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of golden ratio; axial inclination; incisal embrasures; contact point progression; connector progres- sion; shade progression; and surface micro-texture. In smile design, the esthetic con- ditions related to gingival health and appearance are an essential compo- nent. The gingival shape, position, embrasure and contour in relation to the teeth are interdependent. The following are major aspects that should be addressed during smile design to achieve gingival or pink esthetics: gingival shape; gingival contour; gingival embrasure; gingi- val zenith; and gingival height (posi- tion or level). To achieve higher patient satis- faction and long-lasting treatment results, the following should be the sequence in any smile design pro- cedure: proper comprehension of psychological aspects, the establish- ment of health and the restoration of function within its normal limit, and the subsequent enhancement of esthetic components. Conclusion Today, various protocols of smile design are available in cosmetic dentistry. However, most clinicians wish to use the simplest protocol with the most predictable results. It is to be noted that smile design should always be a multifactorial decision-making process that allows the clinician to treat patients with an individualised and interdisciplinary approach. The Smile Design Wheel present- ed in this article clearly indicates the most important components (PHFA pyramids) of smile design, their clinical significance and sequence to be maintained during the smile design procedure. I believe that the Smile Design Wheel is a simple and practical pro- tocol in smile design that can help the clinician to easily comprehend the ‘complex’ smile design proce- dures of esthetic dentistry. CT Editorial note: A complete list of references is available from the pub- lisher. COSMETIC TRIBUNE | May 2010 Clinical 5C About the author Dr. Sushil Koirala is the found- ing president of the Vedic Institute of Smile Aesthetics (VISA) and maintains a private practice focusing primarily on MI cosmetic dentistry (MICD). He can be contacted at skoirala@ wlink.com.np. Fig. 8 AD