We are always working to further our knowledge in the area of comprehensive care treatment-planning. We are a member of several Seattle and Spear Study Clubs and watch videos on comprehensive care concepts each Wednesday at lunch-n-learns. We recently participated in a Spear Course on “Facially Generated Treatment Planning” in Scottsdale and thought we would share some highlights on smile analysis.
Step 1: Central incisor edge to face. The starting point for determining tooth position is always the maxillary central incisors. Until we establish the correct position for the central incisors we cannot determine the position of the maxillary teeth. Evaluation should include incisal edge position at rest and in a full smile as it relates to the lower lip, as well as the relationship to the posterior occlusal plane. One question to ask is: “Do the centrals exhibit acceptable, excessive, or inadequate tooth display?”
Step 2: Maxillary incisor inclination The next point of reference is facial inclination. Do the centrals exhibit acceptable, correct, labial-lingual inclination? Or are they proclined or reclined?
Step 3: Midline Location Is the midline correct or does it need adjusted right or left?
Step 4: Midline Alignment Even more significant than the position of the midline is its inclination. It should be perpendicular to the floor.
Step 5: Maxillary Occlusal Plane Following the determination of the central incisor position, it is possible to evaluate the position of the remaining maxillary teeth based upon the incisal edge of the centrals. In this image you can see the centrals are apical to the occlusal plane of the posteriors. If the centrals are lengthened 1 to 1.5mm, the existing posterior position looks quite good.
Step 6: Determine Gingival Levels Display Following the determination of the desired incisal and cusp position, the correct gingival-levels should be evaluated. Is the amount of gingival display acceptable or excessive? Remember that often teeth erupt as they wear. By evaluating overall tooth length from our desired incisal edge position, we can determine if some gingiva needs to be moved based upon pleasing width-to-length ratios.
Step 7: Determine Free Gingival Margin Levels and Pupilla Levels Are the gingival zenith positions symmetrical among partner teeth? Are they allowing proper esthetic tooth proportions?