10 details to notice on this photo

Let’s work out together 10 details we can see in this beautiful lady’s initial smile:


  1. Crowding on upper and lower arches
  2. Color discrepancy between all teeth
  3. Heavily filled dentition with few crowns 
  4. Uneven gingival margins
  5. Interesting tooth form on upper right canine
  6. Exposed dentine/recession on upper central incisors
  7. Asymmetry in her lip dynamics
  8. Smile curve is pleasant 
  9. Dissimilar tooth form of the two upper central incisors
  10. Length discrepancy of the upper two central incisors in her face

What are 30 more things we could consider:


  1. What does the photo series/OPG/bitewings/periapical radiographs reveal?
  2. Are there any jaw joint sounds?
  3. Load test? Immobilisation test?
  4. Any jaw deviation?
  5. Is the range of movement of the jaw within the normal range?
  6. Does her jaw move symmetrically on lateral excursions?
  7. Does she have any muscle tension?
  8. Does she clench or grind or have any other para-functional habits?
  9. What is her existing occlusion like?
  10. Is her occlusion acceptable?
  11. Does she have bilateral, equal intensity contacts?
  12. Is the crowded lower central incisor a chewing interference?
  13. Is there any urgent caries or root canal therapy you would need to attend to first?
  14. Is the upper left first premolar crown supported with an implant or natural tooth?
  15. Are the upper central incisors crowns?
  16. Did the upper central incisors extrude over time to now expose cervical dentine?
  17. Are there any younger smile photos of the patient to compare the cervical margin location of her central incisor crowns?
  18. How would you design her smile?
  19. Probing depths? Gingival assessment? Existing recession? Bone levels?
  20. Is she open to having orthodontic treatment?
  21. Is orthodontics alone enough to give her a nicer smile?
  22. Is she aware of the existing black triangles between her front teeth?
  23. Will she be compliant with orthodontic treatment?
  24. Is she aware that with orthodontics and unravelling of the crowding more black triangles can open up?
  25. Is she open to gingival or connective tissue grafts post orthodontics?
  26. How to manage the central incisor black triangle with any new restorations?
  27. Is it sustainable for her to have 4 monthly hygiene reviews while in orthodontic treatment?
  28. Is she open to further crowns/veneers post ortho?
  29. How many crowns/veneers at a minimum might she need to consider post orthodontic treatment to improve her smile.
  30. Will she be committed to the treatment plan? 

……and the list goes on!

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