Page 7 - GP Fall 2020

to-face and the 12:00 position can help pre- instrument to avoid potential cross contam- References
vent a parallax and improper orientations, ination issues. 1. Levin EI. Dental Esthetics and the Golden
the added advantage of the face to face is Proportion. Journal of Prosthetic Dentistry.
that it can help assess lip drape, thereby al- Clinical Example 1978;40:244-252.
lowing the clinician to easily asses incisor A 32-year-old female in good health pre- 2. Jain S, Sharma P, Shetty D, Adarsh K. Gold-
en Proportion in Different Types of Smile: A
display. sented to the office with a chief complaint Photographic Evaluation. Acta Scientific Dental
of, “I am getting married in two weeks, and Sciences 3.12 (2019): 75-80.
3. Mesio-facial Line Angle am unhappy with my smile, especially my 3. Mahshid M, Khoshvaghti A, Varshosaz M,
The primary anatomy of an incisor encom- front teeth.” Figure 8 shows the pre-op- Vallaei N. Evaluation of “golden proportion”
passes the outline form of the tooth. The in individuals with an esthetic smile. J Esthet
6
mesio-facial and disto-facial line angles Restor Dent. 2004;16(3):185-193.
make up two the components of the prima- 4. Magne P, Salem P, Magne M. Influence
ry anatomy for the central incisor. These ar- of symmetry and balance on visual percep-
eas are more forward or buccal on the tooth tion of a white female smile. J Prosthet Dent.
compared to facial depressions. As such, 2018;120(4):573-582.
when light, either ambient or from an ex- 5. Landa, LS. Anterior tooth selection and
guidelines for complete denture esthetics. In
ternal flash, strikes these line angles, they Winkler S, ed. Essentials of Complete Denture
will reflect. These “light reflective zones” Prosthodontics. 2nd ed.1988. Littleton, Mass.,
can prove extremely helpful when trying PSG Publishing Co.
to hone the size and symmetry of a smile Figure 8 - Pre-operative condition. 6. Ash M, Nelson S. Wheeler’s Dental Anatomy,
design. Physiology and Occlusion 7 Edition. Saun-
th
erative condition. Due to the fact that the ders (1992).
The difficulty lies in the fact that the line patient needed comprehensive periodontal 7. Volker AR, Köken S. Interpreting the grounds:
angles may be difficult to ascertain or track treatment, and existing time constraints, The use of Articulating Paper to Hone Symme-
unedited, especially if high magnification single-shade direct composite veneers try, Shape and Surface texture of Anterior Teeth.
and/or lighting is used, which can wash out were completed as a long term provision- American Academy of Cosmetic Dentistry Jour-
the area. There are a number of ways that al. Figure 9 is the post-operative situation. nal (In review).
line angles can be captured, including the Figure 10 is identical to Figure 9, but with
use of articulating paper. A simple method Dr. Arthur Volker
7
for marking the mesial line angle is using a graduated from the
Columbia
University
sharp graphite or wax pencil. School of Dental and
Oral Surgery. Dr. Volker
To capture the line angle, the pencil is held has published articles
at an approximately 45-degree angle to the and lectures nationally
and internationally on
facial surface of the tooth and run along the such topics as cosmetic dentistry, minimally
proximal surface using minimal pressure invasive dentistry, and dental materials. He
(Figure 6). Once marked, the line angles Figure 9 - Post-operative condition. practices in Sunnyside, New York.

Ms. Mayorga is a dental
assistant at Dent-Care
Dental in Sunnyside, NY.
She completed two years
of dental school at the
Universidad Uniandes in
Ecuador and is currently
applying to dental schools in the United
Figure 10 - Post-op highlighting the elements States.
Figure 6 - Using a pencil to mark the
mesio-facial line angle. of the anterior midline critical zone.
can be easily assessed, and adjusted using the elements of the anterior midline critical
burs or disks as needed (Figure 7). It is the zone overlaid, namely the cant, mesio-fa-
recommendation of the authors to consider cial line angle, and incisal embrasure. Note
the use of short golf pencils as a single use the improvement in symmetry and visual
harmony.

Conclusion
Though smile design can be a complex un-
dertaking, understanding and implement-
ing the components of the anterior midline
critical zone offers the practitioner a sys-
Figure 7 - Proximal line angles outlined with tematic approach to honing and predictably
pencil. completing the process. www.nysagd.org l Fall 2020 l GP 7