P hotoshop S mile D esign I mages. S hooting Position. Smile Analysis The Photoshop Smile Design Technique: Part I. e d m claren.

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1 94 Spring 2013 Volume 29 Number 1 Edward A. McLaren, DDS Lee Culp, CDT, AAACD Abstract Computer design software will become the main communication technology between dentists and ceramists and a useful tool for showing patients the possibilities for enhancing their smiles. Despite the modern age of smile design, which enables the use of technology to create and design an ideal smile, ceramists involved with the fabrication process still rely on sound concepts and principles of facial and dentofacial esthetics. By understanding the elements of esthetics and learning how to incorporate technology applications into clinical dentistry, clinicians can predictably plan smile design cases and communicate anticipated results to patients and ceramists alike. This article, the first in a two-part series, introduces elements of smile design and reviews some timeless concepts. It discusses new, step-by-step techniques for incorporating digital technology into the smile design process that can be accomplished in approximately three to four minutes. The second article will address tooth anatomy, morphology, and the various laboratory applications for digital design. Key Words: esthetic dentistry, smile design, digital technology Smile Analysis The Photoshop Smile Design Technique: Part I e d m claren.com P hotoshop S mile D esign I mages 1.Full face cheeks retracted 1:8 or at f16 or 22 (for DIP) iso Full face smiling 1:8 at f16 or 22 iso Full face lips relaxed 1:8 at f16 or 22 or iso 22 4.optional : profile ALL IDEAL BUT OPTIONAL 5.cheeks retracted optional 1:2 at f32 (f22 ok) 6.Lower 1/3 smiling 1:2 at f32 (f22 ok) 7.Contrastor 1:1 at f32 (f22 ok) 1.Cheeks retracted full face 2.Normal Smile full face 3.Lips Relaxed full face f 22 (f16) approx: 1:5 to 8 mag S hooting Position

2 S tart T reatment P lanning F rom M axillary C entral I ncisal E dge 1. WHERE IN THE FACE TO PLACE THE MAXILLARY INCISAL EDGES? 2. WHAT IS THE PROPER TOOTH DISPLAY STATICALLY AND DYNAMICALLY? 3. WHAT IS THE PROPER GINGIVAL DISPLAY AND FORM STATICALLY AND DYNAMICALLY? 4. WHAT IS THE PROPER INTER AND INTRA TOOTH RELATIONSHIPS? 5. CAN I DO IT WITH RESTORATIVE DENTISTRY ALONE? (do the root position, soft tissue, and bone support the desired tooth shape and position

3 RULE OF 42.2 the 4 MAXIMUM OF 4MM OF MAXILLARY CENTRAL DISPLAY WHEN LIPS AT REST (MIN 2MM) the 2 MAXIMUM OF 2MM OF GINGIVAL DISPLAY DURING NORMAL SMILE the.2 2 mm or less from lower lip during smiling Smile Design Session 3: facial esthetics inter-tooth proportions measuring faces in Photoshop and Keynote intra-tooth proportions setting incisal and gingival lines how does face form effect our choice for tooth form and size? TOOTH PROPORTIONS ( INTRA AND INTER- TOOTH RELATIONSHIPS)

4 11 MM 9.5MM 10.5 MM LATERAL CANINE 1. 0MM TO MAXIMUM 2MM SHORTER THAN THE CENTRAL 10 TO 11 MM BUT SLIGHTLY SHORTER THAN THE CENTRAL LENGTH 10.5 to 12 mm ASPECT RATIO 75% to 80% ideal 70% to 75% 80% to 85% acceptable 71% LENGTH 10.5 to 12 mm ASPECT RATIO 75% to 80% ideal 70% to 75% 80% to 85% acceptable 75% LENGTH 10.5 to 12 mm ASPECT RATIO 75% to 80% ideal 70% to 75% 80% to 85% acceptable 80% rule: canine and all teeth distal has to be perceived to occupy less visual space 3/4 to 4/5 2/ % 75 to 80% 60 to 70% 70 to 90%

5 rule: you can move the contact area restoratively up to the root of the adjacent tooth mm display at rest CENTRAL 6.7 mm 1 to 1 aspect ratio 3 mm gingival display RULE OF / 3/.3 3 mm incisal edge to lower lip

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8 VIDEO: open image in PSD VIDEO: selecting, masking, and liquify tool

9 VIDEO: Digital Bleaching using the DODGE tool 4. DENTO- GINGIVAL ESTHETICS

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11 MIDLINE BALANCE 1. You only move midline to establish esthetic inter and intra-tooth proportions 2. midline should be vertical when the head is in the postural rest position: NEVER ANGLE AWAY FROM MIDLINE i mporting t eeth f rom l ibrary Quick Photoshop Smile Design quick Photoshop SMILE DESIGN: i mporting t eeth f rom l ibrary Open ideally full resolution Pre-Op full face image

12 Quick P SD with image open in Photoshop> click command (control PC) J this will duplicate the background layer which is image of full face quick Photoshop SMILE DESIGN: i mporting t eeth f rom l ibrary open image of teeth you like quick Photoshop SMILE DESIGN: i mporting t eeth f rom l ibrary using the move tool drag the image of the teeth on top of the full face quick Photoshop SMILE DESIGN: i mporting t eeth f rom l ibrary use Free Transform to size image initially: >shift/option (alt pc) to scale proportionally and from the center quick Photoshop SMILE DESIGN: i mporting t eeth f rom l ibrary drag the layer of the teeth underneath the duplicate layer of the face image

13 Quick P SD zoom in on the teeth Quick P S D activate the polygon lasso tool Quick P S D select the space between (teeth) the lips-make sure layer on top of face is activated: important to included 1 to 2 pixels of lips Quick P S D select> modify> smooth> 2 to 4 pixels- this smooths the edge of the selection Quick P S D click the delete key with the full face layer activated and whatever was selected disappears

14 Quick P S D zoom out to view full face Quick P S D activate the free transform function edit > free transform or command (control pc) T Quick P S D grab one corner- hold down the shift and option (alt pc) key and scale up or down the teeth to fit the face Quick P S D use up/ down or left / right arrows to make slight movements to image. You can also use the move tool Quick P S D if a rotation is necessary place the cursor next to corner until the curved double arrow appears: move mouse left or right to rotate

15 Quick P S D zoom out> command (control pc) - to view full image Quick P S D in layers palette: change opacity of layer to about 60% to see through to the existing teeth: can give an idea of other necessary interdisciplinary treatment Quick P S D zoom in to show patient: command (control pc) + Quick P S D To make adjustments to the teeth layer go to image> Adjustments and choose adjustment it is common to adjust the brightness: Quick P S D adjust brightness as necessary by using the sliding adjustment

16 Quick P S D viewing position of new teeth relative to position of existing teeth zoom in> turn off visibility of top layer of face> make layer of teeth about 65% opaque VIDEO: using library teeth

17 Redesigning With Individual Library Teeth Or Tracings Photoshop SMILE DESIGN can use library of saved tracings or teeth open image and image with library teeth and tracings Photoshop SMILE DESIGN can use library of saved tracings or teeth drag in tracing from file: size with free transform Photoshop SMILE DESIGN drag in image of tooth: use free transform as necessary to fit design

18 Photoshop SMILE DESIGN if necessary use warp tool Photoshop SMILE DESIGN half mouth finished Photoshop SMILE DESIGN whole mouth finished 4th generation all-bond 3 Creating Custom Tooth Grids, Teeth, and Measuring

19 TEETH/GRID/LINES open image of retracted view of teeth you like and appears to have good esthetic proportions activate the polygon lasso tool: trace the desired tooth set a point by clicking on edge of central (usually at papilla tip)- trace the outline of the central- set points every few pixels- close the loop by double clicking at the starting point creat a new blank layer for each traceing

20 highlight blank layer in layers palette go to Edit menu then click on Stroke for width 2 to 3 pixels, color black, location center- then click OK central tracing on its own layer to see the tracing click on the eye of other layers to make them invisible

21 click eyes back on-- then highlight layer of teethselection will still be active--click Command (Control PC) J to set tooth on its own layer to see the teeth click on the eye of other layers to make them invisible trace the lateral create a new blank layer- then with layer highlighted-- Edit menu then Stroke 2 to 3 pixels with black color visualizing tracing

22 then highlight image layer: and click on Command J to put lateral tooth on its own layer visualizing tooth naming layers completed file with teeth, tracings, lines click on eye of background layer to make invisible: command J to duplicate layer

23 you can alter the aspect ratio from say 80% W/L to 75% W/L using the free transform tool. FIRST MAKE COPY OF LAYER : COMMAND J then save name and save both versions Digital Measurements highlight the ruler tool put the cursor on the most apical position of the central incisor and hold down the shift key and release when at the incisal edge note: the H valuein this case 205 pixels put the cursor on the widest position of the central incisor and hold down the shift key and release when at the contact mesially note: the W value- in this case 164 pixels divide the W by the H to get the aspect ratio in this case it is 80.5%

24 119 measure the width of the lateral incisor note: the W value in this case 108 pixels divide the W value of the lateral by the W value of the central: this gives the optical visual percentage of lateral to central: in this case 65% I would name this image 80/65/82 80 for the 80% W/L central 65 for the 65% lateral to central 82 for the 82% canine to lateral To create a digital equivalent of 1-mm divide the actual tooth length (e.g 11 mm) by the measured height in pixels e.g. 205 divided by 11 is 18.6 in this image 18.6 pixels represents 1 mm (at least on the 4 incisors) establish digital lengths First measure the tooth 8.5 mm P SD establish digital lengths Activate the ruler tool to measure the digital length

25 P SD click at the apex of tooth #8 -- hold down shift key and drag down to incisal edge and stop note the H (height) in this case it is 172 pixels. you can divide the 172 by the exact measured height to get how many pixels equal 1-mm P SD for example his tooth was 8.5 mm. divide 172 by which gives 20.2 pixels (round to 20) in this image represents 1-mm P SD if it is determined the length to be added at the incisal edge is 2.5 mm - the digital equivalent of 2.5 mm is 50 pixels: so the new digital length would be 222 pixels. P SD using Photoshop Grid P SD turning on Grid

26 P SD you can make marks on transparent layer P SD then you can drag new tooth in and size tooth with free transform adjust opacity of layer to see through as necessary Photoshop SMILE DESIGN whole mouth finished Photoshop SMILE DESIGN C HRISTIAN C OACHMAN Alternatively you could use a ruler and adjust size of ruler to known measurement on tooth open image of ruler Photoshop SMILE DESIGN Alternatively you could use a ruler and adjust size of ruler to known measurement on tooth open image of teeth drag image of ruler on top of teeth

27 Dr. McLaren is a Prosthodontist, Professor of clinical dentistry, and director of Post Graduate Esthetic Dentistry at the UCLA school of Dentistry. He is the director of the UCLA Center for Esthetic Dentistry, a full time didactic and clinical program for graduate dentists. He is also the founder and director of the UCLA/LACC Master Dental Ceramist program. The post-graduate program is a full time master ceramist program for dental technicians featuring extensive experience with the newest esthetic restorative systems. Dr. McLaren maintains a private practice limited to prosthodontics and esthetic dentistry in which he does all of his own ceramics. Dr. Johan Figueira graduated from School of Dentistry at the Central University of Venezuela in In 2010 Dr. Johan received acceptance into the Esthetic Restorative Program at the U.C.L.A. Center for Esthetic Dentistry where he continues his studies under leadership of preeminent Prosthodontic and Master Ceramicist, Dr. Edward McLaren. Dr. Johan graduated in Advanced Esthetic Dentistry / Center for Esthetic Dentistry in Dr. Figueira is a member of the American Academy of Cosmetic Dentistry. Currently, Dr. Johan is faculty at Center for Esthetic Dentistry at UCLA. He presents numerous lectures & hands-on clinics internationally. Photoshop SMILE DESIGN ADJUST THE SIZE OR THE RULER TO A KNOWN DIMENSION BY USING FREE TRANSFORM Photoshop SMILE DESIGN e. g. Adjust the Rule to 8.5 mm by lengthening or shortening ruler against the Central This DVD will cover: Photography and necessary images for Photoshop Smile Design Setting up Photoshop interface on your computer Opening images into and using Camera Raw How to make selections and how to use a mask How to create and work with layers How to use the Liquefy filter to do simple smile alterations How to do digital bleaching How to use the various transform functions in Photoshop to create custom shapes How to make and use Library teeth to do a Quick Photoshop smile design How to fix Rotations in images, objects, and layers How to align and size incorrectly composed images How to measure in Photoshop and create a digital to analog (real world) conversion How to create grids to measure tooth proportions How to create grids the shade of real teeth and use in a smile design How to use all these digital tools to create a Full PSD smile design How to present to the Patient using Photoshop Also included with DVD are templates of teeth, and tracings you can immediately use DUAL LAYER DVD Over 4 hours of high impact content. Edward A. McLaren, DDS, MDC Johan Figueira, DDS English Johan Figueira, DDS Spanish Version for more dvds, visit our website: e d m claren.com Text