I had a request to write a post about the relationship between anterior tooth form and incisal enbrasure size and shape and a patient’s gender. I personally associate more rounded open incisal embrasures as being feminine, and smaller more defined embrasure form as being masculine. Personal preference aside I decided to do some research before writing this piece. There are a large number of articles that discuss customizing smile design based on a patient’s age and gender, even their personality or face shape. This information goes back to denture design and esthetics and it seems the concept of “personalizing” dental esthetics was popularized in the 1940’s.
The concept is that feminine teeth are rounded, have larger more open incisal embrasure forms, shorter contacts and a more defined step from the central to the lateral. Conversely masculine smiles feature square teeth with smaller more acute incisal embrasures and a more uniform length to the incisors. I came across one study that advised for patients who wanted to build a harsh business like reputation their smile should be made more masculine. As you can see there is definitely a skew to the information based on the year the article was written and the cultural beliefs of the time.
So is there a relationship between gender, age and smile appearance. In multiple studies both lay people and dentists only had a 50% accuracy in assessing a persons gender from a smile photograph, so about as good as guessing. This data supports fails to support a true anatomic relationship. With that said if our patients believe their is a relationship, they associate different smile features with gender or how they would like to look, then it is valid information. When we turn to discussing age, there is a correlation between smaller incisal embrasures and tooth wear. Physiologic tooth wear does increase with age, so we can draw the association between age and smaller embrasures as well as less tooth display.
I do not spend time explaining incisor shape and embrasure form with my patients. I use a wax-up to create provisionals and then the patient and I evaluate the esthetics. Often they ask me to “round a corner, shorten an edge etc.” Once they love the appearance we take patient approved provisional impressions. When altering anterior teeth during an equilibration I make changes keeping esthetics and function in mind and get the same patient feedback.
Well said Dr. Brady. I find that people’s opinions vary more on the size and shape of laterals. Like you said, mock-ups and trial provisionals are best. Given a little time, some catch on to concepts such as delicate laterals with dominant centrals. It’s all new to them.
Brava! Thank you, Lee Ann!