MACRO AND MICRO

ESTHETICS
CONTENTS
 INTRODUCTION

CLASSIFICATION OF
ESTHETICS
MACRO ESTHETICS

MICRO ESTHETICS

CONCLUSION
INTRODUCTION
“ A facial expression in which the eyes brighten and the corners of the mouth curve
slightly upward and which expresses especially amusement, pleasure, approval, or
sometimes scorn ”
- Merriam Webster

Enhancement of facial beauty is one of the primary elective goals of

patients seeking dental care.

During interpersonal interactions, the eyes primarily scan other people's

eyes and mouth, with little time spent on other features. (Miller, 1970)
34%
eyes

Important
features in
facial esthetics
34% 31%
eyes smile

Important
features in
facial esthetics
 34% 31%
eyes smile

Important
15% features in 10% hair
overall facial esthetics
facial
proportions

5% shape
of nose
It is important to note that there is a wide range
of combinations of smile characteristics that
makes it more or less pleasant, specially when
the entire face of the patient is included in the
observation.

Kokich Jr et.al, observed that people, when

seeing a smiling face, look first and for a longer
period of time to other areas of the face before
they look at the teeth.
For this reason, micro esthetics must be considered with other variables
related to the smile (mini esthetics) and to the face (macro esthetics) and
must be in harmony with the proportions and dimensions in the dental
arches.
The goal of treatment should be attainment of the best possible esthetic
result, dentally and facially.
 SMILE DESIGN WHEEL

For any smile design procedure, the clinician needs to

consider the elements of the smile design pyramids —
psychology, health, function and aesthetics (PHFA)
The Smile Design Wheel was devised as a simple
guide to the most important components of smile
design, their clinical significance and sequence to be
maintained during the smile design procedure.
 Step I: Understand— The pyramid of psychology
Step II: Establish— The pyramid of health
Step III: Restore— The pyramid of function

Step IV: Enhance— The pyramid of aesthetics

MICRO

MINI

MACRO
CLASSIFICATION
OF SMILE ESTHETICS
 MACRO MICRO MINI
ESTHETICS ESTHETICS ESTHETICS

- Assessment of the face in all - Includes assessment of tooth - Focuses on the smile
three planes of space. proportions. framework.
- Orthodontists bring about - This determines the - It includes the assessment
major changes. relationship of teeth to each of the relationship of the
other. dentition to the face.
 MACRO
ESTHETICS
Deals with the overall structure of the face and its relation to the smile.
To appreciate the macro-aesthetic components of any smile, the visual macro-
aesthetics distance should be more than 5 feet.
The first step in evaluating facial proportions is to take a good look at the patient,
examining him or her for developmental characteristics and a general impression.
Assessment is done using various facial photographs, reference points and their
interrelation.
 FACIAL PROFILE
PROPORTIONS

LIP POSTURE SYMMETRY

 FACIAL PROPORTIONS
VERTICAL PROPORTIONS The face is ideally divided into equal thirds:

Upper: trichion to glabella

Middle: glabella to subnasale
Lower: subnasale to menton

Vertical facial proportions in the frontal and

lateral views are best evaluated in the context
of the facial thirds.
 FACIAL PROPORTIONS
An ideally proportional face can be divided into HORIZONTAL PROPORTIONS
central, medial, and lateral equal fifths.
The separation of the eyes determine the central
fifth and the width of the eyes, which should be
equal determine the medial fifths.
The nose and chin should be centered within the
central fifth, with the width of the nose the
same as or slightly wider than the central fifth.
 FACIAL PROFILE
Facial profile helps in diagnosing gross deviation
in the maxillomandibular relationship.

Examination is done by placing the patient in the

physiologic natural head position and viewing from
the side.

Facial profile is assessed by joining two reference

lines.

1. Line joining forehead and soft tissue point A.

2. Line joining point A to soft tissue pogonion.
 FACIAL DIVERGENCE
Coined by the eminent orthodontist-anthropologist Milo Hellman.
Is defined as an anterior or posterior inclination of the lower face relative to the forehead.
Assessment is done by a line drawn from the forehead to the chin.
The facial divergence is to large extent influenced by the patient's ethnic and racial
background.
Divergence of a straight profile line does not indicate facial or
dental disproportions.
It must be distinguished from the profile convexity or
concavity that does indicate disproportions.
 FACIAL SYMMETRY
Facial symmetry is defined by the facial midline.
The midline runs through the center of the face and a philtrum of the lip, dividing it into
right and left sides.

A small degree of bilateral facial asymmetry exists in

essentially all normal individuals.
The more symmetric and identical the sides, the closer
they come to bilateral duplication or mirror images, the
more inherently harmonious and beautiful the face
(horizontal symmetry).
 LIP POSTURE & INCISOR
PROMINENCE
Detecting excessive incisor protrusion or retrusion is important because of the effect on space
within the dental arches.
Excessive protrusion of incisors is determined by prominent lips, separated by more than 3 to
4 mm in relaxed position, that have to be strained to achieve closure.
Retraction of teeth in such a patient will aid in improving lip function as well as facial esthetics.
Burstone has stated that a decrease in lip prominence following retraction occurs only till lips
close at rest without strain.
However, when prominent lips close without strain, then the
dentition is not at fault and retraction in such cases would
provide no benefit apart from making the nasolabial angle
more obtuse.

Lip posture and incisor prominence should be evaluated by

viewing the profile with the patient’s lips relaxed.

In evaluating lip protrusion, it is important to keep in mind that everything is relative, and the lip
relationships with the nose and chin affect the perception of lip fullness.
The larger the nose, the more prominent the chin must be to balance it, and the greater the
amount of lip prominence that will be aesthetically acceptable.
It can be helpful to look at lip prominence relative to a line from
the tip of the nose to the chin (E-line).
Another helpful guideline is to consider the nasolabial angle (the
angle between the ventral surface of the nose and the labial
surface of the lip). A mildly obtuse angle is considered normal.

NASOLABIAL
ANGLE

E - LINE
 For skeletal problems, treatment planning depends on the diagnostic information
from the macro esthetics part of the clinical examination and considering the
possibilities for correcting facial disproportions.

There are three possibilities:

1. Orthodontic camouflage
2. Orthognathic and/or plastic surgery
3. Orthodontic growth modification, for growing patients only.
 MICRO
ESTHETICS
 TOOTH CONNECTORS EMBRASURES GINGIVAL TOOTH SHAPE
PROPORTIONS HEIGHT, SHAPE & COLOR
& COLOR
 TOOTH PROPORTIONS
The smile, of course, reveals the anterior teeth, and two proportions should be considered :
The relation between height and width of each tooth,
The relation of height and width among the teeth.

Gillen et al found the following proportions of width among the upper anterior teeth:
Lateral incisors have 78% of the width of the central incisor and 87% of the width of the canine
Canine has 90% of the width of the central incisor

Gillen RJ, Schwartz RS, Hilton TJ, Evans DB. An analysis of selected normative tooth proportions. International journal of prosthodontics. 1994 Sep 1;7(5).
 Gillen et al suggests that the height of upper lateral
incisor must be 82% of the height of the crowns of the
central incisor and canine.
Most authors define the height/width ratio of 0.80 for
the upper central incisor as a standard.

Chu et al developed a proportionality gauge

(commercialized by Hu-Friedy®) uses a
formula, for dental proportions that are visually
available in a color scale that must be considered
by the professional.
 PRINCIPLES OF GOLDEN
PROPORTIONS
The apparent widths of the maxillary anterior teeth on smile, and their actual mesiodistal width,
differ because of the curvature of the dental arch such that not all of the lateral incisors and only a
portion of the canine crowns can be seen in a frontal view.

These principles suggest that there is an ideal

mathematical ratio of 1.6:1:0.6 exist between the
actual widths of the centrals, laterals and cuspids
when they are viewed simultaneously from the front.
The principles of golden proportion are generally
used as a guide rather than a rigid mathematical
formula.
 CONNECTORS
The connector (interdental contact area) is where adjacent teeth appear
to touch and may extend apically or occlusally from the actual contact
point.

In other words, the actual contact point is likely to be a very small area,
and the connector includes both the contact point and the areas above
and below that .

The connector height moves apically from the centrals to the posteriors.
The most esthetic relationship of connector area between the maxillary anterior
teeth is referred to as the 50-40-30 rule.

The contact point between central incisors must correspond to 50% of the height of
the crown, and must gradually reduce, turning into 40% between central and lateral
incisors, and 30% between lateral incisor and canine.
 EMBRASURES

The embrasures are triangular spaces incisal

& gingival to the contact.
The embrasures are generally larger in size to
the connectors and the interdental papilla fills
the gingival embrasure.

When the interdental papillae are short, open gingival

embrasures are present above the connectors forming
unaesthetic black triangles.
Reshaping of teeth by orthodontic root
paralleling and flattening of the mesial BEFORE & AFTER

surfaces of the central incisors, followed by

space closure, will lengthen this contact area
and correct the black triangles.
 GINGIVAL HEIGHT, SHAPE and
CONTOUR
Proportional gingival heights are needed to produce a normal and attractive dental
appearance.
The central incisor has the highest gingival level, the lateral incisor is approximately 1.5
mm lower, and the canine gingival margin is at the level of the central incisor.

Maintaining these gingival relationships

becomes particularly important when
canines are used to replace missing
lateral incisors or when other tooth
substitutions are planned.
Gingival shape refers to the curvature of the
gingiva at the margin of the tooth.
For best appearance, the gingival shape of the
maxillary lateral incisors should be a symmetric
half-oval or half-circle.
The maxillary centrals and canines should exhibit
a gingival shape that is more elliptical and oriented
distally to the long axis of the tooth.
Orthodontically established by

1. position of the bracket bonded to the upper anterior teeth.

2. second-order bends on orthodontic wires, also known as artistic bends that define
the mesiodistal tippings of these teeth.
Also can be corrected by the applications of a Soft Tissue Laser.
The gingival zenith (the most apical point of the gingival tissue) should be located distal
to the longitudinal axis of the maxillary centrals and canines; the gingival zenith of the
maxillary laterals should coincide with their longitudinal axis.
 Impact of altered gingival characteristics on smile esthetics

This study was designed to determine the perceptions of laypeople to variations in soft
tissue esthetics during smile.

Conclusion: Laypersons have considerable negative perception to asymmetric gingival

alterations and to optical color changes caused due to black triangles, inflammation,
and pigmentation of the gingiva. Whereas alteration in gingival contour and zenith
have least impact on smile esthetics.

Panchali Batra, Anika Daing, Imam Azam, Ragini Miglani, and Ashu Bhardwaj; Impact of altered gingival characteristics on smile
esthetics: Laypersons perspectives by Q sort methodology. Am J Orthod Dentofacial Orthop 2018;154:82-90.
 TOOTH SHAPE AND COLOR
The shape, size and color of teeth should be harmony for an attractive and beautiful smile.
Shape is as noticeable as shade. Each front tooth has a particular ratio of width to height of
each tooth and a relative proportion to the other front teeth.

Shade of six front teeth naturally varies. The

two front teeth i.e. centrals are the lightest,
laterals are slightly less bright than the central
incisors. The next adjacent teeth are cuspids
are typically a full shade different than the
central incisors.
The color and shade of the teeth change with increasing age. The teeth appear
lighter and brighter at a younger age and darker and duller as aging progresses.

This is related to the formation of secondary dentin as pulp chambers decrease in size
and to thinning of the facial enamel, which results in a decrease in its translucency
and a greater contribution of the darker underlying dentin to the shade of the tooth.

A normal progression of shade change from the midline posteriorly is an important

contributor to an attractive and natural-appearing smile.
CONCLUSION
The cumulative visual impact of the smile cannot be associated exclusively with the
beauty of individual teeth.
Harmony amongst all smile components is more important than merely focusing on a
single ideal smile constituent.
Smile design involves several areas of evaluation and treatment planning. It should not
be forgotten that each patient is unique, representing a special blend of age
characteristics and expectations, as well as sex and personality specificity.
The smile management of a patient starts right from understanding the patients
perceptions, concepts and needs of a beautiful smile and integrate it with our diagnosis,
treatment plan, and biomechanics so that at the end of day when treatment finishes both
the clinician and the patient have a reason to smile.
THANK YOU
& keep smiling
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