I special _ smile design Fig. 2 The basic framework and pathway of the MICD TP are illustrated in Figures 2 and 3. It is to be noted that the TP in medical and dental sciences must be dynamic in nature and should be flexible to incorporate evidence-based facts. I have therefore outlined the MICD core principles that are required to achieve the optimum result in terms of health, function and aesthetics with minimum intervention and optimal patient satisfaction. However, it is the practitioner’s duty to incorporate all the necessary guidelines, protocols and regulations of the authority concerned (state or affiliated professional organisations) into the MICD TP. Phase I: Understand In the first step of Phase I, the perception, lifestyle, personality, and desires of the patient are explored. The primary goal of this first step is a better patient–dentist understanding. As the aesthetic perceptions of the dentist and the patient may differ, it is imperative to understand the subjective aesthetic perception of the patient. Various types of questions, personal interviews and visual aids can be used as supporting tools. In this step, the practitioner should ask the patient to complete the MICD self smile-evaluation form. The information obtained will help estimate the perceived smile aesthetic score (a-score) and will be used as the base-line data in the evaluation step. Next, diseases, force elements and aesthetic defects of smile are explored. Information on the medical and dental history, general health and specific health (oral-facial) of the patient is collected and complete dental and periodontal charting is performed. In order to understand the force elements, the existing occlusion, comfort, muscular activity, speech and phonetics are thoroughly examined with the evaluation of para-functional and other oral habits, comfort during mastication and deglutition, and temporo-mandibular joints (TMJ) movements. The necessary diagnostic tests, photographic documentation and the diagnostic study models are prepared during this step for the further exploration of existing diseases, force elements and aesthetic defects. In the following step, the data collected is analysed in relation to the accepted normal values of a patient’s sex, race and age (SRA) factors. The aesthetic components of the smile are analysed in detail grouped into macro(facial and dental midline relation, facial profile, symmetry of the facial thirds and hemifaces), mini- (visibility of upper anterior teeth, smile arc, smile symmetry, buccal corridor, display zone, smile index and lip line) and microaesthetics (dental: central dominance, teeth proportion, axial inclination, incisal embrasure, contact-point progression, shade progression, surface texture; gingival: shape, contour, embrasure and zenith height). The practitioner can now grade the smile in terms of the patient’s health, function and aesthetics as follows: 30 I cosmetic dentistry 4_ 2009