Macroesthetic elements of smile design.

BACKGROUND: Clinicians' expanding use of cosmetic restorative procedures has generated greater interest in the determination of esthetic guidelines and standards. The overall esthetic impact of a smile can be divided into four specific areas: gingival esthetics, facial esthetics, microesthetics and macroesthetics. In this article, the authors focus on the principles of macroesthetics, which represents the relationships and ratios of relating multiple teeth to each other, to soft tissue and to facial characteristics. CASE DESCRIPTION: The authors categorize macroesthetic criteria based on two reference points: the facial midline and the amount and position of tooth reveal. The facial midline is a critical reference position for determining multiple design criteria. The amount and position of tooth reveal in various views and lip configurations also provide valuable guidelines in determining esthetic tooth positions and relationships. CLINICAL IMPLICATIONS: Esthetics is an inherently subjective discipline. By understanding and applying simple esthetic rules, tools and strategies, dentists have a basis for evaluating natural dentitions and the results of cosmetic restorative procedures. Macroesthetic components of teeth and their relationship to each other can be influenced to produce more natural and esthetically pleasing restorative care.