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QUARTER 4 | 2014 | CERECDOCTORS.COM | 13
based on the actual measurements taken
in the mouth. Since we know the length
of tooth#8 is roughly 10mm, that iswhat
the digital ruler is set at (Fig. 5). Once
that ruler is set, it will apply to every
measurement in that specific picture.
An example of this can be seen when we
measure the width of the tooth with the
calibrated ruler (Fig. 6) and find that it is
the same as the actual measurement in
the mouth of 7.93 mm
The next step is to use Photoshop
Elements software to mark both the
midline and the gingival zenith refer-
ence point (Fig. 7). This will give us an
idea of the discrepancy that needs to be
addressed with final treatment. We once
again will calibrate the digital ruler based
on the methods described above (Fig.
8). The measurements indicate that the
width of both central incisors is roughly
8 mm. Measuring the length of the tooth
from the gingival zenith of #8, we can
see that the actual length measurement
is roughly 10.5 mm. This is the length we
would like to achieve on #9 (Figs. 9-10).
Since the ruler in Photoshop is calibrated
to the mouth, you can use it to make
measurements from a reference point on
#9 (existing gingival zenith) as to how far
the tissue needs to be raised: in this case,
0.5 mm. This is also useful information to
createadiagnosticwaxup for fabricatinga
guide for gingivoplasty or osseous surgery.
Another useful thing that Photo-
shop can do is quickly and easily create
digital mock-ups for the patient. These
mockups help create value in treatment
and also help the patient understand the
treatment you are presenting. With this
case, we just simply traced #8 with the
Lasso Tool in Photoshop (Fig. 11) and
had the software mirror #8 over #9 to
create perfect symmetry with both the
teeth and gingival zeniths (Figs. 12-13).
The beauty of this technique is that it
can be done in less than a minute and
looks photorealistic to the patient. This
patient is currently being seen by our
great Periodontist for treatment.
Fig. 1: Full smile
Fig. 2: Digital caliper
Fig. 3: Width measurement
Fig. 4: Length measurement
Fig. 5: Length measurement with ruler
Fig. 6: Width Measurement with ruler
Fig. 7: Midline and zenith lines
Fig. 8: Calibrated width
Fig. 9.: Calibrated length
Fig. 10: Calibrated length measurements
Fig. 11: Initial tracing
Fig. 12: Final digital mock-up
Fig. 13: Final gingival mock-up
8
10
9
13
11
12
In the first case we will look at (Fig. 1),
the patient is concerned by the uneven
gingival zeniths of the central incisors. She
has a higher smile line and it affects the
overall appearance of her smile. Before
presenting the options to the patient, we
first are going to create a digital mockup
of what we are trying to accomplish. Step
one of this process will be measuring the
teeth intraorallywith a digital caliper (Fig.
2). We are going to do this to know what
the overall proportions of her central
incisors are. When measuring tooth #8,
the width of the tooth is 7.96 mm and the
length is 10.03mm(79percent) (Figs. 3-4).
Based on that proportion, we can assume
that #9 is too short and will need to be
lengthened cervically via gingivoplasty or
minor osseous crown lengthening.
When bringing the photo into Photo-
shop Elements, we can now also import
digital rulers. We calibrate these rulers