :
curvature of incisal edges of incisors & canines
to curvature of lower lip in posed social smile
Ideal smile arc /consonant –
Flat smile / nonconsonant –
Reverse smile arc –


Case illustration:

Excessive gingival display due to
Short philtrum height
Excessive curtain on smile
Short max. incisor crown height

Mild vertical max. excess

PART II :
SMILE ANALYSIS AND TREATMENT STRATEGIES

3 dimensions –
1. Frontal
2. Oblique
3. Sagittal
4 th dimension –
“TIME “

FRONTAL DIMENSION:
Vertical and transverse characteristics
Smile index :
“ACKERMAN AND ACKERMAN ”
Area framed by vermilion border during social smile
Intercommissure width
Inter labial gap
-enables comparison ofwww.indiandentalacademy.com
smiles

Vertical characteristics of the smile :
1. Incisor display –
2. Gingival display –
3. Smile arc –
4. Relation between gingival margins & u.lip –
-gingival margins of canines should coincide
with upper lip & lateral incisors slightly inferior.
-gingival margins should coincide with upper
lip in the social smile.
- age factor.


Transverse characteristics of smile
1. Arch formuse of broad square arch forms in collapsed arch
improves transverse smile dimensions
-denture smile
-flattening of smile arc


2. Buccal corridorFrom mesial line angle of I p.m. to interior portion of
commissure


3. Transverse cant of maxillary occ. plane
• Differential eruption
• Skeletal mandibular asymmetry
•Asymmetric smile curtain
Only frontal smile visualization allows visualization of any
dental /skeletal asymmetry transversely.
Frontal full face /close up smile mandatory.

OBLIQUE DIMENSIONS
Characterizes smile as not obtainable with frontal view /
ceph. Analysis

molars to the curvature of lower lip on posed smile.
Consonant /parallel
Nonconsonant /flat

Occlusal cant

Oblique- smile arc


SAGITTAL DIMENSIONS

1.Overjet
In cl.II / cl.III patients , frontal smile appears esthetic.
Oblique & sagittal views shows underlying skeletal pattern &
dental compensation


SAGITTAL MAXILLARY POSITION –influences smile in
frontal view ( transverse smile dimensions )

Transverse smile dimension is a function of both arch
width and A-P position of max. & mnd. arches

2. INCISOR PROCLINATION:
Flaring of incisors – decreased incisor show


THE FOURTH DIMENSION – “TIME”
1. Growth
2. Maturation
3. Aging

Preadolescent
Adolescent
Adult


Effects of maturation & aging on soft
tissues
Profiles flattens over time
Rate of philtrum lengthening is greater than that of
commisures
Flattening of ‘M’ characteristic of vermilion border of
upperlip
Decrease in turgor
Decreased incisor display at rest
Decreased gingivalwww.indiandentalacademy.com
display on smile

TREATMENT
PLANNING
Identify problems and plan correction
Identify &quantify positive esthetic arrangement
Example :

“Consonant smile arc”


Treatment strategy :
1. Maintain vertical incisor position
2. Extrude max. canines to level
3. Finish with periodontal crown lengthening

ALTERING SMILE ARC : strategies to be used.

Treating occlusal plane:
1. Preadolescents – growth modification appliance
2. Adolescents &adults – surgical modification
Bracket placement
Difference in incisal edge-bracket slot distance between
max. central and lateral incisors should be 1-1.5mm to
preserve / create consonant smile arcs.
Cosmetic porcelain laminates /composite bonding
Enamel odontoplasty www.indiandentalacademy.com

Leader in continuing dental education


Dynamic smile /certified fixed orthodontic courses by Indian dental academy

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