ESTHETIC ANALYSIS CHECKLIST

8 steps for systematic treatment planning

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ESTHETIC
FUNCTIONAL
1 CENTRAL INCISAL EDGE
The starting point for determining tooth position is always the maxillary central
incisors, just as it is in a denture. Until we know how to correct the central position
we don’t know where the remaining maxillary teeth should go. The first thing to
Square STRUCTURAL evaluate is the vertical position of the incisal edges, identifying where they should
be positioned at rest and in a full smile.
Square BIOLOGICAL

ESTHETIC ANALYSIS IS THE 2 MAXILLARY INCISOR INCLINATION

The next point of reference for the centrals is their labial lingual inclination.
This involves correcting any problems related to the centrals being proclined
FOUNDATION OF THE SPEAR or retroclined, as well as their facial lingual position.
APPROACH TO SYSTEMATIC
TREATMENT PLANNING.

The challenge for all treatment planning

3 MAXILLARY OCCLUSAL PLANE
Following the determination of the central incisor position it is possible to
evaluate the position of the remaining maxillary teeth, we do this relative to our
is to pay attention to the sequence of desired central incisor position, identifying the correct position for the laterals,
the planning process and the order in then canines, premolars, and molars, all corrected relative to esthetics.
which various elements are organized.
Ideally, you want to achieve a linear
and systematic approach.
4 DETERMINE IDEAL GINGIVAL LEVELS
Following the determination of the desired tooth position, it is possible to
determine the correct gingival levels for each tooth using width to length
The sequence of treatment varies from proportions and gingival display as a guide.
patient to patient based on several factors,

5 MANDIBULAR INCISOR INCISAL EDGES

such as acute problems and interdisciplinary
therapy, but this checklist will help you
achieve consistency.
Especially in wear patients, you want to evaluate the lower anterior teeth and
how they relate to the face in photographs. Secondary eruption is very common
as teeth wear and it is important to see if lengthening worn lower anterior incisal
edges would make them too visible in the face.

6 MANDIBULAR INCISOR OCCLUSAL RELATIONSHIP

The next three steps, which include this one, are typically done on mounted
models. We always set up the anterior occlusal relationships first, relating the
correct mandibular incisor incisal edge position against the lingual of the correct
maxillary incisor position. This effectively establishes the patient’s vertical
dimension of occlusion.

7 MANDIBULAR OCCLUSAL PLANE

Once the anterior occlusal relationship is developed, and the vertical dimension
established, the remaining mandibular posterior teeth are positioned relative
to the maxillary posterior teeth to develop the patient’s intercuspal position.
Following this the other factors such as occlusal guidance schemes can be refined.

8 MANDIBULAR GINGIVAL LEVELS

Similar to the maxillary arch, the mandibular gingival levels are adjusted relative
to the correct mandibular tooth position to create an acceptable tooth length
esthetically and for restoration. If there has been significant secondary eruption
with tooth wear, which did not allow you to increase tooth length at the expense
of the incisal edges or cusp tips, it will be necessary to apically position the gingiva.

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