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More patients than ever are choosing cosmetic dentistry to improve their smile. When we create a beautiful smile for a patient, we often see other changes take place, such as a new hairstyle, a new look, and a new attitude. A beautiful smile can work wonders for the patients self- confidence. Healthy teeth and surrounding tissues have many long-term health benefits.
So how do we design a perfect smile? We begin by stepping back and observing facial structures. If the smile is the picture, the face is the frame. We look at symmetry of facial features, shape of the face, and angles of the face. When we look at the full smile, we observe the width in relation to the face. Is it wide, showing teeth all the way to the molars? Or just the front six teeth? Do lower teeth show? How much?
The first step of smile design is to make sure the periodontal tissues (gums) are healthy. If the gums are not healthy, you are not yet a candidate for cosmetic dentistry. However, periodontal therapy is a common procedure to improve the health of the tissue. Like a building or a bridge, cosmetic dentistry needs a solid foundation. We often enlist the help of a periodontist to treat gum tissues.
Let’s move to the design of the smile. When we observe perfect teeth, the two centrals (front teeth) are mirror images of each other. We use height/width ratios, but the length of the central incisors determines age. Long teeth give a young look. To determine how much of the front teeth you show in a rest position, we ask you to say “M””M””M” and relax. Studies have shown that the average Miss America shows 3 to 3.5 millimeters.
The next teeth back are the laterals. These are the masculine/feminine teeth. Large and square is masculine, small and round is feminine. When I design a smile, I want the front two teeth to be identical, but I never make the laterals the same. Subtle differences in the laterals give a much more natural look. The canines (cuspids) are the passive/aggressive teeth. Aggressive teeth are pointed and large, passive are rounded and tipped slightly inward. We can use many combinations with these characteristics to design a custom look.
Once we determine the characteristics of the teeth, we again look at the overall smile. A commissural smile is the “model” smile, showing upper teeth only (Catherine Zeta-Jones, Halle Berry). A complex smile is wide and large, showing both upper and lower teeth (Brittney Spears, Julia Roberts). With a complex smile, lower teeth are very important.
If they are not straight, it becomes very obvious. A cuspid smile shows a lot of upper gum tissue, and then drops quickly (Elvis Presley, Tom Cruise).
When we look at tooth color, the background shades can vary widely. That is why some teeth can whiten very easily, and others take much longer. If your teeth have a yellow base color, even if they are badly stained, they will lighten much easier and faster than teeth with a gray background color.