IJOPRD

10.5005/jp-journals-10019-1060
Anterior Teeth and Smile Designing: A Prospective View
REVIEW ARTICLE

Anterior Teeth and Smile Designing: A Prospective View

G Rajtilak, S Deepa, V Rajasekar, R Vanitha

ABSTRACT
Smile is a person’s greatest beauty asset. A defective smile
might be considered as a physical handicap as the mouth act
as a focal point where a large share of attention is directed
toward mouth and teeth, it would be nice to have some sort of
tools to assess beauty, which currently does not exist.
Standards for beauty are actually a compilation and
comparison of everything we have seen or experienced. Smile
design is different from tooth design, with tooth design one is
concerned with contour, position and color of individual teeth,
while integration of these teeth into the face and facial features
is paramount in smile design.
This article describes some average desirable characteristic
features of smile to help and achieve optimum result in esthetic
oral rehabilitation.
Keywords: Dynasthetics, Smile design, Esthetics.
How to cite this article: Rajtilak G, Deepa S, Rajasekar V,
Vanitha R. Anterior Teeth and Smile Designing: A Prospective
View. Int J Prosthodont Restor Dent 2012;2(3):117-127.
Source of support: Nil
Conflict of interest: None

INTRODUCTION
An attractive smile enhances the appearance and acceptance
of an individual in our society. Smile is one of the facial
expressions that are essential in expressing friendliness,
agreement and appreciation. This demand for a pleasant
smile drives us to the field of dental esthetics and thus the
role of a prosthodontist becomes significant.

Smile
Fig. 1: Three types of smile
Smile is a person’s ability to express a range of emotion
with the structure and movement of the teeth and lips. Smile
Age
has been classified as high, average and low by Tjan et al.1
High smile shows complete display of cervicoincisal length Oral structures such as teeth, periodontium and lips undergo
of the maxillary incisors along with a contiguous band of constant changes due to aging. These changes have to be
gingiva whereas low smile has less than 75% of display. In incorporated in the oral rehabilitation of an elderly person.
an average smile there is 75 to 100% display of maxillary According to Dong et al, Ahmad et al,2,3 the amount of
incisors with the incisal curvature of the maxillary anterior maxillary incisor exposure gradually decreased with age
teeth paralleling the inner curvature of lower lip and may with a corresponding increase in the mandibular incisor
be slightly or totally touching the lower lip (Fig.1). exposure. This feature has to be inbuilt in the artificial
denture to provide a natural esthetic appearance to the
Design a Smile patient.
When designing a smile, the smile artist needs to consider,
Oral Conditions
the age of the patient, his or her aspiration, individual face
shape, facial features and oral condition of the patient. Missing teeth disrupt a good smile. Dong et al2 investigated
Factors affecting smile design include: the effects of missing teeth, prostheses and misaligned teeth.

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G Rajtilak et al

Results revealed that missing or malaligned teeth impair Composition

smile. But if the missing teeth were restored, then the esthetic
The study of the relationship existing between objects made
level of smile improved.
visible by contrasts in line, color and texture is called
composition.
Sex
Symmetry is the prime requisite for composition5 which
Generally, feminine teeth are round and masculine teeth means oneness. It is this property that gives the effect of as
are squared, but there are no hard and fast rules. According ‘a whole’. The objective of a prosthodontist is to provide a
to gender differences, females display nearly twice the dynamic unity and not a static one. The typical denture look
amount of maxillary teeth, i.e. 3.4 mm as compared to males is obtained when we give a static unity, which is the biggest
which is only 1.9 mm.3,4 crime in denture esthetics. Asymmetry may be given among
the dental composition by binding all the elements together
Personality
with segregating forces, i.e. all the teeth within the denture
Dong et al2 investigated the correlation between personality need not be arranged uniformly which gives the picket fence
factors and smile assuming that smile esthetics is closely appearance to the denture. Instead the teeth can be arranged
related to an individual’s physical and psychological state. with variations within the framework of the dental
There was no statistically significant relationship between composition, e.g. Hogarth’s line of beauty (Fig. 2). It is a
men’s personality and smile. In contrary, women exhibited line inscribed around a cone. The line is never the same
some correlation. This indicates that artificial teeth of female along its course but neither has it left away from the surface.
patients have to match their personality trait. Adoption of this segment of line can be used for tooth
All these factors affecting smile should be considered placement. This along with the festooning of the base
when a denture is made as they affect the esthetic outcome. contributes to dynamic unity.
Dominance is the factor required to provide symmetry,
Evaluation of a Smile
i.e. one tooth must dominate in the anterior tooth
A person is more often viewed from the frontal aspect than arrangement, by virtue of its size central incisors being the
the profile. Therefore, smile has to be esthetically appealing right choice. The central incisor must be larger than the
when viewed from the front. Lombardi5 pointed out that, lateral incisor to dominate the composition.5 The canine is
esthetic qualities can be determined by viewing the patients not used because only its mesial aspect is seen.
from front, in conversation, with facial expressions and Alternative methods to increase dominance includes:
smiling. Smile needs to be considered in both vertical as • Increasing mold size
well as transverse direction. Characteristics observed in • Using lighter teeth
vertical and horizontal directions are as follows: • Placing teeth farther anteriorly
Vertical characteristics observed include the • Increasing exposed cervicoincisal length.
relationship between the incisal edges of the maxillary
incisors and the lower lip.
Transverse characteristics include arch form, buccal
corridor and transverse cant of the maxillary buccal plane.
These factors have to be incorporated in the artificial teeth
replacement because as the patient smiles, the teeth are
exposed.
The inter-relationship between the artificial teeth and
smile can be bridged by applying principles of visual
perception and dynasthetics considerations.

PRINCIPLES OF VISUAL PERCEPTION AND

SMILE DESIGN
There are various factors that govern the principles of visual
perception. Following are some of them which has to be
considered in the process of denture construction. Fig. 2: Hogarth’s line of beauty

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But, however, the amount of dominance given to the

mouth by the denture set up depends upon the evaluation
of the patient’s personality and the strength of the
background facial features.
Proportion is a valuable tool to provide symmetry with
variety, i.e. if two teeth are of the same width but different
lengths, the longer tooth will appear to be narrower (Fig. 3).
This can be made use to achieve dynamic unity. Correct
dental proportion is the key to a beautiful smile. These
proportions are usually based on perceived sizes viewed
from the frontal aspect. Though various proportions were
proposed like the golden proportion, recurring esthetic Fig. 4: Principle of illumination—short bicuspid
dental (RED) proportion, M proportions and Chu’s esthetic
gauges,6 most authors recommend creating harmony and
balance, by eye through proper adjustment and evaluation
of provisional rather than by using any rigid formula.
Symmetry, dominance and proportion are thus essentials
of a proper dental composition.

Gradation
Gradation5 is the progressive decrease in tooth size as we
move from the anterior teeth to posterior teeth and this front
to back transformation must be gradual. If two structures
that are similar are placed at different distances, then the
structures which are nearer will appear larger. If other similar Fig. 5: Principle of illumination—bucally placed bicuspid
structures are interposed between them, then this creates an
illusion of gradual reduction in size. If this principle is
Balance
marred, it destroys the depth of realism.
For example, use of a short premolar violates the Balance is one important factor to be considered in denture
principle of illusion since abrupt size reduction disturbs the esthetics. It denotes the stability resulting from equalization
gradual diminution in size (Fig. 4). of opposing forces. It means that no part of a component is
Buccally placed premolar is also a sin against esthetics out of proportion to another. In other words, it is also called
since it destroys the illusion depth and makes the denture as equilibrium.
look unreal (Fig. 5). If a structural map of lip is drawn, then the most stable
The inclusion of buccal corridor also helps in achieving point is at the intersection of the structural axes. When a
gradation by altering the light needed for illumination, i.e. question arises about the placement of the midline, either
as the teeth are set posteriorly, the available light required in the middle of the head or the middle of the mouth, the
for illumination gets reduced and hence the tooth appears answer according to balance should be at the point where it
to be smaller. remains stable, which is mostly the imaginary midline that
divides the philtrum of the upper lip. However, the midline
cannot be measured, but a long contemplative look will
reveal the position of the midline as eye is a competent
evaluator (Fig. 6).
Balance is not only essential in establishing midline,
but is also required in establishing the direction of teeth on
either side of the midline. The lack of balance in direction
is mostly due to cross bite ridge relation in which the canine
Fig. 3: Proportion is not placed lingually in relation to the lower canine (Fig. 7).

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DYNASTHETICS AND SMILE DESIGN

The term dynasthetics implies movement, action, change
and progression in the esthetic phase of prosthodontics.7
Dentogenic factor (SPA factor) is the application and
correlation of dynasthetic principles. Dynasthetics are only
a guide and they are not a compulsion wherein freedom is
given to our imaginative perception.

Age
Fig. 6: Proposed structural map of tooth
Age changes influence the anatomy of smile. With age, not
only the lips become less elastic and less everted, teeth also
show imperfections. These can be incorporated to the
artificial denture teeth in the form of crazed or fractured
tooth, attrition, gingival recession, abrasion and erosion.
For example, Abrasive wear: As age advances, there
may be progressive abrasion of the natural tooth. A cut can
be made on the incisal edge to simulate abrasive changes
(Fig. 8).
Erosion: A posterior diatoric tooth can be modified to
simulate erosion (Fig. 9).

Personality Changes related to Sex

Fig. 7: Balanced of direction A delicate mold is feminine and a vigorous mold is
masculine. A medium pleasing personality mold can be
Thus, the direction of teeth must be balanced; otherwise made more masculine or feminine by squaring or roundening
the resulting arrangement of artificial teeth will look
the incisal edges (Figs 10 and 11). These personality changes
transitory and unplanned.
Balance should also be obtained in terms of visual
weights in the dental composition over a centrally located
fulcrum. Visual weights are nothing but elements on either
side of the midline requiring equal weightage. Visual
weights that have to be managed in a dental composition
are the teeth, spaces between the teeth and added gold
restorations.
For example, If a gold restoration is present on one side
of the midline, then this visual weight has to be compensated
on the other side either by a diastema between the lateral and
the canine or by a larger canine or a labially prominent canine.
Any visual weight added on one side of the fulcrum Fig. 8: Simulation of abrasive wear of natural tooth
thus, requires a balancing compensation on the other side
of the midline.
In denture esthetics the balancing problem is
complicated by the fact that the patient sees the prostheses
in the mirror in which the left and right are reversed. It is
always advisable for the dentist to make the wax try in with
the mirror along with patient to avoid confusion. An esthetic
denture has its midline placed in a stable position with the
visual weights and directions on either side in a state of
equilibrium. Fig. 9: Simulation of erosion in posterior diatoric tooth

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reference to establish the cervicoincisal length and the

amount of exposure of the anterior teeth.
A guide to the vertical composition using incisal edges
of the central incisors in their relationship to the lipline at
rest as a measure is as follows:7
• Young man: 3 mm below lipline at rest
• Young woman: 2 mm below lipline at rest
Fig. 10: A medium personality mold appear more masculine • Middle age: 1.5 mm below lipline at rest
• Old age: 0-2 mm below lipline at rest.
These values give an idea about the amount of visibility
of the central incisors which can be modified in accordance
to the patient’s esthetics.

Smile Line
Smile line is an imaginary line along the incisal edges of
the maxillary anterior teeth that should mimic the curvature
of the superior border of the lower lip during smiling.
Fig. 11: A medium personality mold appear more feminine Reverse smile line occurs when the centrals appear shorter
than the canines along the incisal plane (Fig. 12). This
with respect to sex can be incorporated to provide gender creates an unesthetic appearance when the patient smiles,
differences in complete denture fabrication. hence reverse smile line are not accepted in a complete
In selecting the artificial anterior teeth, it is useful to denture construction.
follow the 1, 2 and 3 guides5 which are as follows:
Depth Perception
1. The central incisor expresses age: Youthful teeth has
unworn incisal edge, defined incisal embrasure, low Depth perception7 is limited in the artificial tooth since the
chroma and high value. contact area is nearer to the labial surface in contrast to the
Aged teeth have less smile display, shorter teeth, high natural teeth. Thus, the contact area can be increased by
chroma and low value. depth grinding, i.e. a cut can be made on the labial mesial
Thus, age differences can be given by altering the shape, line angle of the artificial tooth. It gives an illusion of the
size, chroma and value of the central incisors. appearance of the natural teeth in an artificial denture
2. The lateral incisor expresses sex characteristics: (Fig. 13).
Feminine and masculine differences can be incorporated
in the shape of the lateral incisors. Buccal Corridor
Feminine: Shape of the lateral incisor can be made more Buccal corridor is the space created between the buccal
round and smooth. surface of the posterior teeth and the corner of the lips when
Masculine: Shape altered to be cuboidal and squarish. the patient smiles. The inclusion of buccal corridor in
3. Canine teeth express personality: Different personality dentogenics is important in achieving the gradation effect.
traits can be established with the cusp form of the canine This effect is achieved by progressively altering tooth
teeth. illumination. Existence of buccal corridor in an artificial
Aggressive, hostile angry personality requires a pointed denture is critical as it provides an added illusion of reality.5
long cuspal form. The appearance of buccal corridor is influenced by:
Passive, soft personality, blunt, rounded and short cuspal • Width of maxillary arch
form can be given. • Tone of facial muscles
These SPA factors play a significant role in applying • Positioning of the labial surface of the upper premolars
the principle of dynasthetics. • Prominence of the canines particularly at the distal facial
line angle.
Speaking Line
Arch form also has a direct influence on the buccal
Speaking line is the incisal length measured when the patient corridor.6 Ideal arch is a broader one that conforms to U
speaks. This speaking line is important since it acts as a shape which can provide the space required for the buccal

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Fig. 14: Insufficiently developed buccal corridor

Fig. 15: Properly developed buccal corridor

between the maxillary central incisors, laterals and canine

is necessary to create an attractive incisal curvature and the
esthetically required dynamic negative space,1 shape of
which is affected by the lower anterior teeth.
With much discussion about smile designing, it will be
an offence if dental composition is not discussed, as it is
the teeth that are exposed during smiling. Our ultimate goal
Fig. 12: Types of maxillary incisal curvature in
relation to lower lip as a prosthodontist is to achieve a pleasing composition in
smile by creating a harmony of various dental elements.

DENTAL COMPONENTS AND SMILE DESIGN

Incorporation of basic features of proximity—a well-aligned
teeth without diastema, similarity in shape and shade of
teeth, continuity denoted by repeated ratios in widths of
anterior maxillary teeth results in stability and harmony of
the dental components in smile design.

Fig. 13: Depth perception

corridor. The buccal corridor should not be completely

eliminated because it imparts the quality of depthness to
the artificial smile (Figs 14 and 15).

Negative Space
Negative space provides the illusion of teeth by portraying
the dark space of the mouth behind the teeth (Fig. 16). This
is important as it gives the composition of the object
depicted, i.e. the teeth. A correct interincisal distance Fig. 16: Negative space

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Tooth Size
Though various proportions have been proposed to establish
an esthetically pleasing smile, these are used only as a guide
rather than a rigid mathematical formula.8 Factors guiding
individual tooth dimensions are as follows:6

Maxillary Central Incisor

They are the focal point of a pleasing smile and should be
dominant than the rest of the teeth. Approximate length of
the central incisors should be 10 to 11 mm and the width is
calculated accordingly so that the ratio falls between 75
and 80%.

Maxillary Lateral Incisor

They are never symmetrical and influence gender
characterization.7,9 They are 2 to 3 mm lesser in width when Fig. 17: Determination of midline by dividing middle
lobe of upper lip
compared to central incisors.

Maxillary Canine the degree of tipping in any plane of reference. The guideline
for labiolingual inclination is as follows (Fig. 18):
It depicts the personality.7,10 Canine is wider than the lateral
incisor by 1 to 1.5 mm. Also canine and central incisors are Maxillary Central Incisor
longer than lateral incisor by 1 to 1.5 mm.
Maxillary central incisor can be positioned vertically or with
Midline slight labial inclination depending upon the lip support
required.
Midline refers to the vertical contact interface between the
two maxillary central incisors. Midline should be: Maxillary Lateral Incisor
• Parallel to the long axis of the face
• Perpendicular to the incisal plane Cervical part of the maxillary lateral incisor is more lingual
• Over the papilla, i.e. the midline should drop straight than the incisal edge.
down from the papilla.
A well-placed midline in conjunction with a solid
interproximal contact relationship between two central
incisors produces a desirable effect of cohesiveness of the
dental composition. A midline diastema divides dental
composition into two separate entities and disturbs the
cohesiveness of the dentition. Various anatomical landmarks
are used to establish the midline. They are midline of the
nose, forehead, chin, philtrum and interpupillary plane.
Among these anatomical guide posts, the philtrum of the
lip is the most accurate (Fig. 17).6
It is also to be noted that maxillary and mandibular
midlines do not coincide in 75% of cases. 6 So it is
inappropriate to use mandibular midline as a reference point
for establishing the maxillary midline.

Tooth Inclinations
Axial inclination is used to compare the vertical alignment Fig. 18: Relationship of upper front teeth to horizontal plane and
of the maxillary teeth to the central midline. It also refers to vertical axis

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Maxillary Canine Interproximal Contact Point

Neck of the canine is positioned more labially than the cuspal It is the most incisal aspect of the interproximal contact
tip. area. Interproximal contact point moves apically as we move
posteriorly from the midline.
Interdental Contact Area
Interincisal Distance
It is defined as the broad zone in which two adjacent teeth
touch. It follows the 50:40:30 rules6 in reference to the A correct interincisal distance among the centrals, laterals
maxillary central incisor, i.e. as we move from canine to and canine is necessary to create an attractive incisal
the central incisors, there is a gradual increase in the curvature that parallels the inner curvature of the lower lip
interdental contact area (Fig. 19). which is called incisal silhouette11 and also creating a
dynamic negative space. Smile line is related to the
Incisal Embrasure interincisal distance. A sharp curve denotes youthful smile
The incisal embrasure is the divergence of the proximal line, whereas a broad curve indicates an older dental
surface of the anterior teeth from the contact point incisally. composition (Fig. 21).
Incisal embrasure gradually increases in size from the central Smile line can be defined as silhouette that incisal edges
incisors to the canine. As a result the contact points also of upper teeth meet against negative space, i.e. the darkness
move apically. Failure to provide depth and variation to the of the open mouth. This can be easily manipulated by
incisal embrasures will result in uniform, box-like lengthening or shortening of central incisors, minimizing
appearance of the anterior teeth. If the incisal embrasures or maximizing the incisal embrasure and by deepening or
are too deep, then it makes the teeth look unnaturally pointed flattening of arch form.
(Fig. 20). This presence of an incisal embrasure gives
Incisal Edge Position
freedom to the dental composition.
Incisal edge position is determined by the degree of tooth
display required, phonetics and the patient information. This
position is crucial since it gives the pitch of the anterior
tooth which is determined by lip support and the labiolingual
positioning of incisal edge.

Tooth Alignment
Incorporating mild rotation of teeth as found in natural teeth
can be attempted. Maxillary lateral incisor, generally have

Fig. 19: Interdental contact area

Fig. 20: Incisal embrasure Fig. 21: Different smile lines

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the most predominant irregularities.12 Irregularities can be of not critical importance since the concentration of hue in
introduced in accordance with the patients’ desires, but dental shades is very less. The factors that play a major role
nevertheless should violate the rules of nature. in shade selection are:

PREPLANNED ESTHETICS Value

After considering the dental components in smile designing, Selection of appropriate value results in successful shade
planning esthetics will be our next phase. Preplanned esthetics selection. Lightness or darkness of a particular hue is called
determines the tooth space allocation of the proposed denture. as value. The lightness or darkness of the tooth is affected
Features to be considered include width and height of the by the amount of light striking the tooth that will be reflected
teeth and the location of the commisures of the mouth. to the beholder’s eye, i.e. the teeth with better illumination
The edentulous space is visualized as the surface to be appear lighter. Hence, anterior teeth appear lighter than the
utilized for a dental composition, followed by establishing posterior teeth.
the midline after which space for each tooth is horizontally
allocated (Figs 22 and 23). Tooth Texture
The space for each tooth follows a ratio: Value is affected by the texture of the tooth. Glazed surface
A/B = B/C = C/B = D/E = E/F = K, where K is a constant. or less convoluted reflective surface reflects more light than
Once incisal length is established, the actual tooth shapes unglazed surfaces. Thus, a tooth receiving more light
are then placed in the area that is assigned (Figs 24 and 25). appears lighter than when it is receiving less light. Hence,
The paramount issue of gaining esthetic approval in a the surface finish of the artificial tooth also plays a vital
composition is ensuring harmony and balance, irrespective role.
of size or ratio.
Light Source
COLOR IN DENTURE ESTHETICS
Light source is yet another factor that requires special
Color is also an important factor when considering anterior mention. It is not advisable to select shades under particular
teeth, which forms the most visible area of a smile. Hue is

Fig. 22: Preplanned esthetics—midline established Fig. 24: Vertical space allocation

Fig. 23: Horizontal space allocation Fig. 25: Actual tooth shapes assigned

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light sources as the patient is subjected to different This may be applied to all but they eliminate the personal
environmental (lighting) conditions as he or she goes about attributes of talent and the need for learning specific
her daily routine. So shade has to be selected such that it formulas that can be eluded as sins in the field of esthetic
merges with the total facial composition. dentistry, the sin against the principles of visual perception
and the sin against principles of reality.
Background Unfortunately, the factors which govern the restoration
In female patients, try-in must be done when the patient of natural appearance for edentulous patients are often
wears her lipstick because the lipstick gives the background, discussed, but frequently misunderstood. This dental art
mouth outline form and it also forms a unifying border. does not always occur automatically or are present in the
nature, but is purposely and carefully incorporated into the
Personality treatment plan, thus creating an attractive smile, which
Personality may be classified as strong, average and soft. A enhances the acceptance of an individual in our society.
strong personality is the one who is dynamic with full of
CONCLUSION
energy whereas a weak personality is exactly the opposite
of former. Thus, a strong personality indicates a need for Smile pattern of the individual patient will depend on
stronger tooth arrangement and therefore lighter shade arrangement of anterior teeth in accordance with the
selection. principles of dynasthetics and visual perception. It is
regrettable to find that the appearance of an edentulous
Facial Features patient is decided by the dental technician setting the
Dental composition has to complete with the facial features artificial teeth who has never seen the patient by himself. It
to ensure better esthetics. If there are strong facial features is the sole responsibility of the prosthodontist to accomplish
such as a large nose or dark hair, then lighter teeth are used a complete denture treatment that is much more than
to harmonize the mouth with the total facial structure. mechanics. The importance of dental art as proposed in the
Thus in complete denture construction, it is insignificant statement: ‘My physician keeps me alive but my dentist
to select a particular shade for the artificial teeth, but it is makes my life worth living’ should never be underestimated.
mandatory that teeth of different shades should be used
within the composition. There should be also mixing of REFERENCES
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ABOUT THE AUTHORS

G Rajtilak (Corresponding Author) V Rajasekar
Professor, Department of Prosthodontics, RVS Dental College and Senior Lecturer, Department of Prosthodontics, RVS Dental College
Hospital, Coimbatore, Tamil Nadu, India, e-mail: [email protected] and Hospital, Coimbatore, Tamil Nadu, India

S Deepa R Vanitha
Reader, Department of Prosthodontics, RVS Dental College and Reader, Department of Prosthodontics, RVS Dental College and
Hospital, Coimbatore, Tamil Nadu, India Hospital, Coimbatore, Tamil Nadu, India

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