M

PROPORTIONS
The new Golden Rules in dentistry
History
Dr. Alain Mthot

Abstract
Since the beginning Cosmetic Dentistry has been using the
principles of Golden Proportion (1: 0.618) as a guideline
for smile design... It has been taught that the dental team
must develop an artistic view for smile creation which is
based on Scientific guidelines. The reason that we must
use our Artistic eye so much, has been because in most
cases, the Golden Proportion guidelines do not give a
realistic view for tooth proportion.1
The standard Golden Rule works well for the
determination of the central incisor ratio, but in the
majority of cases, fails to provide a pleasing smile
when used to develop the proportion of central to
lateral to cuspid. This article shows that by using new
Modified Golden Proportions which are individually
determined for each patient by using mathematical
formulae invented by a Canadian Dr. Alain Mthot,
we are able to create a pleasing smile design proportion
for our patients. The modified Golden Proportion
formula provides the Cosmetic Dentist with the ability
to reduce the Artistic Element, in preference to a
Scientific one resulting in a more accurate approach to
the creation of smile design and proportion.
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From the days of Greek antiquity, the theory of proportion has

served as reference to create harmony. A link has been
established between numbers and the nature first described by
Fibonacci in the early 1200s. His discovery of the mathematic
formula which he called the Golden Number was expressed as a
function of Phi and 1.
To obtain the formula we add the 2 preceding numbers
together in order to achieve the next value.2

This is the formula Fibonacci used to determine the Golden

Number of: 1.618

Many forms have been created using the golden proportion

such as the rectangle and many other forms used as the most
pleasing to the eye forms in all aspects of our lives.
B

Figure 1

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All these Figures and

proportions are found in
nature 3 as you can see
in these photos.

As well as many other figures such as the triangle and the

spiral... Figure 2, 3

Figure 4
Figure 2

Figure 3

Correlation with Teeth

The Golden Rectangle has been used to determine the
proportion of the centrals by placing the two centrals in the
Rectangle representing the length of 1.618 by the width of 1 for
the purpose of that example as shown in Figure 4. By then
dividing the length of that Rectangle by 2 one is able to
determine the width of .809 for one central. The .809/1
equation give a value of 81%. This 81% ratio for the
width/length measurement of the centrals is the ideal
proportion for the two predominant teeth of the smile, and we
can say that a variation of +/- 5%4 is normal and it is what we
see in the majority of natural mouth.
It has been argued that a more natural look is represented by
a ratio greater than 81% compared to a ratio of less than 81%.
A longer or narrower tooth is often seen in cases where there is
periodontal disease or in some full mouth rehabilitation where
an increased vertical dimension of occlusion has been attained.
According to Sterrett et al5 average measurements made on
normal white subjects offer significant help in defining relative
tooth dimensions, the relative tooth dimension width/height
ratio for the central is 85% for men compare to 86% for women.
An 85% ratio does represent a more square tooth than an 80%
or less ratio.

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For a long time, the proportionality of teeth has been compared

with classic elements of art and architecture. If we extend the
Golden Proportion to the rest of the teeth it is shown in Figure 5
that each line should mark the distal surface of each teeth.

Figure 5

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Many authors observe that natural teeth do not follow the

Golden Proportion for the display of teeth. Lombardi was the
first to discuss the golden proportion of the anterior teeth.6 He
concluded that strict application of the golden proportion has
proved to be too strong in dentistry and that variations occur.
According to Preston, the golden rule does not give a realistic
appearance and using the golden proportion results in an
excessive narrowness of the maxillary arch and compression of
lateral segments. 7 Magne & Belser showed in figure 6
Measurements have been made according to the apparent
width of teeth, as viewed directly from the anterior. The original,
untouched view of the central incisor to canine does not
conform to the golden proportion (23a). The same image was
digitally modified to generate golden number (23b) 8
Figure 7

By using this photograph we can apply the needed lines to

analyse the dento-facial aspects of the subject. For the purposes
of the present article we will use 3 sets of lines:
one horizontal line: to verify the inter papillary line
one vertical line: to verify the midline
set of Golden Proportion lines or modified Golden
Proportions lines

Figure 6

Visual Effect

It must be understood that every object can be subject to

apparent deformation in geometric shape whenever observed
from certain positions. These deformations result from two types
of phenomena: (1) the effect of perspective and (2) the effect of
optical illusion. Though they seem to show specific properties,
one is aesthetic, the other scientific, a precise distinction
between these two phenomena is difficult to establish.9
When using two dimensions to study a three dimensional
subject, there are two majors concerns: the distance and the
angulations between the observer and the subject. It is therefore
crucial to take the photograph directly in front of the subject
demonstrating a full natural smile at a focal distance of 1:10. It
must be understood that the photo is taken without distortion
due to angulations either horizontally or vertically. See Figure 7
In order to obtain a consistent result the subject must place
their hair behind the ears, in order that the ears are equally
exposed and the cheeks equally exposed. The photograph must
have the facial horizontal plane parallel to the lower frame of
the photo usually associated with the inter papillary line
following the horizontal plane.

Figure 8

In Figure 8 horizontal and vertical lines are applied in order to

verify the position of the 2D image from the 3D subject. Once
the correlation is confirmed, the image can be enlarged and the
Golden Proportion lines as generated by the computer software
are applied. See Figure 9.

54 3 2 1 2 3 45
Figure 9
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As seen in Figure 9 the usual Golden Proportion does not

correlate to the natural visual tooth display. The actual lines
should display the first premolar between the line 4 and 5. By
placing 7 lines on each side of the midline as in the Figure 10. It
is showing that the first molar should be between line 6 and 7,
in this Figure the 1.618 ratio of the lines give an inter molar
distance narrower than that which is naturally displayed by the
subject.

754 3 2

The use of computer generated lines superimposed on the

patient photograph, these lines can be altered by sliding the
lines en masse. These lines will maintain their modified
Golden Proportion as they slide, these new proportions are
called M Proportions. By positioning the first line (no1) on
the midline and moving the end line (no 7) to the buccal cusp
of the first molar, then line no 2 will have to be at the distal of
the central. If the rule of the Golden Proportion was correct,
then all patients will have the lines match, and we know this
not to be the case. In order to achieve that result, the ratio of the
Golden Rule must be changed or adapted to be individually
corrected for each patient. The new mathematical formula
determine a variable ratio in function of Phi called the M
Proportions, (M for Methot the inventor) It can be seen that
the modified ratio for this patient is 1.367 as opposed to the
Golden Rule of 1.618. (Figure 12)

2 3 457

Figure 10

The remainder of the article will explain how the modified

Golden Proportions are individually adapted for each patient by
using the inter-molar distance and the central width to
determine the appropriate ratio for that patient. This adaptation
is a new innovation and a giant leap forward in the science and
art of proportions.

The Discovery

The Golden Proportion Rule, or Divine Rule, represents a ratio of

1:1.618. This ratio has been used in a multitude of applications
for many years and is well known in the arts and architecture
dating back many centuries. Over the course of time, these
Golden Proportion Rules have been applied to facial aesthetics
and dentistry in order to provide mathematical guidelines for
the creation of pleasing and aesthetic smiles by the
determination of the appropriate proportions of central, lateral
and cuspid teeth in the smile. the Golden Rule may be expressed
as: (Figure 11)

AB
CB
=
CB
AC

= 1.618 (Equation 1)

A_________________C___________________________B
Figure 11

If the distance AB is 10mm, then the distance AC will be

3.82mm and CB will be 6.18mm.
It has been shown that this Golden Rule cannot be
universally applied to all patients, it therefore became necessary
to adapt or modify this Golden Rule by individualizing the
formula according to each patient. This modified Golden Rule
has been achieved by application of a mathematical formula
related to the inter-molar distance of each patient, representing
the width of the arch, and the width of the central to determine
the correct balance for the teeth displayed within that arch to
create a pleasing smile.
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765 4 3

3 4 567

Figure 12

Computing the position

of the side lines
As the central line (1) is placed in the midline between the two
centrals (the smile line) and the outermost line (7) is positioned
by the user, advantageously on the buccal face of the first molar,
(representing the arch width) the remaining lines (2, 3, 4, 5, 6)
are positioned by the computer software using the M formula.
The modified equations of the M formula allow the use of
a variable M Proportions Computerized Ruler that is applied
to each individual subject and is directly correlated to arch
width, and the central width. During the process of the
invention, subjects where analysed using the Guided
Positioning Software program which uses this M Proportions
Ruler. All the subjects studied fell within a certain ratio of 1.25 to
1.618 with the majority of the cases falling in the 1.38 area and
only very few cases being found at the lower and higher ratio
extremes. The 1.38 ratio has been labelled as the Reference
Ratio.
In an alternative embodiment, shown in Figure 13, the lines
(1, 2, 3, 4, 5, 6, 7) may have corresponding angles (q1, q2, q3,
q 4 , q 5 , q 6 , q 7 ) in order to better conform to the natural
positioning of the teeth. For example, angles of 0, 1.00, 2.00,
2.50, 3.75, 4.40 and 4.50 degrees may be used for angles (q1, q2,
q3, q4, q5, q6, q7), respectively to follow the axial inclination of
teeth. It is to be understood that other angles may alternatively
be used.
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Figure 14

Figure 13

The M Proportions Table shows the most common ratios and

may be used by the practitioner to select the appropriate ratio.
Table 1 gives an example of the M Proportions ratios based on
common widths of the central incisor and inter molar distances.
The inter molar distance is the distance between the buccal sides
of the left and right first upper molars in a transverse aspect. It
may be observed that the greater the inter-molar distance, the
smaller the M Proportion ratio becomes.
M PROPORTIONS RATIO

WIDTH OF THE
CENTRAL INCISOR

INTER MOLAR
DISTANCE

1:1.36

8.0mm
8.5mm
9.0mm
9.5mm
10.0mm

50.8mm
54.0mm
57.2mm
60.4mm
63.6mm

1:1.38

8.0mm
8.5mm
9.0mm
9.5mm
10.0mm

49.7mm
52.8mm
55.9mm
59.0mm
62.1mm

1:1.40

8.0mm
8.5mm
9.0mm
9.5mm
10.0mm

48.6mm
51.6mm
54.6mm
57.7mm
60.7mm

Table 1 Example of a M Proportions ratio guide

The M Proportions ratio guide may be expanded to include

other ratios as previously disclosed as well as other central
incisor width and inter molar distances.
The tool used to determine the table measurements was the
dental GPS computer software program. Value of the central
incisor width and inter molar distance entered into the
computer program allowed the lines to be displayed on the
computer screen as seen in Figure 14. As a test of proof the real
proportion of the subject picture have been set on the screen,
the inter papillary distance is measured on the patient and
transferred into the computer in order to calibrate the program
for the individual patient.
To attest to the precision of the calibration, a plastic ruler in
millimetres was apposed on the screen of the computer to
validate the measurements. The actual width of the central
subject is 8.25mm and the inter molar distance is 52mm
(millimetres) who give a 1.367 ratio. As seen in Figure 14 the
value of the ratio 1.367 has been entered in the program and the
inter molar distance of 52mm as been verified and corresponds
to the value in the Table.
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In Figure 15 the pre-op model of the same subject is shown

before the wax up with a ratio of 1.618 on the screen, the
8.25mm central width has been verified on the computer screen
with a plastic ruler in millimetres.

Figure 15

In Figure 16 the same pre-op model is shown before the wax up

with a ratio of 1.367 on the computer screen.

Figure 16

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In Figure 17 the wax up is showed at the same 1.367 ratio on the

computer screen. It is seen that the space between each lines
displays a tooth mesio distally on the 2D image.

About the author

Dr. Mthot graduated from University of Montral in 1981. He maintains a

solo practice in complex restorative and cosmetic dentistry in Lorraine,
Qubec. A firm believer in continuing education, Dr. Mthot is a graduate of
the L.D. Pankey Institute, LVI, and the International Dental Institute in
Dentofacial Orthopaedics and Orthodontics. Dr. Mthot is currently
completing his Masters Degree in TMJ Dysfunction at Donau University,
Austria. A founding member of the Canadian Academy of Cosmetic
Dentistry, Dr. Mthot is a respected researcher and has developed the GPS
computer software system as described in this article.

Acknowledgements

I would like to thank Dr. Ron Goodlin for his assistance in writing this article.

References

Figure 17

Conclusion
The evolution of Dentistry is dependant on the development
and refinement of the principles we rely on for the
understanding and application of current dental techniques.
The formulation of an individualized Golden Proportion for
each patient allows the practitioner to create the perfect smile for
each patient. The application of this modified golden proportion
computer system determines the correct mathematical indices
in order to create the size and display of the maxillary teeth
necessary to fit within the confines of the smile.
Using this modified golden proportion software, a printout of
the modified proportion template is used to develop the ideal
diagnostic wax up for that patient.
The resulting smile will allow the practitioner to rely on
mathematical and scientific formulations to get closer to the
ideal smile for each patient before applying the artistic
refinements to the size and shape of the anterior teeth to
conform with the patients ideals and the Dentists vision.

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1. Ward D. Proportional Smile Design Using Recurring Esthetic dental (RED)

Proportion. Dental Clinics of North America 2001, Volume 45;1:143-154
2. Williams R. The Golden Proportion. The Geometrical Foundation of Natural
Structure: Source Book of Design. New York, NY: Dover Publications Inc; 1979.
3. Fischler R. How to find the golden number without really trying. Fibonacci
Quart. 1981:19:406-410
4. Javaheri D. & Shahnavaz S. Utilizing the Concept of the Golden Proportion
Dent Today. 2002 Jun;21(6):96-101
5. Sterrett JD, Oliver T, Robinson F, Fortson W, Knaak B, Russell CM. Width/lenth
ratios of normal clinical crowns of maxillary anterior dentition in man. J Clin
Periodontal 1999;26:153-157
6. Lombardi RE. The principles of visual perception and their clinical application
to denture esthetics. J Prosthet Dent 1973;29:358-382
7. Preston JD. The golden proportions revisited. J Esthet Dent 1993;5:247-251
8. Magne P & Belser U Bonded Porcelain Restorations in the anterior dentition a
biomimetic approach. Berlin: Quintessence, 2002:66-67
9. Rufenacht CR. Fundamentals of Esthetics Berlin: Quintessence, 2000:73-81

(The M Proportions, the M Ruler as the computerized adjustable ruler,

plates and tools for the M Proportions in dentistry are patent pending
Internationally.)

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