Smile Design - Science and Art
When people go to the dentist for a filling, crown, veneer or full mouth rehabilitation they really have little idea about how their teeth should look. The do know what looks good in the mirror and what their friends and family have to say.
Esthetics and teeth is an art form that requires a vocabulary that is unique to dentistry but not to the art world. Words like: color, saturation, hue, chroma, surface texture and light transmission, translucency are examples of words used when a dentist communicates with an expert ceramicist before making Lumineers, Razor thin veneers, Empress Crowns, Da Vinci veneers or a host of other products on the market today.
Popular Post Graduate Training Programs
Dentists who develop a special focus on Cosmetic Dentistry and Dental Makeovers have training from esteemed centers like the Center for Esthetic Excellence, Pankey Institute, Las Vegas Institute (LVI), Hornbrook Group, Dawson Center. Many of these dentists may also have affilitations with the American Academy of Cosmetic Dentistry or the Academy of General Dentistry.
Doctors who have participated in post graduate training programs that focus on aesthetic dentistry, as a general rule, are progressive minded dentists who make it a cornerstone of their practices to discuss the nuances and artistic checklists to create gorgeous smiles and celebrity makeovers.
When a dentist asks a patient what they would love to change in their smile, most patients typically ask for "white" teeth, straight teeth or a pleasing smile. Then they would add natural, harmonious, pain free and use other words to try and express themselves.
The restorative dentist will then discuss the patient's goals, needs, wants and desires. Perhaps a person will be pleased with whitening and some cosmetic reshaping of teeth. Perhaps they have gaps, chips, worn teeth with a need for extensive crowns or veneers to "upgrade" their existing dentistry.
The following will illustrate some of the concepts a dentist may discuss with you when discussing your goals of treatment. They are not exhaustive but are meant to give a common language that will stimulate the discussion to make you as happy as possible with your cosmetic outcome.
Rule of Golden Proportions in Aesthetic Dentistry
The Rule of Golden Proportion otherwise known as the Divine Proportion was recognized by Phidias a Greek Sculptor for being a commonality in size and shape for spirals and patterns found in nature. This became know as the Fibonacci Series, and has a beauty and magic that is found in many of natures most beautiful creations from butterfly wings to the Great Pyramids of Egypt.
In teeth this proportion is a guide for dentists to determine the amount of tooth you see when you smile.
Mathematical Proportioning of Cosmetic Dental Makeovers
If a lateral incisor is "x" then the amount of tooth you see when you smile would translate to your front tooth would be 1.618X more than the lateral and the canine (because it is twisted slightly) would allow you to see .618X . In other words the dentist can use this as a guide for the amount of width of tooth you see when you smile. It is only a guide or starting point for a dentist.
There are proportions used such as the width of the face divided by 16 and the length of the face divided by 16 will correspond with the width and length of your front tooth! Notice it is the same number as the Golden Proportion!
There are other ratios that can be applied to teeth to help a dentist find the most pleasing length and width such as a 75-80% length to width ratio. This has been shown to create sexy full teeth and is also a guide by which sizes of teeth can be extrapolated.
The midline of the teeth should correspond to the midline of someone's face but again if it's less than 5 mm off it is usually unnoticeable by anyone but your dentist. Tom Cruise's midline is off a lot more than that and it hasn't hurt his looks or popularity.
Importance of Cosmetics and Phonetics
Then a dentist will use phonetics to determine proper placement of incisal edges of teeth. They will check "F", "V", "Th", "S" sounds to create an edge that is in the right place for speech. One area of dentistry that requires a watchful eye on these principles is the design and fitting of dentures and partials. These lessons all pertain to "cosmetic" dentistry as well.
Sizing and Harmony
Should teeth be round, flat, square? Is there a male vs. a female smile? There are a lot of opinions about this. The difference may be in the use of slightly flatter teeth with a slightly different amount of tooth display for a man, with a softer, curvier tooth for a woman.
It is still important to display front teeth dominantly and create a warm, harmony with the rest of the patients face. It is less about male versus female and more about what looks good in someone's mouth. If a person is a softer featured person or a vigorous dominant person it will show in their smile display and size and shape of their teeth.
Gingival Arching Characteristics
How should gums look? Should they be the same height for the laterals and the centrals? Should canines be pointy? Should teeth be the same shape as someone's face? Example, should a person have rounder teeth for a rounder face?
These are all individual questions that should be discussed with the dentist as they will all have their own opinion. The important aspect of cosmetics is to see if they can be tested!
Critical Role of Temporaries and the Diagnostic Waxup
The testing period involves the patient wearing temporaries and undergoing adjustments until the cosmetic goal is reached. If the embrasures are too closed - meaning teeth look like chiclets against each other can they be widened to make the tooth more individualized? Can a patient look at their diagnostic wax-up to make changes once the temporary restorations are made?
That is where science meets art. Art is in the "Eye of the Beholder" so is beauty. So the ratios of smile display to full smile, the proportion of gum to tooth, the amount of tooth display at rest or upon full smiling, the soft tissue cosmetics of lip size to nose size or upper facial height to lower facial height are more than any patient needs to know!
They need to trust their dentist to use the guides at their disposal to create a framework for a smile that will be cosmetically pleasing and meet the needs of the person they are treating. It has been said "just because it's white and bright doesn't make it right". The issue of what is one person's version of beauty may be glowing white teeth or the smile of a naturally aged 70 year old.
Proper esthetics is a highly individual goal.
Wisconsin Reconstructive Implant Dentistry
Richard Winter, DDS MAGD
Hampton Dental Associates
5323 W. Hampton Avenue
Milwaukee WI 53218