Diagnosis Part 3 (Smile) PDF

4 3D FRAME OF THE SMILE 5 Macroesthetics Miniesthetics Microesthetics Dr David Sarver 7 Macroesthetics Miniesthetics Microesthetics https://www.jco-online.com/archive/2005/03/155-overview-the-eight-components-of-a-balanced-smile/ 8 SAGITTAL DIMENSION 9 REST POSITION Bracket Posi...

4 3D FRAME OF THE SMILE 5 Macroesthetics Miniesthetics Microesthetics Dr David Sarver 7 Macroesthetics Miniesthetics Microesthetics https://www.jco-online.com/archive/2005/03/155-overview-the-eight-components-of-a-balanced-smile/ 8 SAGITTAL DIMENSION 9 REST POSITION Bracket Positioning for Smile Arc Protection THOMAS R. PITTS . JCO 2017 SMILE (PROFILE) 11 • Anteroposterior position of jaws in relation to carnial base • Anteroposterior position of incisors • Incisor inclination https://www.speareducation.com/spear-review/2017/11/ideal-position-of-the-central-incisor 12 TRANSVERSE DIMENSION 13 BROAD SMILE VS LATERAL NEGATIVE SPACE Sabri R. overview the eight components of a balanced smile. Journal of Clinical Orthodontics 2005 14 ASYMMETRY Proffit W. Contemporary Orthodontics 5th edition TYPES OF SMILE • Commissure Smile : Mona Lisa (Zygomaticus Major + gradual elevation of upper lip -Levator Labii superioris- ) • Canine/Cuspid smile (Elevators of the upper lip) • Complex (Elevators and depressors of the lower lip) Adapted from Rubin COMMISSURE SMILE (67% OF POPULATION) CUSPID SMILE (31 % OF POPULATION) https://www.ellecanada.com/culture/celebrity/linda-evangelista-s-beauty-comeback COMPLEX SMILE (2 % OF POPULATION) https://www.dailymail.co.uk/home/you/article-2473392/Julia-Roberts-exclusive-The-original-Pretty-Woman-upping-game-ageing-supermodel.html CONTRACTION OF THE MUSCLES OF SMILE Posed smile (static, sustained, fairly reproducible) Spontaneous smile (Enjoyment, maximal contraction, involontary) Duchenne smile (true Smile : zygomaticus major and orbicularis oculi) Differentiating Duchenne from non-Duchenne smiles using active appearance models J. Vandeventer, E. PattersonPublished 2012Computer Science2012 IEEE Fifth International Conference on Biometrics: Theory, Applications and Systems (BTAS) 20 CANT OF THE OCCLUSAL PLANE Gauw, et al. IJO n2015 Bracket Placement According to Malocclusion 21 Sabri R. overview the eight components of a balanced smile. Journal of Clinical Orthodontics 2005 EXAMPLE 1 Amat P. The search for excellence in adult orthodontics; an interview with Bjørn U. Zachrisson. November 2014 l Orthodontie Française 85(4):301-26 EXAMPLE 1 Amat P. The search for excellence in adult orthodontics; an interview with Bjørn U. Zachrisson. November 2014 l Orthodontie Française 85(4):301-26 24 VERTICAL DIMENSION 25 INCISOR DISPLAY AT REST PHILTRUM & INTERCOMMISSURAL DISTANCES Subnasale 20 mm in average ♀ 23 mm in average ♂ Vermillon tip of the cupid’s bow Incisor display during speech and smile: Age and gender correlations Angle Orthod. 2015;86(4):631-637. doi:10.2319/042515-284.1 26 INCISOR DISPLAY DURING SPEECH, SMILE High smile line. 27 INTERLABIAL DISTANCE MEASUREMENT 28 INTERLABIAL DISTANCE MEASUREMENT INCISOR DISPLAY WITH GROWTH • Both upper and lower lips grow more than the skeletal lower face in children. • The lower lip grows more than the upper lip • Most children with lip incompetence at age 6 experience self-correction by the age of 16. https://pocketdentistry.com/6-growth-and-development-of-the-soft-tissues/ INCISOR DISPLAY WITH AGING age Upper incisors Lower incisors Up to 30 3,5 0,5 30 to 40 1,5 1,0 40 to 50 1,0 2,0 50 to 60 0,5 2,5 60 and over 0,0 3,0 31 INCISOR SHOW ON SMILE 32 INCISOR SHOW AT REST 33 VERTICAL MAXILLARY HEIGHT Sabri R. overview the eight components of a balanced smile. Journal of Clinical Orthodontics 2005 34 INCISOR SHOW & INCISOR INCLINATION 35 Sabri R. overview the eight components of a balanced smile. Journal of Clinical Orthodontics 2005 EXAMPLE 2 Amat P. The search for excellence in adult orthodontics; an interview with Bjørn U. Zachrisson. November 2014 l Orthodontie Française 85(4):301-26 38 SMILE ARC Machado AW. 10commandements of smile esthetics. Dental Press J. Orthod. vol.19 no.4 Maringá July/Aug. 2014 39 Sabri R. overview the eight components of a balanced smile. Journal of Clinical Orthodontics 2005 40 EXAMPLE 3 Bracket Positioning for Smile Arc Protection THOMAS R. PITTS . JCO 2017 EXAMPLE 4 Bracket Positioning for Smile Arc Protection THOMAS R. PITTS . JCO 2017 Bracket Positioning for Smile Arc Protection THOMAS R. PITTS . JCO 2017 Bracket Positioning for Smile Arc Protection THOMAS R. PITTS . JCO 2017 45 INCISOR SHOW ON SMILE VS REST VS SPEAKING Muller C. Display of the mandibular incisors in older adult patients: orthodontic applications J Dentofacial Anom Orthod 2013;16:202 46 INCISOR SHOW WHILE SPEAKING (OLDER ADULTS) Muller C. Display of the mandibular incisors in older adult patients: orthodontic applications J Dentofacial Anom Orthod 2013;16:202 47 IDEAL SMILE ? • Should expose minimal gingiva (unless young, female) • Gingival contour should be symmetric and in harmony with the upper lip • Anterior and posterior segments should be in harmony • Smile arc should be consonnant with the inferior lip • Minimal corridors laterally • Teeth should be of normal length, ideal proportions, progression • With central incisor dominance 48 UPPER LIP CURVATURE (SOFT TISSUE ANATOMY & FUNCTION) 49 UPPER LIP LENGTH (SOFT TISSUE ANATOMY) 50 With age, the philtrum height increases at a greater rate than does commissure height, resulting in a flatter and thinner upper vermilion. Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning. David M. Sarver. AJODO 2015 52 INCISOR SHOW AT REST & LIP ELEVATION 53 INCISOR SHOW AT REST & LIP ELEVATION 54 DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE • Lip hypermobility : normal incisor edge position at rest and posed smile (compared to when smiling) • Short lip • Skelettal vertical maxillary excess ? Facial signs (thirds, • Upper incisor over-eruption ? Upper incisor retroclination ? (deep bite and uneven gingival margins) • Gingival Hyperplasia (gingivoplasty) • Altered Passive eruption (gingivoplasty +/- osteoplasty) • Insufficient crown length 55 SEVERITY OF GUMMY SMILE Garber and Salama (1996) • Degree I. 2 to 4 mm of gingival display Orthodontics (intrusion if deep bite), crown lengthening, crown lenghening followed by restoration • Degree II. 4 to 8 mm of gingival display Combination of all above + Orthognathic surgery • Degree III. Over 8 mm of gingival display Orthognathic surgery + Combination of all above 56 https://www.dailymail.co.uk/femail/article-3475211/What-does-smile-say-you.html 57 https://www.dailymail.co.uk/femail/article-3475211/What-does-smile-say-you.html 58 59 MEASUREMENTS FOR ACCURATE DECISION MAKING • Clinical crown length (gingival margin to incisal edge) • Anatomic crown length (CEJ to incisal edge) • Width of keratinized tissue (mugogingival junction to free gingival margin) • Radiographs • Locate CEJ with probing under local anesthesia 60 61 NORMAL ERUPTION Incisor crown height increases dramatically during adolescence and tapers off in later years. Interactions of hard tissues, soft tissues, and growth over time, and their impact on orthodontic diagnosis and treatment planning. David M. Sarver. AJODO 2015 63 ALTERED PASSIVE ERUPTION Chu SJ, Karabin S, Mistry S. Short tooth syndrome: diagnosis, etiology, and treatment management. J Calif Dent Assoc 2004; 32(2): 143-152. 65 DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE • normal Attached Ging 1.5mm N Free Ging M Attached Ging Free Ging M 66 • Type 1; increased. KG A width normal bone DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE 67 Robert A Levine Compendium of continuing education in dentistry (Jamesburg, N.J.: 1995) · August 1997 68 DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE • Type 1 ; increased. KG width B Osseous crest at CEJ 69 • Type 2 : normal KG DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE A Subgroup Attached Ging 0 Free Ging M Attached Ging Free Ging M 70 DIFFERENTIAL DIAGNOSIS OF GINGIVAL SMILE • Type 2 : normal KG Subgroup B Attached Ging 0 Free Ging M Attached Ging Free Ging M 71 72 73 https://glidewelldental.com/education/chairside-dental-magazine/volume-4-issue-2/altered-passive-eruption-diagnosis-and-treatment/ 74 Machado AW. 10commandements of smile esthetics. Dental Press J. Orthod. vol.19 no.4 Maringá July/Aug. 2014 75 Macroesthetics Miniesthetics Microesthetics https://www.jco-online.com/archive/2005/03/155-overview-the-eight-components-of-a-balanced-smile/ DENTAL COMPONENTS Prostho, Perio, Restorative… From Proffit W. Contemporary Orthodontics. 5th edition Elsevier (David Sarver) From Proffit W. Contemporary Orthodontics. 5th edition Elsevier (David Sarver) From Proffit W. Contemporary Orthodontics. 5th edition Elsevier (David Sarver)