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Esthetic Form and Function
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Question #1: From reading this issue, it appears that symmetry and harmony are more important than following the golden proportion. Is this a correct assumption?

Answer: Rules, as in the golden proportion, should be seen as guidelines to provide a starting place. Generally, it is best to complement the patient's existing tooth ratios if they are pleasing. Removing asymmetries and nonharmonius shapes and angles will do a lot more for a patient's smile than adding something new. The end result should be a unique, pleasing smile which is harmonious with the patient's face. This generally requires less tooth alteration and maintains the characterization associated with the patient's appearance.

Question #2: It seems that from the ratio formulas you presented that only one is needed. Is it OK to only calculate one tooth size and then apply the ratio directly to get the other sizes?
Answer: Yes. If either the central or lateral formula is used the other tooth size can be found by applying the desired ratio to the first tooth calculated. For example in the middle of Figure 5 once the central of 8.1 mm was calculated the lateral would equal 8.1 X (.71) = 6.4 mm. This is a useful time saving technique that we use on a regular bases.

Question #3: All of this seems so confusing to me. I just do what looks right to me. Do I really need to use a formula to determine esthetics?

Answer: No, but it sure does help. It is nice to work out two or three different possibilities for more difficult cases. When appropriate options are determined the clinician and patient can choose which of the options is the most pleasing. Esthetics is relative. One design may look OK by itself, but when compared to other possibilities it might be considered a poor choice. The more information the clinician has available the easier and more gratifying the result. Esthetic treatment is an art which is best determined in relationship to the various possibities that can exist.
Esthetic treatments can be highly challenging if the goal is to achieve optimal results. Most feel the effort is well worth it since few areas of dentistry are as gratifying to the dentist and patient as the beauty of a smile restored or created.

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