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f CT page 1C COSMETIC TRIBUNE | May 2010 Clinical 3C on personal beliefs, cultural influ- ences, esthetic trends and fashion, and input from the media. Hence, smile esthetics is a mul- tifactorial issue, which needs to be adequately addressed for any esthet- ic treatment. The objective beauty of a smile can be established with the application of various principles of smile design, and the creation of subjective beauty may enhance cos- metic value.5,6 Smile design Smile design has been defined in various ways in the literature; I would like to summarise it as fol- lows: “Smile design is a systematic process governed by the psychology, health, function and rules of natu- ral esthetics to bring about some changes in soft- and hard-oral tis- sue within anatomical, physiologi- cal and psychological limitations, thereby creating a positive influence on the overall esthetics of a person’s face and personality as a whole”.7 We all appreciate a beautiful smile when we see it, but it is dif- ficult to explain exactly what makes a smile beautiful. It is evident that a pleasing smile depends on the following features: the quality of the dental and gingival components, their conformity to the rules of structural beauty, the rela- tionship between teeth and lips, and their harmonious integration with the facial components.8 Overall facial beauty and smile esthetics are normally judged by psychological aspects — perception, personality, desire — the state of health, the mathematical ratio of the facial, dento-facial and dento- gingival components. The psycho- logical aspects are highly subjective and fluctuate constantly because of identity, peer and media pressure. Hence, the only objective method of esthetic analysis is mathematical. Indeed, mathematics has been considered the only frame of refer- ence for comprehending nature.8 Therefore, the cosmetic dentist needs to be familiar with various mathematical and geometric con- cepts for achieving smile esthetics and their clinical protocols. The Smile Design Wheel For any smile design procedure, the clinician needs to consider the ele- ments of the smile design pyramids — psychology, health, function and esthetics (PHFA), listed here accord- ing to order of importance.7 It is necessary to determine the patient’s psychological status, establish a healthy oral environ- ment, restore function and then give attention to enhancing the esthetic aspect. All four pyramids should be accorded equal importance to achieve a desirable clinical result. By integrating these PHFA pyra- mids, I developed the Smile Design Wheel (Fig. 1), in which each pyra- mid is subdivided into three related zones. The Smile Design Wheel was devised as a simple guide to the most important components of smile design, their clinical significance and sequence to be maintained dur- ing the smile design procedure. I believe that the Smile Design Wheel will help clinicians to easily comprehend the “complex” smile design procedures of esthetic den- tistry. In the next section, I will briefly explain the Smile Design Wheel protocols with PHFH pyra- mids assessment and their basic objectives. Step No. 1: Understand the pyramid of psychology According to Prof. Robert A. Baron, psychology is best defined as the science of behaviour and cognitive processes. Behaviour deals with any action or reaction of a living organ- ism that can be observed or mea- sured. Cognitive processes deal with every aspect of our mental life: our thoughts, memories, mental images, reasoning, decision-making, and so on, in short, with all aspects of the human mind. In smile design, we normally try to understand the second part of psychology, i.e., the human mind or rather the minds of our patients. There are three fundamental zones we consider in detail for the psycho- logical pyramid assessment: percep- tion, personality and desire. Do you have general comments or criti- cism you would like to share? 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Wehkamp j.wehkamp@dental-tribune.com Dental Tribune America, LLC 213 West 35th Street, Suite 801 New York, NY 10001 Tel.: (212) 244-7181 Fax: (212) 244-7185 Published by Dental Tribune America © 2010 Dental Tribune America, LLC All rights reserved. Cosmetic Tribune strives to maintain utmost accuracy in its news and clini- cal reports. If you find a factual error or content that requires clarification, please contact Group Editor Robin Goodman at r.goodman@dental-tribune.com. Cosmetic Tribune cannot assume respon- sibility for the validity of product claims or for typographical errors. The pub- lisher also does not assume responsibility for product names or statements made by advertisers. Opinions expressed by authors are their own and may not reflect those of Dental Tribune America. COSMETIC TRIBUNE The World’s Dental Newspaper · US Edition Perception Perception is the process through which a person can select, organ- ise and interpret input from their sensory receptors. A person can- not imagine beauty and esthetics without some input in advance. The media is the most common source of information at present regarding beauty and esthetics. A patient usually conceives his or her own perception of smile esthet- ics based on his or her own personal beliefs, cultural influences, esthetic trends within society and informa- tion from the media. Dentists need to communicate with their patients to determine such information during the initial consultation, which helps in under- standing the patient’s perception of the treatment result. The use of questionnaires, visual aids, such as previous clinical cases or smiles of various celebrities, can aid immensely in this process. Personality According to the human psychol- ogy, personality is an individual’s unique and relatively stable pattern of behaviour, thoughts and emo- tions. It is to be noted that each patient’s problem or concern should be comprehensively evaluated with respect to his or her personality type. According to Roger P. Levin,9 there are four personality types. Driven: This type of person focuses on results, makes decisions quickly and dislikes small talk. They are highly organised, like details in condensed form, are businesslike and assertive. Expressive: This type of person wants to feel good, is highly emo- tional, makes decisions quickly, dis- likes details or paperwork, and likes to have a good time. Amiable: People with this person- ality type are attracted by people with similar interests, fear conse- quences, are slow in decision-mak- ing, react poorly to pressure, are emotional and slow to change. Analytical: This type of person requires endless details and infor- g CT page 4C Fig. 2 Fig. 3