Review - Golden proportion in denture esthetics

REVIEW

GOLDEN PROPORTION IN DENTURE ESTHETICS

MEENU MERRY C. PAUL 1 AND SANU TOM ABRAHAM 2
1

Department of Prosthodontics and 2Department of Orthodontics Indira Gandhi Institute of Dental Sciences, Nellikuzhi PO Kothamangalam, Ernakulam, Kerala 686691, India Correspondence to : drsanutom@yahoo.co.in; meenumerry@yahoo.com

Abstract Esthetic dental treatment involves artistic and subjective components designed to create the illusion of beauty. Scientific analysis of beautiful smiles has shown that the principle of golden proportion can be systematically applied to evaluate and improve dental esthetics in predictable ways.The golden proportion mathematically denotes that the ratio of a smaller to a larger length is equal to the ratio of the larger length to the total length. This ratio has been used for centuries by artists, mathematicians, architects and engineers to study and design proportion in art and nature. This review article describes the application of the Golden Proportion in dentistry, as a tool for the initial evaluation of symmetry, dominance and proportion for esthetic treatment planning.

Health Sciences 2013;2(1):JS008

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Review - Golden proportion in denture esthetics

Introduction One of the important features, predicting the attractiveness of the face is the smile and most often the need for esthetics motivates the patient to seek dental 1,2,3 treatment. Beauty is power, a smile is its sword- Charles Reade. 4 But, what is beauty? Is it something that can be produced by taking some measurements, or is it based purely upon the perception and realization of the beholder? In the study of nature, art and life itself, we discover the existence of a common principle running throughout with a pleasant, magical proportion - The Golden Proportion. Why Golden? because it seems to be so noble and perfect with many amazing properties. The first feature to understand is that the beauty of nature shows not just one simple Golden proportion, but a multiple of relationships in the Golden Proportion. Can we do exactly the same when making our dentures? History of golden proportion The term golden proportion (GP) has been used for centuries by artists (Leonardo Da Vinci, Sectio Aurea The Golden

section), mathematicians (Pythagorus, Luca Paccioli-Da Divine Propportine -The Divine Proportion, Fibonacci -Fibonacci numbers), architects and engineers to study and design proportion in art and nature. Golden Proportion was used in the ancient Greek architecture, Parthenon, considered the most beautiful architectural creation in history, has all its parts laid out in GP. One cannot talk about Golden Proportion without referring to its counterpoint, which is the Fibonacci Series. The concept of golden proportion The ancient Greeks believed that there was a constant proportion between a large and a small in the beauty of nature.Whilst the concept of golden proportion is easy to understand, attempts at its application have proved to be complex and difficult to explain.5 The golden ratio is the number you get when you compare the lengths of certain parts of perfectly beautiful things. The peacock feather has 12 discreet Golden proportions, which are all interrelated (Figure 1). Nature is abundant with examples of golden proportion. From the double helical form of our DNA to flowers and insects; the golden proportion is evident all around us.

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Review - Golden proportion in denture esthetics

Golden Rectangle, whose sides are having a golden relationship to each other. The Golden Rectangle is said to be one of the most visually appealing of all geometric forms.8 The Golden Proportion Caliper (The Golden Mean Gauge)-The GP Calipers were developed by Ricketts. 9 These Calipers always open to a constant Golden Proportion between the larger and smaller portions (Figure 2). The use of the gauge makes it easy to assess the golden proportion.

Figure 1. Peacock feather having 12 discreet golden proportions The Golden Proportion mathematically denotes the ratio of a smaller to a larger. Length is equal to the ratio of the larger length to the total length. The ratio is equal to 0.618 or 1.618.6 It is mathematically depicted as Greek letter phi- (studied by Greek sculptor, Phidias)7 This ratio is also referred to as the Fibonacci Ratio or Divine Ratio. The symbol of golden proportion is the pentagon, which was the symbol of the Pythagorean School, which was deeply involved in the study of golden proportion. Golden Proportion occurs in triangles, circles and spiralsbut notably in the

Figure 2. Golden Proportion Calipers always opens in GP GP in dental esthetics Application of GP to dental esthetics was first documented by Levin in 1978.10 He explained the association of proportion with an esthetically pleasing dentition and smile. A proportion between 2 adjacent parts which is repeated across enhances the unity

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Review - Golden proportion in denture esthetics

within the diverse parts of a composition. 11 Lombardi stated that when this repeated ratio is equal to the Golden Mean, the composition is said to be esthetic. Chiche published a prosthodontic book with references to Golden proportion.12 Shoemaker wrote a series of articles relating to GP and aesthetics.13

Tooth to tooth proportion Levin advocated the use of the golden proportion for establishing tooth size and stated that the width of the central incisor is in golden proportion to the lateral incisor, as is the lateral to canine and the canine to first premolar, when viewed from the front (Figure 3 and 4).14

Figure 3. Central incisor, lateral incisor & canine are not in golden proportion

Figure 4. Central incisor,lateral incisor and canine are in golden proportion This phenomenon has been combined in a grid (developed by Lewin) called the diagnostic grid or golden proportion grids which can be used to assist in perfecting the

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Review - Golden proportion in denture esthetics

esthetics of anterior teeth (Figure 5). 15These grids are templates for spaces in the GP, between the teeth, from central incisor, to first bicuspid, based on the widths of the central incisor, with 4 grids varying from 7.5 to 9.0mm.16 It also shows that the width of teeth is in Golden Proportion to the width of smile(from lips at one corner of the mouth, to the other corner) as seen in Figure

5. But the common errors due to parallax should be avoided while using the gauge at chairside. These errors can be avoided by using the accurate paper grids in the mouth.16 Levin also states that when doing facings for teeth, it is necessary to remove tooth substance mesially and distally on central and lateral and buccally on the canine and premolar.

Figure 5. Golden Proportion Grid illustrating how well the teeth fit into the golden proportion spaces. Note that the neutral buccal space is in golden proportion to the teeth showing in the smile Bukhary et al conducted an interesting study in which six photographs with different widths of lateral incisor were used.When people were asked to choose the best; not surprisingly, the lateral incisor closest to the golden proportion was selected.17 However, in a recent study, golden proportion was not found between the width of the right central and lateral incisors in 53% of women and 47% of men (in Indian population).18 The results of the study revealed that the golden percentage was rather inconstant in terms of relative tooth width.18 Anterior teeth and width of smile The anterior aesthetic segment (8 teethcentral incisor,lateral incisor,canine and 1 st premolar is in Golden Proportion to the

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Review - Golden proportion in denture esthetics

width of smile) is in golden proportion to the width of the smile.19 The Golden rectangle of the central incisors : Stephen Marquardt found that the height of

the central incisors is in the Golden Proportion to the width of the two centrals (Figure 6).

Figure 6. The width of both central incisors is in golden proportion to their height (The Golden Rectangle) The golden rectangle defined by the incisal edge of the maxillary central incisors, if they are of normal length, to the superior tip of the eyebrow and the pupillary width can be used as a guide in determining incisal edge position.20,21,22 Another guide to assess the incisal edge of the maxillary central incisors is the golden proportion between subnasale to the incisal edge and that to the menton. The incisal edge of the incisors divides the distance from the bottom of the nose to the bottom of chin into golden proportion. Still, one can also assess incisal edge position with the golden proportion that exists between the eyes, the incisal edge of the maxillary incisors (if ideal in length), and the chin.22 The Golden Proportion gives good guidance for the position of the height of the incisors but this only applies in about 75% of the population.23 The maxillary central incisors, because of their position in the front of the arch, should appear to be the widest, whitest, and therefore, the most predominant teeth when viewed from front.

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Review - Golden proportion in denture esthetics

Height of lip line: In the relaxed face, where the teeth are not touching together (when the lower jaw is in the rest position with free way space present) the lip line divides the lower third of the face into the GP. Golden proportion exists between (Figure 7) 1. The central incisor and lateral incisor, lateral incisor and canine, canine and 1st premolar (8 teeth of the anterior aesthetic segment are in GP to each other) 2. The 2 central incisors(width of centrals is in GP to their height) 3. The anterior teeth and width of smile (8 teeth of the anterior aesthetic segment is in GP to the width of smile) 4. The lower edge of the nose to the incisal edge of the maxillary incisors 5. The incisal edge of the maxillary incisors to the bottom of the chin 6. The inner canthus to the outer canthus of each eye 7. The inner canthus of the right eye to the inner canthus of the left eye. 8. The pupil of the eye to the inner canthus of the eye

9. The midline between the eyes to the inner canthus of the eye 10. The cervical apex of a tooth to the height of the gingival papillae 11. The height of the gingival papillae to the incisal edge of a tooth.

Figure 7. Various golden proportions seen in the face (explained in detail in the text) At times, the GP of maxillary anterior teeth may have a larger ratio on one side of the arch relative to the other side ( eg., when a peg lateral is present unilaterally). Therefore

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Review - Golden proportion in denture esthetics

it is clear that for golden proportion to be useful in esthetic dentistry, it must be adapted for easy bilateral analysis of the teeth. Snow advocates the use of the Golden Percentage as a means of applying the golden proportion across the midline to encompass the total canine-to-canine width (six anterior teeth).24 According to him, the proportional width of each tooth should be: canine 10%, lateral 15%, central 25%, central 25%, lateral 15% and canine 10% of the total distance across the anterior segment. The principle of the golden percentage in evaluation and treatment planning appears to be of significant benefit in esthetic smile design. Whats the latest? A new dental software has been developed to determine the dental golden proportions digitally (PhiDental). In addition to the clinical grids used in mouth and the golden gauge we can do a GP analyses and manipulation with a digital camera. Conclusion In today's health and esthetic conscious world, the smile is considered an important component of an individual's overall appearance and well being. Golden Proportion is considered as the Starting Point in designing the relative width of teeth in a beautiful smile. Esthetic dental treatment involves artistic and subjective

components designed to create the illusion of beauty. Scientific analysis of beautiful smiles has shown that the principle of golden proportion can be systematically applied to evaluate and improve denture esthetics in predictable ways. Golden Proportion is undoubtedly a useful tool in the initial evaluation of proportion in tooth arrangement and cosmetic dental treatment planning. Acknowledgement: We thank Dr. Sanu Tom Abraham for providing photographs and pencil drawing for the publication of this article. References 1. Mack MR. Perspective of facial esthetics in dental treatment planning. J Prosthet Dent 1996;75:169-76. 2. Morley J, Eubank J. Macro esthetic elements of smile design. J Am Dent Assoc 2001;132:39-45. 3. Murell GA. Complete denture esthetics. Dent Clin North Am 1989;33:14555. 4. Hatfield E and Sprecher S. Mirror, Mirror- The importance of looks in everyday life. SUNY Press, Albany, NY, 1986.

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Review - Golden proportion in denture esthetics

5. Vegter F, Hage J. Clinical anthropometry and canons of the face in historical perspective. Plastic and Reconstructive Surgery 2000;106:1090-1096. 6. Ricketts RM. The biologic significance of the divine proportion and Fibonacci series. Am J Orthod 1982;81:35169. 7. Lombardi R. The principles of visual perception and their clinical application to dental esthetics. J Prosthet Dent 1973;29: 358-381. 8. Philips E. The perfect gap. Oral Health 1999 April; 57-66. 9. Ricketts RM. The golden divider. J Clinical Oncology 1981;15:752-759. 10. Levin EI. Dental esthetics and the golden proportion. J Prosthet Dent 1978;40:244-252 11. Ward DH. Proportional smile design using the recurring esthetic dental (red) proportion. Dent Clin North Am 2001;45:143154. 12. Chiche G. Esthetics of anterior fixed prosthodontics. Quintessence, Chicago, IL 1994. 13. Shoemaker WA. How to take the guess work out of dental esthetics and

function. FLA Dental Journal 1987;58:2529. 14. Murthy BV, Ramani N. Evaluation of natural smile: Golden proportion, RED or Golden percentage. J Conserv Dent 2008;11:1621. 15. Preston J. The golden proportion revisited. J of Esthetic Dentistry 1993;5:24725. 16. Edward IL. The updated application of the golden proportion to dental esthetics. Aesthetic Dentistry Today 2011;5 No: 3. 17. Bukhary G, Tredwin M. The influence of varying maxillary lateral incisor dimensions on perceived smile aesthetics. British Dental Journal 2007;203:687-693. 18. Naveen GC, Vaikunth VK, Vedant R. Golden proportion assessment between maxillary and mandibular teeth on Indian population. J Adv Prosthodont 2012;4:7275. 19. Gillen RJ, Schwartz RS, Hilton TJ, Evans DB, et al. An analysis of selected normative tooth proportions. International Journal of Prosthodontics 1994;7:410-417. 20. Bell AR. The geometric theory of selection of artificial teeth: is it valid? J Am Dent Assoc 1978;97:637-40.

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Review - Golden proportion in denture esthetics

21. Philip NS, Daryll CJ, Harrison A. Methods used to select artificial anterior teeth for the edentulous patient. A historical overview. Int J Prosthodont 1999;12:51-8. 22. Latta GH Jr, Weaver JR, Conkin JE. The relationship between the widths of the mouth, inter alar width, bizygomatic width and inter pupillary distance in edentulous patients. J Prosthet Dent 1991;65:250-4. 23. LaVere AM, Marcroft KR, Smith RC, Sarka RJ. Denture tooth selection: An

analysis of the natural maxillary incisor compared to the length and width of the face. Part I. J Prosthet Dent 1992;67:810-2. 24. Snow SR. Esthetic smile analysis of maxillary anterior tooth width: The golden percentage. J of Esthetic Dentistry 1999;11:177-184.

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