Smile Design– How to determine the Size of the teeth?

Once we determine the size of the centrals that is used to determine the size of the adjacent teeth. The centrals set the tone for the smile.

Here are the steps I follow to pick the size of the teeth or the centrals.

First, I look at the preop length vs how much of the central incisors they show at rest, while speaking, and when smiling.

Photos and videos of the patient talking and smiling are helpful here.

I always measure the preop centrals as reference. Then based on how much the patient shows or doesn’t show I determine the desired length of centrals. Or if we like the length of the centrals or one of the centrals we make a note of that.

Here are some thoughts that help guide me:

– Does the patient show enough of their centrals Versus do they wish they showed more?

– Which tooth is closest to the right size and position?

– How long is too long? How short is too short?

– When the patient says “M” do they show any of the incisal edges? When they say “M” this shows the lips resting position.

The average length of centrals that we choose for waxups or the final porcelain is 9mm to 11mm.

Remember we talked about women showing 2-3mm of incisal edge when the lip is at rest, while men show 1-2 mm of their incisal edges at rest.

Another aspect of the sizing is how do we frame the smile with the lips and when the patient is smiling? We don’t always have to cover the lower teeth by 100%

When determining the size of the centrals, I like to consider the height of the patient and the existing size of the teeth. Again, that way it still looks like that person’s teeth, just better or more youthful.