DentalAnatomy/RestorativeDentistry

Louis Mackenzie

Tooth Anatomy: A Practical Guide

Part 2: Drawing Anterior Teeth
Abstract: Understanding the anatomy of anterior and posterior teeth is important as the main aims of restorative dentistry are to restore
the form, function and often the aesthetics of damaged teeth. The appearance of individual anterior teeth is complex and variable. The
three most important aesthetic determinants are widely considered to be tooth shape, surface texture and colour, which are further
complicated by soft tissue and dento-facial factors. Learning how these interlinked anatomical features affect the aesthetic appearance
of anterior teeth is difficult and presents challenges to teachers. Also, tooth anatomy teaching and clinical training in restorative dentistry
may be separated by months or even years, making it difficult for students to apply previously learned anatomical principles to aesthetic
restorative procedures. This is the second of two papers describing a series of step-by-step tooth drawing exercises which aim to simplify
the teaching and learning of tooth anatomy.
CPD/Clinical Relevance: Detailed understanding of tooth anatomy will help clinicians accurately and predictably plan the restoration of
anterior teeth.
Dent Update 2017; 44: 821–832

Restoration of form and function may training there is a risk that students may the maxillary incisor and canine teeth;
be considered to be the main aims of graduate with limited skill in: 2. Exercise one is repeated and
restorative dentistry. When anterior  The accurate shaping of direct supplemented with basic surface texture
teeth are involved there is an important restorations using tooth-coloured features;
aesthetic component and aesthetic materials; 3. Freehand drawing of student’s
dentistry is a rapidly growing subject area.  The design and prescription of fixed own maxillary anterior teeth (using a
In this regard, there is a wide range of and removable prosthodontic restorations photograph);
peer and non-peer reviewed literature on so that they integrate functionally and 4. Freehand drawing of student’s own
dental aesthetics dating back to the late aesthetically with the residual dentition; mandibular anterior teeth (from mirror
1960s.1  Understanding of the ‘ideal’ view or photograph).
During preclinical training, relationships in the aesthetic zone to The maxillary anterior tooth
the amount of time and resources given inform orthodontic, aesthetic restorative drawings are completed on a blank
to teaching the anatomical and aesthetic and cosmetic procedures. template by using online step-by-step
properties of anterior teeth (and the The self-directed anterior instructions. The mandibular anterior
related subject of smile design) varies tooth drawing exercises are comparable tooth drawings are performed freehand
between dental schools and different to the posterior versions.2 While they are without any instructions.
countries. generally less time-consuming, they also Along with the posterior tooth
If the well-established include two freehand drawing exercises, exercises, the completed anterior tooth
principles of occlusion and aesthetics enabling artistically talented students to drawings (Figures 1 and 2) are submitted
are not mastered during undergraduate demonstrate their skills. as an original, hard copy portfolio for
Prior to starting the drawing
formative assessment and feedback.
exercises, students have their own
maxillary anterior teeth photographed
Louis Mackenzie, BDS, GDP, Clinical
and then complete four drawings in the Anterior tooth drawing
Lecturer, University of Birmingham
order listed below: exercise design
School of Dentistry, 5 Mill Pool Way, 1. Systematic drawing exercises that The appearance of anterior
Birmingham B5 7EG, UK. demonstrate the labial outline forms of teeth is determined primarily by the
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 DentalAnatomy/RestorativeDentistry

The learning outcomes are designed so

that, by the end of the anterior tooth
drawing exercises, students should be
able to:
 Demonstrate knowledge of the
common labial outline forms of the
maxillary and mandibular anterior teeth;
 Understand the proportions of
individual anterior teeth and their
relationships with each other;
 Recognize surface texture features
that affect the optical properties of teeth;
 Appreciate that natural dentitions
very rarely conform to the idealized,
stylized interpretations often cited in the
literature;
 Apply anatomical knowledge to
inform the restorative management of
anterior teeth.
In common with the posterior
tooth drawing exercises, design of the
anterior version was developed by
combining average measurements from
multiple sources including:
 Anatomical study guides for dental
students and technicians;4-14
 References related to the principles of
aesthetic dentistry;15-22
 Practical guides for the restoration
of anterior teeth using direct
composite;3,23-29
 Plastic teeth designed for simulation
training eg Kavo (Biberach, Germany),
Frasaco (Tettnang, Germany) Nissin
(Kyoto, Japan);
 Extracted natural incisors and canines;
 Direct observation and clinical
photographs of anterior teeth (Figure 3).
The anterior tooth drawing
exercises were designed according to the
following principles:
 The exercises may be carried out using
relatively simple, inexpensive and easily
Figure 1. Exemplary maxillary anterior tooth drawing exercise completed by a second year available materials;
undergraduate student.  The exercises are carried out
independently following online step-by-
step guidelines;
 The drawing exercises are of the
optical properties of tooth shape, surface in an immediate aesthetic failure of the
permanent dentition and focus on the
texture and colour.3 When restoring procedure in patient terms.3
aesthetically obvious labial surfaces;
anterior teeth there is general agreement Accordingly, the main focus  2D drawings were chosen rather than
in the literature that the most important of the anterior tooth drawing exercises is more complex 3D projections;
of these three interlinked properties is to teach tooth shape, then basic surface  Pencil drawing is recommended to
tooth shape followed by surface texture. texture features are incorporated. As the allow corrections;
Slight errors in colour-matching may nature of the pencil drawing does not  Teeth are drawn oversized but to scale
be undetectable, but errors in tooth enable the study of tooth colour, this (5.0 mm² graph paper representing 1.0
shape are often obvious and may result teaching is delivered via other methods. mm² clinically);
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 DentalAnatomy/RestorativeDentistry

canine teeth. The guidelines that follow

conform to widely-accepted anatomical
principles and nomenclature.4-22

Step-by-step anterior tooth

drawing exercise

Step 1: Maxillary anterior

tooth proportions and
relationships
At the top of a (portrait-
orientated) piece of 5 mm² A4 graph
paper the maxillary central incisor midline
is drawn vertically 12 squares in length.
Adjacent to the midline, draw
six boxes that will enclose the incisor
and canine drawings using the width
and length proportions provided in
Table 1. These measurements are based
Figure 2. Exemplary mandibular anterior tooth drawing exercise completed by a second year
on published averages, rounded to the
undergraduate student.
nearest 0.5 mm for expediency.
Figure 4 shows the completed
boxes and the following guidelines
provide explanations for the chosen
dimensions and for the idealized
interdental relationships.

Length guidelines
 The average length of unworn central
incisors ranges from approximately 10.0 to
11.0 mm;
Figure 3. Clinical photograph of maxillary anterior teeth. Slightly digitally manipulated to demonstrate
 The incisal edges of central and lateral
‘idealized’ anatomical size, shapes and relationships.
incisors should ideally be flat and parallel
to the patient’s interpupillary line;
Teeth (Maxillary right and left) Height (squares) Width (squares)
 The incisal edges of lateral incisors are
generally shorter (range 0.5−1.0 mm)
Central incisors 10 8 than those of the central incisors and the
canine tips;
Lateral incisors 8.5 5
 The gingival zeniths (the highest visible
Canines 10 4 points on the gingival margins) of lateral
Table 1. Maxillary tooth proportions. incisors are on average 0.5−1.0 mm incisal
to that of central incisors and canines;
 Maxillary canines have very similar
crown lengths to central incisors, with an
 To enable size, shape and relationship averaged, stylized interpretations. approximate +/- 0.5 mm range of natural
comparison teeth are drawn together in Stock photographs are made available variation;
boxes based on published proportions;10 for students undergoing orthodontic  The gingival zenith positions of
 While the exercises use graph paper, procedures or not wishing to have their maxillary central incisors and canines are
making them suitable for both artists teeth photographed. ideally at a similar level.
and non-artists, freehand drawings are The following step-by-step
also included to enable the identification tooth drawing exercises may be used Width guidelines
of artistically talent students; to learn or revise the common features  The maxillary central incisors are the
 Students draw their own teeth to making up the basic labial anatomy of largest and most aesthetically important
allow anatomical comparison with maxillary and mandibular incisor and anterior teeth;
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 DentalAnatomy/RestorativeDentistry

Guidelines Central incisor Lateral incisor Canine

Golden proportion ratio* 1.618 1 0.618
Recurring Esthetic Dental (RED) ratio30 1.0 0.7 0.5
Drawing exercise (squares) 8 5 4
Table 2. Maxillary anterior width relationships. *NB: Although widely recommended in the published literature it has been demonstrated that the majority of
maxillary anterior tooth width ratios do not correspond with the golden proportion ratio.17

 Maximum widths of maxillary central

incisors should ideally be 75−80% of
their maximum lengths. (Therefore 10 x 8
boxes are selected for this exercise.)
 Ideally the widths of maxillary anterior
teeth should decrease moving distally.
The specific ratios listed in Table 2 are
proposed as guidelines.
 Approximate lateral incisor widths are,
Figure 4. Maxillary anterior tooth midline and six symmetrical adjacent boxes outlining average width on average, 2−3 mm less or 2/3 of the
and length proportions and demonstrating idealized interdental relationships. width of central incisors (8.5 x 5 boxes are
selected for this exercise);
 Although canines are approximately
1.0−1.5 mm narrower than central
incisors, only the mesial half of the tooth
is usually displayed when viewed from the
anterior aspect (10 x 4 boxes are selected
for this exercise).

Step 2: Outline form

Following completion of the
Figure 5. Outline forms of maxillary anterior teeth when viewed from the labial aspect. boundary boxes, the next stage is to draw
the labial outline forms of the six maxillary
anterior teeth using the intersection
points illustrated in Figure 5.
The specific points may
then be joined together with straight
and curved lines to create a close
approximation of the labial outlines
of the maxillary incisors and canines.
The guidelines that follow provide an
overview of the aesthetic principles
governing the shapes chosen for the
drawing exercises.

Outline form guidelines

 The central incisors should dominate
the patient’s smile and be symmetrical
with each other, as small amounts of
asymmetry are obvious, even to lay
observers;16
 For convenience, the right and left
lateral incisors and canines are also drawn
symmetrically (however, it has been
Figure 6. Light reflection from labial surface texture features on maxillary central incisors
reported that the majority of patient’s
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 DentalAnatomy/RestorativeDentistry

lateral incisors are asymmetrical);16 labial surface texture is often highly incisal edge to the middle third of the tooth
 The majority of distal incisal line angles reflective, resulting in an attractive bright before blending into the cervical bulge;
of the central and lateral incisors are more appearance (Figure 6).  The central developmental lobes are
rounded than their mesial counterparts. Surface texture anatomy may usually the widest and extend to form the
(Therefore they are drawn as 1 x 1 and 2 x be arbitrarily divided into the primary, majority of the gingival bulge. They are
2 curves, respectively); secondary and tertiary features listed in usually less prominent than the mesial
 Ideally, the incisal embrasures (spaces Table 3. lobe and may be flat or slightly concave
between incisal angles) should increase in The first part of the surface (although occasionally they are more
depth, moving distally from the midline; texture exercise requires students to repeat pronounced);
 The long axes of all the maxillary steps one and two. Repetition reinforces  The distal developmental lobe is often
anterior teeth should ideally have a slight the tooth shape learning outcomes and quite prominent but is shorter than the
mesio-angular orientation (therefore the provides a framework for the drawing of mesial lobe. It may be rounded or separated
gingival zenith positions of anterior teeth the basic surface texture features, which are from the cervical bulge by a slight
are marked slightly distally to the incisal described below and illustrated in Figure 7. depression.
midlines and canine tips); Developmental grooves
 Clinically, the gingival zenith positions Primary surface texture  As demonstrated in Figure 7, the
of lateral incisors are often closer to When incident light strikes the developmental grooves are V-shaped
their tooth midline compared to central labial surface of the anterior teeth most of it depressions of variable length that are
incisors; is reflected back towards the observer. This aligned with the long axes of the maxillary
 The interdental connectors (the areas reflective area, which has various names anterior teeth;
where teeth appear to touch) are longer (reflective zone/face; apparent face; silhouette  Developmental grooves divide the
than the actual contact points and the form), is bordered by curved surfaces developmental lobes longitudinally and
connector positions have been found to which deflect light giving a darker outline may also be present on the labial surfaces
move cervically, progressing distally from (deflective zone). of canine teeth;
the midline; The junctions of the reflective  On central incisors, the mesial
 Joining the intersections marked on the and deflective zones are often referred to developmental groove is usually the longest
graph paper completes the labial outline as transition lines. Transition lines are key and extends into the middle third of the
forms of the maxillary incisor teeth and features in restorative dentistry as their tooth. The distal groove is usually shorter
‘joining the dots’ also develops the planar accurate positioning strongly affects the extending just to the middle third;
surface of the canine teeth and stylized aesthetic integration of direct and indirect  On lateral incisors, the mesial
interpretations of canine tip forms. restorations.3 developmental grooves usually resemble
those on the central incisors, but the distal
Step 3: Surface texture Secondary surface texture groove is often diminished;
This is referred to as macro-  On maxillary canines, the mesial
Following tooth shape, surface
texture and includes the following developmental groove is usually confined
texture is considered to be the next most
important determinant of the optical anatomical features. to the incisal third, whereas the distal
properties of anterior teeth.3 Surface Developmental lobes
groove is often longer.
texture anatomy is infinitely variable  There are usually three developmental Cervical bulge
between individual teeth and between lobes on the labial surface of maxillary  The cervical bulge may also be referred
patients. This is diminished with age as anterior teeth; to as the cervical/gingival convexity or the
teeth undergo non-carious tooth tissue  On maxillary central incisors the mesial emergence profile;
loss (NCTTL) from attrition, erosion and developmental lobe is usually the longest  The cervical bulge is formed from the
abrasion. and most prominent and may exhibit a convergence of the developmental lobes in
In young patients, unworn twisted morphology. The lobe runs from the the gingival third of the labial surface.

Primary Surface Texture Secondary Surface Texture (Macro-texture) Tertiary Surface Texture (Micro-texture)
Reflective zone Developmental lobes Micro-grooves
Deflective zone Developmental grooves Perikymata
Transition lines Cervical bulge Imbrication lines

Mamelons
Table 3. Examples of surface texture features affecting the optical properties of anterior teeth.

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 DentalAnatomy/RestorativeDentistry

horizontal surface striations caused by

the formation of enamel prisms;
 Imbrication lines which are subtle,
broken, crescent-shaped ridges on the
cervical bulge, running parallel to the
amelo-cemental junction (ACJ). They are
usually less apparent on lateral incisors.

Step 4: Anatomical
Figure 7. Annotated drawing demonstrating common surface texture features of maxillary anterior teeth.
comparison exercise
The third maxillary anterior
tooth drawing exercise requires
students to use a high resolution, close-
up photograph to guide a freehand
drawing of their own teeth. A stylized
digital example is provided to enable
comparison (Figure 8).

Step 5: Drawing mandibular

anterior teeth
The final drawing exercise
Figure 8. Idealized digital rendering of the maxillary anterior teeth shown in Figure 3. requires students to draw their own
mandibular incisors and canines. The
teeth are drawn freehand, without
following specific guidelines, using
photographs or mirror views. Students
are encouraged to compare the anatomy
of their own mandibular anterior teeth to
the following aesthetic guidelines:10
 The lengths of mandibular incisors are
usually similar;
 Mandibular central incisors are usually
symmetrical;
 Mandibular lateral incisors are
usually wider than their central incisor
counterparts (the opposite relationship
to maxillary incisors);
 The average maximum widths of
mandibular central and lateral incisors
are reported to be 5.0 mm and 5.5 mm,
respectively;
 Mandibular incisal widths may be
used restoratively to plan prospective
Figure 9. Exemplary freehand pencil drawing of mandibular anterior teeth completed by a second year maxillary incisor widths using the
undergraduate student. following equation:
width of upper central incisor =
width of lower central incisor + ½ width
of lower lateral incisor.
Mamelons Tertiary surface texture
Following the freehand
 Mamelons are small, rounded This is referred to as micro- drawing, students should be able to
protuberances on the edges of central and texture and includes: demonstrate understanding of the
lateral incisor teeth;  Accessory ridges/grooves which are following:
 While mamelons are often present on smaller than the main developmental  That there is considerable variation
the tips of newly erupted incisors, they are
lobe/grooves; between natural teeth;
relatively quickly worn away by mastication.
 Perikymata which are very small,  That virtually no human teeth conform
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 DentalAnatomy/RestorativeDentistry

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