Dentistry has certainly come a longway since the barber shop image ofthe past. Today, digital technology

affects every aspect of the profession, andpatients use the Internet to search for qual-ified dentists who specialize in smiledesign. Bacon’s Media Source reports thatthe average monthly circulation of articlesabout cosmetic dentistry reached 40 mil-lion in 2004. And that includes only printmedia—not television.1

The computer has made smile designcosmetic simulations possible with exactcolor-matching capabilities, and new com-puted tomography (CT) images with 3-Dviews of the patient to help with virtualplanning and surgery is a reality. Conebeam CT technology, which uses a differentapproach to conventional CT, is remarkablein its ability to acquire whole volume dataduring a single sweep of the scanner.

For years, many dental offices have beenusing CAD/CAM systems such as SironaCEREC technology to fabricate restorationsduring a single visit. Others have begunusing the Cadent iTero system, which is thefirst all-digital solution for fabricating den-tal restorations using an intraoral scannerto create an accurate 3-D image of the pre-pared tooth. In recent years, dental labora-tories have begun to acquire contact scan-ners such as the Procera (Nobel Biocare) tohelp design and mill a restoration usingcomputer-assisted design.

Along with these scanner advance-ments, cutting-edge dental software hasevolved to help dentists design a smile thatallows patients to choose tooth shapes,sizes, colors, etc—all with just the softwareand a digital camera.

THE AESTHETICS OF SMILE DESIGN The creation of a smile design requires thedentist to prepare an aesthetic dentalmakeover by using several indispensable

protocols. This involves proper planning ofthe aesthetic component in advance so thatexpectations are discussed and realizedprior to any tooth preparation.

The rules of smile design are the archi-tectural blueprints for the dentist, thepatient, and the laboratory. Smile designevaluates the deficiency of balanced aes-thetic characteristics from an objectivestandpoint, but precise protocols allow thedentist to achieve a more subjective goal—the specific aesthetic wishes of the patient.

Collectively, the following aestheticcharacteristics of smile design have been

proven to be predictable protocols that den-tists must evaluate prior to performing thedental makeover.

1. Line angles: the area where the facialsurface of the tooth turns interproximallyinto the contact area.

2. Outline form: the shape of eachrespective anterior tooth when mesial anddistal line angles and the incisal and gingi-val aspects of a tooth are connected.

3. Embrasure spaces: these must be eval-uated to determine if they increase slightlyas the teeth go from central to canine.

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Peter D.Vastardis, DMD

Patient expectations can be obtained withaccuracy via computers and software, aslong as they fit scientifically into the proto-cols of our original, tested systems.

Figure 2. Interactive Smile Style Guide.Figure 1. Preoperative full facial view.

Figure 4. Facial analysis using GPS.Figure 3. Modified Golden Proportion grid for diagnos-tic wax-up.

AESTHETICS86

4. Axial inclination: theknown fact is that all teethhave their own long axisalignment that compares tothe vertical alignment of the

maxillary teeth. From cen-tral to canine, there shouldbe a subtle increase in me-sial inclination when view-ing a patient’s smile fromthe front.

5. Contact points: thesegradually decrease from cen-tral to canine. The moreyouthful the teeth, the moreapically positioned the inter-dental contact. The moreincisal the contact is placed,the more mature the teethwill appear.

6. Gingival levels: doesthe upper lip follow the levelof the upper gingival archi-tecture? Do the incisal edgesof the maxillary teeth followthe lower lip line?

7. Buccal corridor (ves-tibular space): this is thespace between the maxillaryposterior teeth and the innercheek. Depending on archwidth, soft-tissue patterns,and muscle, the most ap-pealing smiles have little orno negative dark buccal cor-ridor space.2

8. Incisal edge position:this is second in importanceto centric relation, accordingto Dawson. The key control-ling factors are the contourand position of the labial sur-faces of each tooth. If theincisal edge is to be changed,it is best to first accomplishthis with temporaries toevaluate controlling factorsintraorally, and placementshould be assessed in rela-tion to the patient’s lip mo-bility. Anterior guidance mustalso be maintained or devel-oped where necessary.3 Thecentral incisor is approxi-mately on the same plane asthe tips of the canines andthe buccal cusp tips of thepremolars and molars. Speartells us that the more mobilethe lip, the less we can showthe incisal edge at rest, whilethe less mobile the lip, themore we must show at rest to create the most appealingsmile. Ideally, the incisaledge should just touch thedry side of the wet-dry innervermillion border of thelower lip.4

9. Dental/facial midline:this is another important cri-terion because you want acohesive succession of coinci-dental lines that are in bal-ance with the dentition,dentofacial, and facial com-plexes. Is the facial midline

coincidental with the dentalmidline for the perception ofsymmetry? (ie, Is the verticalplane 90° to the horizontalplane that we determine fromthe eyes and lips?) If there isan imbalance, the aestheticstrength is reduced.

10. The Rule of GoldenProportion: a mathematicalrule that defines a specific ra-tio between dimensions of alarger length to a smallerlength. As you look straightat an anterior situation, thewidth of the central has amathematical relationshipto the width of the lateral tothe smaller width of the cus-pid. The ratio of the GoldenProportion has long beenconsidered to create an aes-thetically perfect appearanceof harmony and balance. Ifthe laterals are a factor of 1,then the centrals are 1.618,with the size of the lateralslooking straight on from thefront, and the cuspids 0.618of the size of the laterals.While the Golden Proportioncannot always be achieved,we strive to get as close to itas possible. For example,closing a diastema may re-quire a slight deviation fromthe Golden Proportion—some-thing that Stephen Snow,DDS, calls the Golden Per-centage. By using percent-ages to help design a bal-anced smile, the analyses ofsymmetry, dominance, andproportion of each tooth with-in the anterior segment canbe evaluated for their contri-bution to the entire smile.5

11. Occlusal plane: Isthere an acceptable occlusalplane especially with an em-phasis on the incisal plane ofthe anterior teeth? Does theimaginary line touching theincisal edges of the maxillaryanterior teeth and the inter-pupillary line appear levelwhen using the simple rule ofaligning the face-bow withthe eyes? Dawson tells usthat there are few mistakesthat affect aesthetics morenegatively than a slantedincisal plane. Is the labialsurface of the central to theocclusal plane near or about90 degrees to the occlusalplane, which is the mostpleasing angle? How are thecurve of Spee and the curve ofWilson? Properly mountedcasts are a must for determi-nation of these variables.

12. Facial assessment:this is necessary to deter-mine if there are asymme-tries that make it difficult touse certain facial anatomiclandmarks to establish spa-tial relationships for theteeth. We often use the nose,chin, and eyes to help us de-termine midline placement,but the entire dento-facialcomplex must be weighedbecause the features andfacial forms of each patientare unique.6 The first consid-eration is the outline form of the patient’s face (facialshape)7 and what outlineform, therefore, should becreated for the teeth.

a. A round face can bemade narrower by elongatingthe teeth.

b. A narrow face willappear wider with a flattersmile line.

c. An oval face can acceptmany different smile designs.

d. A square face can bemade to look more oval withproper smile design. Long,narrow teeth, for example,will elongate the face, whilesquare teeth will accentuatethe square facial appearance.

e. A heart-shaped or ta-pering face can be de-empha-sized with flatter teeth.

13. Phonetics: the soundsproduced when speaking areshaped mechanically by thecombination of teeth, lips,and tongue. The F soundhelps to guide us in placingthe upper incisal position inthe correct plane. Pre-evalu-ating the position of theincisal edges with the speechpattern of your patients canhelp you assess where to cor-rectly place the edge in waxand then intraorally in thetemporaries for the final aes-thetic determination.

A CHALLENGING CLINICALEXAMINATION AND

DIAGNOSIS A 20-year-old woman came tomy office complaining of anunbalanced smile with dis-colored teeth and aged com-posite and porcelain veneerrestorations. She had beenin a severe automobile acci-dent a few years earlier, whichhad caused extensive facialand dental trauma, and teethNos. 7 to 10 had been restoredwith direct bonding and por-celain crowns.

She wanted a more ap-

pealing, youthful smile thatincluded whitening her teethand replacing the old, dis-colored restorations. First, Ireappointed her for a com-prehensive medical/dentalexamination that consistedof a functional analysis ofher TM joints, including loadtesting, palpation of her mus-cles of mastication, range ofmandibular motion/dopplerauscultation, a full series ofdigital radiographs/panorex,12 American Academy ofCosmetic Dentistry preoper-ative digital photos, soft-and hard-tissue evaluation,periodontal probings, face-bow (Rotofix [Jensen In-dustries]) mounted studymodels on a semiadjustablearticulator (Artex [JensenIndustries]) with CR biterecords using a lucia jig(Great Lakes Orthodontics),and an evaluation of herentire dento-facial complexusing the Dr. Jose-LuisRuiz aesthetic diagnosisform. This form helps todiagnose the patient’s exist-ing dento/facial problems,as well as determine herdesires and expectations.8

Upon clinical examina-tion, we discovered that thepatient had trauma to herface, especially to the leftcheek area immediatelyunder the eye, chin, andlower left border of her lip. Apermanent scar was appar-ent to the lower lip, both atthe wet and dry border,which gave it a swollen ap-pearance. Her lip and chinalso had permanent devia-tions (Figure 1).

Radiographic evidence re-vealed that she had hadendodontic therapy to teeth

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Figure 5. Facial/dental determina-tion using GPS.

Figure 6. Preoperative photo ofanterior teeth.

Figure 7. Post-bleaching of posteri-or maxillary and entire mandibulararch.

Figure 8. Stumpf shade determina-tion.

Figure 9. Shade determinationusing Vita 3-D Master ShadeGuide.

By using percent-ages to help designa balanced smile, theanalyses of symme-try, dominance, andproportion of eachtooth within the ante-rior segment can beevaluated for theircontribution to theentire smile.

AESTHETICS88

Nos. 8, 9, and 10, and teethNos. 9 and 10 had been re-planted after the endodontictherapy. Large, prefabricat-ed posts and porcelain crownswere present, and when thenew radiographs were com-pared to an old series, sheunfortunately was found to

have periapical pathology.Initially, she was referred toher endodontist to evaluatethe large radiolucencies, andthe endodontist felt that dueto the large posts and reim-plantation, there would be arisk of fracture if we tried toremove the posts and retreatthe teeth.

Therefore, we offered tohave an endodontist treather with apicoectomies orhave her teeth removed andreplaced with implants. Sheopted to try to save herteeth, and I advised her thatwhen metal posts are pres-ent, the natural transmis-sion of light through all-por-celain crowns and down tothe tooth’s root is impossible.Since I believe it is often pre-ferable to articulate possibleproblems before treatment isinitiated, I wanted her tounderstand that she wouldprobably have dark discol-oration around the gingivalmargin as compared to herother teeth. Therefore, wediscussed exactly what shewanted versus the realisticresults I could provide her.

We discussed her dissat-isfaction with the overallcolor of her teeth, the exist-ing aesthetic concerns I felt Icould improve, and the smiledesign that she preferred.My goal was to create pro-portionate, symmetrical di-mension to her incisors andtransform her smile into asofter, more youthful, femi-nine appearance. Using newsoftware called the Inter-active Smile Style Guide(iSSG {Digident.com]) co-developed by Drs. Lorin Ber-land and David L. Traub, Idiscussed cuspid, lateral,and central incisor toothshapes and sizes with thepatient. I wanted to get afeel for her tooth dimensionpreferences. By using thiscutting-edge technology onmy computer monitor, wecould easily show her specif-ic tooth shapes and sizesstep by step (Figure 2).

I spent considerable timewith her to get a sense of herexpectations. We discussedtooth color, her speech pat-tern (especially when shespoke words with F and Vsounds), and her overallfacial appearance. This gaveme an understanding of notjust her personality, but her

dental personality. I findthat this co-discovery withthe patient is invaluable forthe success of the aestheticcase. Once I feel that thepatient’s expectation is with-in my reach, I can proceedwith the smile design.

Preparation Thankfully, we have manymodern tools to help us diag-nose an aesthetic case usingthe above parameters ofsmile design. First and fore-most, the visual informationthat digital dental photogra-phy provides to the patient,dentist, ceramist, and anyother specialist involved isindispensable. Instant digi-tal images can allow thephotographer to immediate-ly evaluate the desired im-age that will be used withthe advanced technologiesthat follow.

New and innovative soft-ware called the Guided Po-sitioning System (GPS [my-dentalgps.com]), developedby Dr. Alain Methot,9 takesdigitized images of the pa-tient’s facial view at 1:10ratio and studies them usinga step-by-step system fordental aesthetics. This sys-tem allows the restorativedentist to utilize specificparameters of smile designwith technological accuracy.The values that are entered,which are obtained clinicallyduring the photography ses-sion, are the interpupillarydistance, the width of the cen-tral incisors, and the inter-molar distance.

The software determineswhat Methot calls the Mod-ified Golden Proportion For-mula, which is specific foreach patient. It establishesthe correct guidelines, proto-cols, and dimensions to en-sure that the postoperativesimulation results will matchthe desired balanced smileas closely as possible. Usingthe photographic protocol inthe dental GPS, axial incli-nations, length of teeth, soft-tissue levels, contact points,midline placement withinthe full facial complex, buc-cal corridor space, etc, are alldetermined. The softwarealso prints out a grid of themodified Golden Proportionratio, which you can forwardto the laboratory in order forthe dimensions of the teeth

to be waxed up to this pro-portion (Figure 3). The proj-ect can also be digitally e-mailed to the laboratory orperiodontist. Figure 4 showsthe simulation of the pa-tient’s pre-existing smile.The vertical bands show theexisting midline, buccal, andvestibular space.

Figure 5 shows the trueinterpupillary, midline, andocclusal level for this pa-tient. You may simply wantto move the midline 1 mm,adjust the occlusal level tocorrect any canting, andalter incorrect tissue levelsand contact points with thissoftware.

The software takes youthrough a step-by-step proc-ess to answer certain ques-tions according to the desiresof the patient and dentist,and your answers can beadjusted as necessary.

After you have enteredall of the necessary informa-tion in the software, the lab-oratory can provide you witha diagnostic wax-up of thecase. Obviously, a wax-up isan educated guess, and theintraoral temporaries arethe best means of evaluatingthe proposed smile design.Once the patient approvesthe case, you can proceedwith the permanent smiledesign. With this particularpatient, she needed slighttissue augmentation to pro-vide a more desirable level(Figure 6).

The patient’s next wishwas to brighten her teeth.Using a take-home 16%bleaching system (Nite-White ACP [Discus Dental])for several weeks, she at-tained her desired shade(Figure 7). This bleachingsystem combines the bene-fits of carbamide-hydrogenperoxide with a patentedamorphous calcium phos-phate (ACP) technology, po-tassium nitrate, and fluo-ride. This has allowed for anincrease in patient comfortand compliance. Note howwonderfully the posteriorand lower mandibular teethbleached. Due to the exist-ing restorations, of course,the maxillary central inci-sors did not bleach.

Bleaching is probablythe most requested electivedental procedure, and ob-taining such nice results

instills a level of confidencein the patient for the rest ofthe treatment sequence. Oncethe patient was satisfiedwith the bleaching results, Iwaited a few weeks becausevital bleaching with even10% carbamide peroxidecauses a significant reduc-tion in the natural amountsof calcium and phosphorusfound in enamel. Haywoodstates that we should allowfor color stabilization andremineralization in order toensure sufficient bond strengthbefore continuing with re-storative therapies.10

Tooth preparation beganwith the removal of the oldrestorations and all evidentdecay, which was unfortu-nately excessive in teeth Nos.9 and 10 (Figure 8).

There was an excessivedegree of discoloration, andthe stumpf shade guide re-vealed an even darker colorthan the St.3 shade tab atthe gingival one third oftooth No.10. Although mostdentists use this guide forprepared teeth, I have hadequal success simply usingthe classic Vita shade guide(Vident) with digital photog-raphy to assist me in closelymatching the existing stumpfshade and relaying this infor-mation to my ceramist.

Two images are very im-portant for shade communi-cation. The first involvestaking the 2 closest valueshade tabs to the teeth. Oneis a bit higher in value, whilethe second is a bit lower. Thesecond image is for chro-ma—again, one tab provid-ing a shade higher and onelower. Taking the images ofthe shade tabs in the samevertical plane allows thequantity of surface light re-flection to be equal.11 I chosethe excellent aesthetic den-tal team that Daniel Mater-domini, MDT, has put to-gether at daVinci DentalStudios, using IPS Empress-pressed veneers (IvoclarVivadent). Over the years,they have provided my prac-tice with extraordinary aes-thetic results. Empress is alucite-reinforced pressableglass ceramic with a long,successful track record. Itprovides excellent fit, trans-lucency, and vitality, and thecorrect brightness value ofthe final shade is exclusively

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Figure 10. Final glazed indirectLuxatemp temporaries.

Figure 14. Postoperative right lat-eral view showing canine guidance.

Figure 11. Final Empresscrowns/veneers.

Figure 12. Final Empress restora-tions showing internal effects.

Figure 15. Postoperative left later-al view showing canine guidance.

Figure 13. Postoperative 1:1.

AESTHETICS89

determined by the ingot ma-terial. Masking of a dark dieis usually achieved by usingan ingot that exhibits both ahigh degree of opacity andlow color intensity. The cor-rect final shade of the veneer

is a combination of the dieshade, the ingot material,and the layering material, aswell as the staining proce-dure and the cementationmaterial that is used.12

Studies have also demon-strated strengths between160 and 180 MPa.13

The shade guide chosenfor the final restorations wasthe Vita 3-D Master system(Vident). The OM-1 shadewas quite accurate to theexisting shade seen in Fig-ure 9, but I wanted to verifythat it was as accurate as itappeared. While many prac-titioners find it challengingto determine the correctcolor, I have had successusing the ClearMatch soft-ware-based system (ClarityDental), which easily ana-lyzes color measurement ofshade and value with noneed for proprietary hard-ware. A standardized blackand white tab, along with aspecified Classic Vita (Vident)shade tab (in this case A2), isplaced adjacent to (incisaledge to incisal edge) an ex-isting tooth that is to beclosely matched. A high-res-olution digital image is thentaken. The ClearMatch soft-ware adjusts the hues of theimage to compensate for anycolor imbalances that mayhave occurred while takingthe image.

After the color was cho-sen that closely matched theunprepared teeth, digitalphotos were taken to aid theceramist in closely matchingthe teeth color. A new stick-bite, face-bow, and CR bitewere also taken to assist inmounting the case.

The stick-bite record helpsverify any shift in the face-bow that could result fromlateral auditory meatus dis-crepancies. If these discrep-ancies occur when takingthe face-bow, the intercondy-lar axis could result in a sig-nificant change in the func-tional and aesthetic planesof occlusion.14 The incisaledges of the anterior teethshould be parallel to theinterpupillary line and per-pendicular to the facial mid-line, and the patient’s chinmust be parallel to the hori-zon. Use of a miniature levelgauge for correct alignmentis very helpful in helping toavoid a skewed incisal plane,

which can result from skele-tal issues and can create acanted, unattractive smile.Note, too, that if the pa-tient’s head is incorrectlypostured, the ceramist mayposition the incisal edgesincorrectly. Digital images of the stick-bite allow theceramist to view the positionof the interpupillary/incisaledge position.

Temporaries were fabri-cated by using a putty ma-trix that was duplicatedfrom the diagnostic wax-up.Luxatemp shade BL (Zenith/DMG) was the material ofchoice, which is a syringablebis-acryl temporary materialthat is very aesthetic andaccurate (Figure 10). I choseto use the indirect method oftemporary fabrication inorder to have more controlover embrasure spaces, thethickness of material, andmarginal fit. Certainly, if Ihad found thin areas withinthe temporary, I would haveperformed additional prepa-ration in those areas.

The prepared teeth werescrubbed clean with a chlor-hexidine gluconate rinse(PerioRx [Discus Dental]),and each individual toothwas spot-etched with 35%phosphoric acid, followed bya coating of a desensitizingagent (Acquaseal [Acqua-Med Technologies]). Acqu-aseal contains HEMA, whichhelps seal open dentinaltubules, and contains fluo-ride and benzalkonium chlo-ride, which act as antimicro-bial agents. Once this mate-rial is air-dried, a flowablecomposite such as Revo-lution 2 (Kerr) can be lightlyflowed within the intagliosurface of the temporaries.Since all bis-acryl materialsare partly composite andpartly resin, the flowablecomposite binds to the tem-porary itself and strength-ens it. Only where the teethhave been slightly etcheddoes the temporary/ flowablecombination actually adhere,however. When the patientreturns for the final seatingof the definitive restora-tions, the temporaries andcured flowable material areremoved with little, if any,flowable material adhered tothe teeth.

Once the temporarieswere in place, the patient

and I could evaluate the aes-thetics, occlusion, and func-tion of the new smile. Shewas told to return in oneweek to discuss how theteeth felt, at which time wetalked about color mappingin terms of the level ofincisal translucency, prob-lems with speech patterns,and any other concerns.Once the temporaries wereaccepted, an impression ofthe approved provisionalswas taken for the lab to usein designing the porcelainrestorations. The final res-torations were then fabricat-ed and returned to the officefor evaluation (Figures 11and 12).

The End Result For the final restorations, an-esthesia was administered,and a dry field was obtainedusing the OptraGate system(Ivoclar Vivadent). Patientsfind the OptraGate morecomfortable to wear overlonger periods of time, as itis 3-dimensionally flexible.The temporaries were re-moved, the teeth were redis-infected, and water was usedto try the veneers in place.

The patient was allowedsome time to evaluate howthey felt before the bondingprocedure began. The finalresults are seen in Figures13 to 15. Lateral views showthe incisal edge levels, al-though there was a greatdeal of trauma to the lipfrom the automobile acci-dent (Figures 16 to 18).

Although this was aquite difficult case, especial-ly with the loss of naturaltranslucency with teeth Nos.9 and 10, the harmoniousbalance we achieved is evi-dent in Figure 19. The finalsmile reveals a very happypatient (Figure 20).

CONCLUSIONAlthough the protocols weuse daily in aesthetic dentalmakeovers have been testedsuccessfully for many years,cases that are less than idealprovide us with special chal-lenges. Extensive planningand dialogue with the pa-tient are essential. Hippoc-rates said, “without diagno-sis there can be no treat-ment.” Today’s new technolo-gies can guide us in obtain-ing the desired results by

helping us properly diag-nose each individual case.Patient expectations can beobtained with accuracy viacomputers and software, aslong as they fit scientificallyinto the protocols of ouroriginal, tested systems. F

References 1. Nelson E. Capitalize on the cover-

age. Academy Connection. March/April 2005;3.

2. Morley J. Smile design terminology.Dent Today. June 1996;15:70.

3. Dawson PE. Anterior guidance andits relationship to smile design. In:Functional Occlusion: From TMJ toSmile Design. St Louis, MO: Mosby;2007:164-165.

4. Spear F. The maxillary central incisaledge: a key to esthetic and function-al treatment planning. CompendContin Educ Dent. 1999;20:512-516.

5. Snow SR. Application of the goldenpercentage in smile design andesthetic treatment success. Con-temp Esthet. Sept 2006. http://www.contemporaryestheticsonline.com/issues/ar t ic les/2006-09_01.asp.Accessed November 5, 2007.

6. Chiche GJ, Pinault A. Esthetics ofAnterior Fixed Prosthodontics. Chi-cago, IL: Quintessence; 1994: 13-14,1.

7. Mechanic E. Smile Design: A Pa-tient’s Guide. Montreal, Quebec,Canada: EC Dental Solutions; 2005:5-10.

8. Ruiz JL. A systematic approach todento-facial smile evaluation usingdigital photography and a new photo-graphic view. Dent Today. Apr 2006;25:82-85.

9. Methot A. Get the picture with a GPSfor smile design in 3 steps. Spectrum.2006;5:100.

10. Haywood VB. Consideration for vitalnightguard tooth bleaching with 10%carbamide peroxide after nearly 20years of proven use. Inside Dentistry.2006;62-67.

11. McLaren EA, Chang YY. Photographyand Photoshop: simple tools andrules for effective and accurate com-munication. Inside Dentistry. Oct2006;97-102.

12. Heffernan MJ, Aquilino SA, Diaz-Arnold AM, et al. Relative translucen-cy of six all-ceramic systems. Part I:core materials. J Prosthet Dent.2002;88:4-9.

13. McLean JW. Evolution of dentalceramics in the twentieth century[published correction appears in JProsthet Dent. Apr 2001;85:417]. JProsthet Dent. Jan 2001;85:61-66.

14. Almog D, Sanchez Marin C, ProskinHM, et al. The effect of esthetic con-sultation methods on acceptance ofdiastema-closure treatment plan: apilot study. J Am Dent Assoc.2004;135:875-881.

Dr. Vastardis maintains an activegeneral dental practice in GardenCity, NY, with an emphasis onrestorative, aesthetic, and implantdentistry. He graduated from TuftsUniversity School of Dental Medi-cine and is the founder of the con-sumer educational Web site Floss.com. He is a member of the ADA,American Academy of CosmeticDentistry, European Society of Es-thetic Dentistry, Nassau County Den-tal Society, Academy of Osseo-integration, and the InternationalAcademy for Sports Dentistry. Hecan be reached at (516) 326-0770or peter@gardencitydentistry.com.

DECEMBER 2007 • DENTISTRY TODAY

Figure 18. Postoperative 1:2frontal view. Using the GPS sys-tem, an evaluation of the finalsmile can be seen in Figure 20.

Figure 16. Postoperative 1:2 rightlateral view.

Figure 17. Postoperative 1:2 leftlateral view.

Figure 19. Postoperativefacial/dental midline evaluationusing GPS.

Figure 20. Final full facial appear-ance with new smile.