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Evaluation of ‘‘Golden Proportion’’ in Individuals with

an Esthetic Smile

M I N O O M A H S H I D , D D S , M S*
A L I R E Z A K H O S H V A G H T I , D D Sy
M A S O U D V A R S H O S A Z , D D S , M Sz
N A S E R V A L L A E I , M S§

ABSTRACT
Background: One of the most important tasks in esthetic dentistry is creating harmonious
proportions between the widths of maxillary anterior teeth when restoring or replacing these teeth.
The ‘‘golden proportion’’ is a main guideline introduced in this field.
Purpose: This study aimed to investigate the existence of the golden proportion between the
widths of the maxillary anterior teeth in individuals with an esthetic smile.
Materials and Methods: This study was conducted with 157 dental students (75 women and
82 men), with ages ranging from 18 to 30 years. Students whose natural smile did not develop any
visual tension (see below) with regard to the study’s and their own criteria were selected as having
esthetic smile. An image measurement program was used to measure the apparent mesiodistal
widths of six maxillary anterior teeth on the scanned photographs of these subjects. The existence
of the golden proportion was investigated in the width ratios of maxillary anterior teeth.
Results: The golden proportion was not found to exist between perceived maxillary anterior
teeth widths of individuals with an esthetic smile.
Conclusion: The golden proportion is not a common factor in esthetic smiles.

CLINICAL SIGNIFICANCE
This article suggests considering the dentofacial specificities of each individual and also the wide
variety of natural teeth proportions when restoring or replacing the maxillary anterior teeth.
However, individual cultural characteristics and perception of beauty must be considered.
(J Esthet Restor Dent 16:185–193, 2004)

A considerable number of studies


have shown that people are
more concerned about missing ante-
function of the teeth.1 One of the
most important tasks in esthetic
dentistry is the creation of harmo-
The concept of the ‘‘golden propor-
tion’’ has often been offered as a
cornerstone of smile design theory.2
rior teeth and their replacement than nious proportions between the
about posterior ones as esthetics widths of maxillary anterior teeth Aristotle pointed out the value of
seems to be more important than the when restoring or replacing them. proportion in esthetics as early as

*Associate professor, Department of Fixed Prosthodontics, Dental School, Shahid Beheshti University of
Medical Science, Tehran, Iran
y
General practitioner, Tehran, Iran
z
Assistant professor, Department of Radiology, Dental School, Shahid Beheshti University of Medical
Science, Tehran, Iran
§
Statistical consultant, Dental Research Center, Dental School, Shahid Beheshti University of Medical
Science, Tehran, Iran

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GOLDEN PROPORTION IN INDIVIDUALS WITH AN ESTHETIC SMILE

the fourth century BC. The golden He also devised a grid with the spaces teeth, which had been categorized
proportion was described by the in golden proportion and suggested according to different tooth heights
Pythagoreans in the sixth century BC, that this grid be used to evaluate and proportions.14 The images were
and a little later by the Greek and develop well-proportioned sent via e-mail to dentists in 38
geometrician Euclid. However, long teeth.2 Shoemaker has also endorsed countries to determine their esthetic
before the Greeks, the Egyptians the use of the golden proportion in preferences. It was reported that the
had found and set up the golden anterior esthetics.7,8 dentists preferred the golden pro-
number f (1.618), as the width to portion when viewing very tall teeth
length ratio in the Egyptian rect- Preston measured 58 computer- and that they considered this pro-
angle was 0.6 (fV).3 The golden generated images of dental casts portion less desirable for teeth of
proportion was used in ancient with an image-measurement pro- normal height or shorter teeth.14
Greek architecture to design the gram and evaluated the frequency of Ward believed that when the golden
Parthenon, and also in da Vinci’s the golden proportion (considered proportion is used, the lateral
classic drawings of human anatomy. to be in the range of 0.61–0.63) in incisor appears too narrow and the
This ratio is approximately the ratios of the perceived maxillary resulting canine is not prevalent
1.61803:1; that is, the smaller sec- lateral to central incisors and canine enough.15 He preferred using the
tion is about 62% the size of the to lateral incisors.9 He found that 70% proportion, and he also
larger. The uniqueness of this ratio natural teeth were rarely in the recommended adhering to the
is that the ratio of the smaller part to golden proportion (17% maxillary concept of repeated ratio, which
the larger part is the same as the lateral to central and 0% canine to had been defined by Lombardi
ratio of the larger part to the whole.4 lateral). He also reported that the in 1973.6
mean perceived maxillary lateral-
Ricketts devised a golden propor- to-central incisor ratio was 0.66 Surprisingly, according to Levin’s
tion caliper to establish and evaluate and the mean perceived maxillary idea,2 the golden proportion has
the ratios between various elements canine-to-lateral incisor ratio was been introduced in most textbooks
of the attractive face.5 Lombardi 0.84.9 Gillen and colleagues, in a as an esthetic guideline in maxillary
was the first to propose the appli- study of 54 subjects, found that the anterior teeth restoration.4,16–19
cation of the golden proportion in golden proportion was rarely Consequently, when using golden
dentistry, but he also stated, ‘‘It has seen.10 Their measurements were proportion, we deal with various
proved too strong for dental use.’’6 made directly on the casts, rather and sometimes contradictory issues,
In addition, he defined the idea of than on the frontal images. which is confusing for both the
a repeated ratio, which implies clinician and technician.
that in an optimized dentofacial Snow stated that the concept of the
composition from the frontal aspect, golden percentage is a useful appli- Therefore, the object of this study
the lateral to central width and the cation in the diagnosis and devel- was to investigate the existence
canine to lateral width are repeated opment of symmetry, dominance, of the golden proportion between
in proportion.6 Levin pointed out and proportion for an esthetically the widths of the maxillary ante-
that ‘‘the width of the maxillary pleasing smile.11 Some other rior teeth in individuals having an
lateral incisor is in the golden pro- authors have also mentioned the use esthetic smile. The null hypothesis
portion to the width of the central of this proportion in anterior of this study was that there is no
incisor and also the width of the esthetics.12,13 Rosenstiel and col- golden proportion for the per-
maxillary canine to the lateral inci- leagues generated some computer ceived maxillary anterior teeth
sor when viewing from the front.’’2 images of the six maxillary anterior widths. The working hypothesis

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was that the golden proportion tute visual tension if they disturbed form (eg, square, oval) during
exists between the widths of the the balance of dentofacial composi- smiling. Those who expressed their
maxillary anterior teeth. tion during smiling (Figure 2)16: dissatisfaction with two or more of
the above items or who were not
MATERIALS AND METHODS  Unpleasant dental alignment satisfied with their smile at all were
In this descriptive study, sequential (crowding, spacing, rotation, or classified as having visual tension
sampling was employed. Those severe dental tilt) per their own judgment. All such
students entered into the study did  Remarkable malformations, individuals were also excluded from
not have any missing teeth, except discoloration, or structural defor- the study.
for possibly the third molar. In mities of the teeth
addition, none of the students had  Unpleasant fractured teeth A frontal photograph was taken of
received any orthodontic treatment.  Severe dentofacial deformities each individual with an esthetic
Those with maxillary anterior  Unpleasant gingival color or smile. The upper lip was retracted
restorations, trauma, or any max- contour in all photographs to clearly display
illofacial surgery were excluded  Obvious asymmetries the maxillary anterior teeth as well
from the study. The individuals as its respective gingiva (Figure 3A).
whose natural smile did not de- Those students whose smile cre- Lighting and staging were kept
velop visual tension with regard to ated visual tension according to constant. All photographs were
the study’s and their own criteria study criteria were not enrolled in scanned and saved in a personal
were considered to have an esthetic the study. computer using an image-
smile (Figure 1). The approval to measurement program (DimaxisR
use human subjects was obtained Individuals who did not develop 2.3.3, Planmeca, Helsinki, Finland).
from the governing body of the visual tension according to the This was to enable measurement of
Shahid Beheshti University of criteria of the study were asked if the apparent mesiodistal width of
Medical Science. they were pleased with the color each tooth from canine to canine.
of their teeth, the color of their All measurements were performed
The following were considered gums, their tooth visibility, their by one individual. The zoom func-
within study parameters to consti- gum visibility, and their tooth tion of the program was used to

Figure 1. A, B, Individuals with an esthetic smile.

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GOLDEN PROPORTION IN INDIVIDUALS WITH AN ESTHETIC SMILE

Figure 2. The study’s criteria for visual tension: A, unpleasant dental alignment; B, unpleasant dental discoloration and gingival
contour; C, unpleasant dental alignment and remarkable malformation of teeth; D, unpleasant dental alignment and
dentofacial deformity.

Figure 3. A, The upper lip was retracted in all photographs to clearly display maxillary anterior teeth as well as their respective
gingiva. B, Magnification of the images (zoom function), providing precise indication of the mesial and distal contour of the
tooth and measurement.

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achieve a more precise measure- Because of the negative effect of 47.6% were excluded because of
ment and indication of the mesial some factors, including rotation, their visual tension according to
and distal contour of the anterior spacing, overlapping, and other the study’s criteria. A further
teeth (Figure 3B). malalignments of teeth, on the 11.3% were excluded because of
relative proportion of each anterior their own perceptions of visual
Ten images were remeasured by tooth as seen in the frontal view,11 tension. Finally, 157 subjects, 82
the two other investigators to all photographs were evaluated males and 75 females, ages 18 to
establish the validity of the mea- again. Any individuals exhibiting 30 years, were considered to have
surements. The Test Re Test such factors were excluded from an esthetic smile, and the golden
examination indicated a correlation the study (Figure 4). The golden proportion was investigated in their
of .95 for the three measure- proportion was also investigated perceived maxillary anterior teeth
ments. Furthermore, 10 of the within Preston’s range in each width ratios.
images were remeasured under the individual who had completely
same conditions 10 days later to aligned maxillary anterior teeth,9 The golden proportion of 0.6 was
establish the reliability of the with an additional comparison found in 34.9% of the perceived
measurements. The Test Re Test made to the subjects excluded lateral-to-central incisor ratios and
examination showed a correlation from further classification. in < 10% of the perceived canine-
of .97 for the measurements. to-lateral incisor ratios, within the
The golden proportion in maxillary 0.55 to 0.64 range. Within Pres-
The golden proportion (0.618) anterior teeth was then evaluated ton’s range (0.61–0.63),9 the pro-
was calculated at 0.6.18 This was according to sex. Chi-square portion was found in 11.1% of
evaluated within the range of statistical analysis was performed lateral-to-central incisor widths and
0.55 to 0.64 for the perceived on the data to look for the < 5% of canine-to-lateral incisor
maxillary lateral-to-central incisor possible differences. widths. Furthermore, the existence
ratio and the maxillary canine-to- of the golden proportion was
lateral incisor ratio. However, it found to be similar in the left and
was calculated at 0.62 (rounded RESULTS right side and for both sexes. As a
from 0.618) and investigated The present study involved 338 result, the golden proportion was
within the 0.61 to 0.63 range.9 dental school students, from which not determined to be correlated

Figure 4. A, B, Individuals with malaligned forms of the maxillary anterior teeth (eg, tilt, rotation, and overlapping).

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GOLDEN PROPORTION IN INDIVIDUALS WITH AN ESTHETIC SMILE

TABLE 1. PRESENCE OF THE GOLDEN PROPORTION. ceived maxillary anterior teeth


Group Lateral-to-Central Incisor Ratio Canine-to-Lateral Incisor Ratio width ratios and the mean perceived
A* (n = 73) 18 (24.7%) 4 (5.5%) lateral-to-central incisor and canine-
y
B (n = 84) 17 (20.2%) 3 (3.6%) to-lateral incisor ratios were similar
*Those with maxillary anterior teeth that were not completely aligned.
to findings of this study.9 Gillen and
y
Those with completely aligned maxillary anterior teeth. colleagues found a poor correlation
between tooth dimensions and
the golden proportion.10 However,
with the relationship between the therefore higher in men compared because their measurements were
perceived maxillary anterior teeth with women. made directly on casts, those find-
in all conditions. ings could not be compared to
DISCUSSION findings in the current study.
Reevaluation of the images indi- Although golden proportion has
cated that 73 individuals (46.5%) been proposed in the literature as a Rosenstiel and colleagues found
had some degree of malalignment in useful application for achieving that golden proportion was pre-
the maxillary anterior teeth (group proportion and esthetics,4,16–19 no ferred only with regard to tall
A), whereas 84 students (53.5%) one has yet evaluated this propor- teeth.14 This might confirm present
had completely aligned maxillary tion in esthetically accepted cases. findings on the golden proportion.
anterior teeth (group B). The exis- This investigation is therefore con- However, our findings corroborated
tence of the golden proportion sidered the first step taken in this Ward’s idea to refuse the use of
was compared for groups A and B regard. The measurements were also golden proportion,15 but they do
(Table 1). The mean perceived made with maximum effort for their not prove his preference for using
lateral-to-central incisor ratio for validity and reliability. the 70% ratio since the mean
groups A and B was 0.67 F 0.07 lateral-to-central incisor ratio was
(range 0.47–0.92).The mean ratio Several other studies have estimated 0.67 in the selected cases of this
was the same in individuals with the esthetic quality of smiles by study, with the mean canine-to-
completely aligned maxillary ante- employing a judgment panel (in- lateral incisor ratio being 0.84.
rior teeth, but the range was 0.51 cluding nondentist volunteers,20 or The range of existing ratios was so
to 0.86. The mean perceived lateral- dentists and fine art professors21). extensive in the present study
to-central incisor ratio was not dif- The differences of opinion between that it might be wise to rethink
ferent between men and women. dentist and nondentist groups sug- Lombardi’s theory defining the
gest that it is wise to seek patients’ repeated ratio for the first time.6
The mean perceived canine-to- opinions regarding dental appear-
lateral incisor ratio for groups A ance.22 The present study tried to Attempts have been made to find the
and B was 0.84 F 0.15 (0.86 in men use defined criteria of the study and right magnification in photographs.
and 0.82 in women), with a range the subjects, rather than the judg- Preston positioned a millimeter ruler
of 0.37 to 1.23. The mean ratio ment of a panel. The aim was to directly below the cast during pho-
was 0.86 F 0.13 (0.87 in men and augment the objectivity and tography.9 Ward suggested com-
0.85 in women) in individuals reduce the subjectivity of selecting puting a conversion factor that came
with completely aligned maxillary esthetic smiles. from the division of the cast dimen-
anterior teeth, with a range of 0.58 sion by the image dimension.15 This
to 1.23. The mean perceived canine- Preston’s findings regarding the was to correlate the size of the image
to-lateral incisor ratio was golden proportion in terms of per- to the actual size of the teeth. As this

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factor appears in both the numera- tion develops pleasing proportions, ciate the participation of the 338
tor and denominator of the fraction the results of the present study have students of Dental School of Shahid-
for calculating the ratio of the teeth, shown that this golden proportion Beheshti Medical Science University.
it was ignored in the present study. did not exist between the widths of
the maxillary anterior teeth in indi- The authors have no interest in any
Snow’s suggestion regarding the viduals who have an esthetic smile. of the companies whose products
use of the golden proportion in the The alignment of the maxillary are mentioned in this article.
diagnosis and development of sym- anterior teeth and the sex of the
metry, dominance, and proportion individual did not affect the existence
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