JOURNAL.

OF ESTHETIC D E N T I S T K Y

The Golden Proportion Revisited

J A C K D . P R E S T O N , DDS

n the search t o create more

esthetic dental restorations, severa1 authors have advocated using
geometric or mathematic proportions to aid in establishing tooth
forms. For example, J. Leon
Williams postulated the relationship between the form of the inverted maxillary central incisor and the
outline form of the face. He stated
that the greatest harmony existed
when the two were correlated, and
advocated the square, tapering, and
ovoid typal tooth forms. However,
it should be noted that he also stated that this correlation was the
exception in nature, rather than the
rule, but when it existed, it produced the most esthetic appearance.
Although the use of typal tooth
forms resulted in the production of
numerous denture tooth molds
based upon this philosophy, the verity of this relationship has been
largely discounted.

Some authors2-s have advocated the

use of the ratio of 1:1.618 for the
development of specific dental relationships. This ratio has its origins
in antiquity and has been used by
mathematicians and artists for centuries. It has been given the name
golden proportion or divine
p r ~ p o r t i o n and
~ is used in many
other disciplines. It is the ratio
described by Leonard0 de Pisa,
Fibonacci, in his development of
the mathematic sequence shown
in Table 1. It has been used in the
design of such classic edifices as the
Parthenon, and it appears frequently in da Vincis sketches. Botanists
have found the golden proportion
to be of value in phylotaxis, the
classification of plants by their leaf
and stem structure. It is beyond the
scope of this article to discuss the
origins and development of the
ratio, but an excellent source for
such information is The Divine
Proportion by Huntley.*

Ricketts2 used the dynamic spiral

described by Huntley as a determinant for predicting growth of the
mandible. He also devised a golden

Figure 1A
Divider,

The Ricketts Golden

Figure 1 B The divider used to

evaluate facial proportions.

Presented before the American Academy of Esthetic Dentistry, August 1993.

* The Don and Sybil Harrington Foundation Professor o Esthetic Dentistry,
Chairman, Department of Continuing Education, and C airman, Department of
Oral and Maxillofacial Imaging, The University of Southern California School of
Dentistry, Los Angeles, California

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The Golden Proportion Revisited

Figure 2 The Shoemaker-Nestor

Golden Link caliper.

proportion caliper3 (Figure lA),

which he used for establishing and
evaluating ratios between various
elements of the attractive face
(Figure 1B). Lombardi noted that
the teeth have a harmonious perspective from the dominant central
incisors transitioning posteriorly,
with each element (tooth) in harmonious proportion to those adjacent.
He stated that the golden proportion
was too strong for use in determining relative tooth size, however.

1:2

= 0.500

2:3

= 0.666

3:5

= 0.600

5:8

= 0.625

8:13

= 0.615

13:21

= 0.619

2 1:34

= 0.618

3455

= 0.618

55:89

= 0.618

89:144

= 0.618

The continuation of this progression to infinity

will continue to yield a ratio of 1:0.618.

248

1991

Levin4 advocated the use of the

golden proportion for establishing
tooth size and stated that the (perceived) width of the (maxillary)central incisor is in golden proportion
to the width of the lateral incisor
(1:0.618). Similarly he found that
the width of the (maxillary) lateral
incisor is in golden proportion to
the width of the canine. It must be
noted that this proportion was
derived from the apparent size, as
viewed directly from the anterior,
for Levin also stated that attempts
to find the relationship between the
measured widths of the incisors
have been futile. He devised a grid
with the spaces in golden proportion and advocated the use of this
grid to evaluate and develop the
harmonious proportions of teeth.
Rufenacht5 repeated Levins theories
and illustrated the use of the grid.

S h ~ e m a k e radvocated
~?~
the use of
the golden proportion, and developed a precise caliper, the
Shoemaker-Nestor golden link
caliper (Figure 2), for developing
esthetic tooth ratios. He stated that
the width of the maxillary central
incisor x Q= the width of the
mandibular lateral incisor and that
in some situations the mandibular
central incisor may be used as Phi.
(The term Phi is derived from
Phidias, a Greek sculptor and
Q=0.618).Just when the mandibular central incisor was to be used
instead of the mandibular lateral
incisor was not explained.

An obvious problem arises when

actually measuring the apparent
width of teeth. It is impractical to
make such measurements directly
on the patient, and if photographs

Figure 3 A composite image of maxillary and mandibular

casts. A millimeter rule is imaged at the same time as the cast
to provide reference for the computer measuring program.

are used, a correction ratio between

photographic dimension and actual
tooth size must be established.
Nonetheless, both apparent dimension and actual dimension must be
measured for any test of the theories advanced to be conducted.

The purpose of this investigation

was (1)to evaluate the relationship
of the golden proportion to the ratio
of the size of the maxillary central
incisor to that of the mandibular
central or lateral incisor and (2)to
evaluate the relationship of the
golden proportion to the perspective
dimensions of the maxillary dentition anteroposteriorly.

Figure 4 Magnification of the image

(zoom function) facilitated measurement.

Figure 5 T h e tips of the calipers were

modified to allow more precise interproximal lacement for direct measurement of t e casts.

The null hypothesis of the study

was that (1)there is no golden proportion relationship between the
maxillary central incisor and the
mandibular central or lateral
incisor and (2) there is no golden
proportion relationship for the perceived anteroposterior progression
of the maxillary teeth. The working
hypothesis was that the theories of
Levin and Shoemaker were valid.
MATERIALS AND METHODS

Orthodontic casts of 58 second-year

dental students at the University of
Southern California were obtained.
Individual images were made of the
maxillary and mandibular casts
using a video camera and an image
capture board with a personal computer. During image capture a millimeter rule was positioned directly

below the cast to obtain a measurable relationship between the image

and the actual dimension (Figure
3 ) . Lighting and staging were kept
constant. An image measurement
program (OrthoCeph, New Image,
Tarzana, CA) was used t o measure
the apparent mesiodistal width of
all the teeth from the right canine
t o the left second molar. N o
attempt was made to separate the
material by age, gender, ethnic origin, or any other criteria. Ten of the
images were remeasured twice
(three measurements for each of the
10 images) on different days to
establish the relative repeatability
of the measurements. One individual made all the measurements. To
improve accuracy a zoom function

of the program was used to allow

more precise measurement from
pixel to pixel (Figure 4).
Fifty-two of these casts were measured directly. After trying various
calipers, the tips of a dial caliper
(Dental Dial Caliper, Masel
Industries, Bristol, VA) were
replaced with needle points flattened
on one side to allow more positive
interproximal placement (Figure 5 ) .
Attempts to make such measurements with unaltered calipers and
various other instruments had resulted in unacceptable repeatability. As
with the virtual measurements, 10
casts were remeasured twice to
establish relative error.

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I O U R N A L O F FSTIJP I I C D F N T I S T K Y

The Golden Proportion Revisited

RESULTS

Inasmuch as the measurements

could only be made to the first decimal point it was ludicrous to maintain three decimal places on the
golden proportion. Therefore,
1.618 was rounded to 1.62.
Following this logic, ratios investigated were evaluated as being within 0.03 of 1.62:l. Therefore, any
ratio that was between 1.59 and
1.65 was considered as being effectively within the 1.618:l ratio.

Of the 58 imaged casts, 10 (17%)

had a perceived maxillary
centra1:lateral incisor ratio of
between 1.59 and 1.65:l. The mean
perceived maxillary centra1:lateral
incisor ratio was 1.51:l. The range
was 1.22 -2.04:1, and the standard
deviation was 0.17.
No cast had a perceived maxillary
lateral incisor:maxillary canine ratio
within the 1.59-1.65:l range. The
mean perceived maxillary lateral
incisor:maxillary canine ratio was

1.19:l. The range was 0.56-1.58:l

and the standard deviation was
0.23. The failure to find a relationship between the maxillary lateral
incisor and canine obviated the need
to seek further relationships between
more posterior teeth.

port such theories. The results of

this study, however, not only deny
the existence of such ratios in the
average natural dentition, but also
call for the reevaluation of the
results of preceding studies that are
in contrast to this investigation.

The mean measurement deviation

for maxillary and mandibular teeth,
for both perceptual and direct measurement was 0.2 mm for the 10
casts measured three times on different days.

In the illustrations of Levins writings it is apparent that the calipers

used are not adequate to establish
actual measurements. The caliper
tips were too large to permit accurate interproximal placement.
Furthermore, no attempt was made
to present actual data, or establish
a range of error. The use of the
Levin grid similarly left much to the
imagination of the user as to precisely where the grid was to be
placed and how much latitude
might be given in its use. The
results of the use of the Levin grid
on casts that do not meet the criteria postulated (situations in which
the teeth are not in golden proportion) is not discernibly different
than the use as illustrated by Levin
(Figure 6). The grid may be made
to appear to be adaptable to a dentition, even when the dimensions
are outside the golden proportion.
It is the authors opinion, therefore,
that previous studies have suffered
from an imprecision that severely
weakens the primary premise of the
authors. When one wishes a theory
to apply, it is not difficult to invoke
it if the methods of measurement
are imprecise enough to allow such
application.

For the 52 casts measured directly,

the mean maxillary central:
mandibular lateral incisor ratio was
1.41:l. The range was 1.25-1.63:1,
and the standard deviation was
0.15. The mean maxillary
centra1:mandibular central incisor
ratio was 1.58:l and the range was
1.42-1.8O:l. The standard deviation was 0.10. Only two casts ( 3 % )
had a maxillary central incisor:
mandibular lateral incisor ratio
between 1.59 and 1.65:l. The two
casts that had ratios within this
range had the most extreme maxillary centra1:mandibular central
incisor ratios. Of these 5 2 casts, 1 3
(25%) had a maxillary
centra1:mandibular central incisor
ratio between 1.59 and 1.65:l.
DISCUSSION

Figure 6 A cast of teeth lacking the

2:.628 ratio still appears to fit the Levin
grid.

250

1YY3

It is tempting to seek mathematic or

mechanical assistance in developing
dental esthetics. It would be helpful
if valid relationships existed to sup-

PRESTON

This is not to say that the use of the

grid or the ratios advocated will not
produce an esthetic result. Such use
may well provide a pleasing outcome, as might many other
approaches. There is nothing mystical or exclusively correct about the
use of the golden proportion. The
parallel to the findings of Williams'
is obvious. Although the advocated
ratios may provide a result that is
esthetically pleasing, they are not
the ratios found in nature.
Even though the size of the n in this
study was minimal to permit extrapolation to larger populations and
for use throughout ethnically
diverse applications, the overwhelming failure of the postulated ratios
to be supported by measurements
leaves little doubt of the possibility
to make such an extrapolation.
Curiously, the mean of the maxillary centra1:mandibular central
incisor ratio of the 13 directly measured casts falling within the
1.59-1.65:l ratio that was deemed
valid was 1.618:l-exactly the
golden proportion. This is considered to be only a statistical anomaly
but is reported in the interest of
completeness. However, these casts
represented only 25% of the sample
and the range from which the mean
was derived was 1.25-1.63:l. One
must remember that dentists treat
individuals, not averages.

If one wishes to use the golden proportion as proposed by the cited

authors, it should be done with the
understanding that the theory is not
derived from nature. This study
made no attempt to evaluate or
contest other applications of the
golden proportion, but focused
solely on the ratios cited.
CONCLUSIONS

A sample of 58 images of maxillary

and mandibular casts and 52 actual
casts were measured to discern possible ratios within the golden proportion for maxillary central
incisor:maxillary lateral incisor
relationships, and maxillary lateral
incisor:maxillary canine relationships. Similarly the ratio between
the maxillary central incisor and
mandibular lateral and central
incisors was evaluated. Within the
limited sample size of this study, the
following conclusions can be made:
1. The golden proportion of
1.618:l was not found to be correlated with the relationship
between the maxillary central
incisor and the mandibular lateral incisor.
2. The golden proportion was found
to be correlated with the relationship between the maxillary
central incisor and mandibular
central incisor in only 25 YOof the
material surveyed.
3 . The golden proportion was
found in the relationship
between the perceived width of
the maxillary central and lateral
incisors in 10 of 58 images (17%).

4. The golden proportion was not

found to exist between any perceived maxillary lateral incisor
and canine widths.
5. The null hypotheses of the study
were supported by the results.
ACKNOWLEDGMENT

The author thanks Dr. Stephan

Neyret and Dr. Kathy Slama for
their work in making the images in
this study and in the pilot study
that preceded this report.
REFERENCES

1.

Williams J L . The temperamental selection

of artificial teeth, a fallacy. Dent Dig
1914;20:63-75, 125-1 34, 185-1 92,
243-259,306-321.

2.

Ricketts RE. The biologic significance

the divine proportion. A m J Orthod
1982;81:351-370.

3.

Ricketts RE. The divine proportion in

facial esthetics. Clin Plast Surg
1982;9:401-422.

4.

Levin EL. Dental esthetics and the golden

proportion. J Prosthet Dent 1978;40:
244-252.

5.

Rufenacht C. Fundamentals of esthetics.

Berlin: Quintessence, 1990.

6.

Shoemaker W A Jr, Nestor J. A time to recognize the science in the art of healing.
Florida Dent J 1981 ;52:22-23, 46-47.

7.

Shoemaker WA Jr. How to take the guesswork out of dental esthetics and function.
Florida Dent J Part I: 198758 (31:
35-39; Part 11: 1987;58 (4):25-26, 28-29.

8.

Huntley HE. The divine proportion. Netu

York: Dover Publications, 1970.

9.

Lombardi R. The principles of visual perception and their clinical application to

dental esthetics. J Prosthet Dent 1973;9:
358-381.

of

Reprint requests: Jack D. Preston, DDS, The

University of Southern California School o f
Dentistry, University Park, M C 0641, LOS
Angeles, CA 90066
01993 Decker Periodicals

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