Smile Design: Tooth Contouring and Reshaping

Sameer Puri, DDS

by Sameer Puri, DDS | August 17, 2010 @ 10:00AM

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According to a recent survey by the American Academy of Cosmetic Dentistry, 9 out of 10 people surveyed agreed that an attractive smile is an important asset to their overall appearance. In addition, three-fourths of the same group said that an unattractive smile could hurt their chances for career success. Despite this overwhelming perception, most people are unaware that their smile can be improved with cosmetic dentistry. With recent advances in materials and techniques, cosmetic dentists are able to take a worn, dull, chipped, crooked smile and transform it, in many cases, in as little as two visits.

The term for this transformation of a person's smile is referred to as Smile Design. Smile Design is a technique used in our practice whenever a patient is evaluated for any type of esthetic enhancement to his/her smile that involves more than one or two teeth. Since the main focus of our practice is cosmetic dentistry, patients normally come in to the office seeking better-looking teeth. The patient may not realize it but what they really want is a better-looking smile. Though teeth are a major component of a beautiful smile, they are not the only component. It is possible to have nice looking teeth and not have a good-looking smile. The job of the cosmetic dentist is to evaluate the teeth, as well as the entire smile complex, the overall structures that make up a smile. By concentrating on only improving the teeth, the true desires of the patient's chief concern may not be addressed.

Determining which aspects of a persons smile can be changed is not an arbitrary process but a precise scientific diagnosis in which certain criteria must be followed to achieve the ideal smile. The doctor usually does this at the information-gathering visit after a thorough conversation has determined the specific desires and expectations of the patient. By doing a comprehensive exam, which includes obtaining diagnostic models of the patient, doing a diagnostic wax up of the teeth, a complete photographic series, and possibly computer imaging, the doctor is able to gather all the needed information to determine which aspects of the smile are deficient and what steps need to be taken to correct the defects. If you visit a doctor that does not do the above steps to diagnose your condition, consider finding a new doctor. These are the basic minimums that must be done for a thorough evaluation to determine the patient's needs.

Let's go through each component of a smile one by one and discuss how they all come together to create the perfect smile. We will also discuss how cosmetic dentistry plays a role in changing these components. Determining the proper technique to restore the teeth will have a dramatic effect on the supporting components.

The first component of a beautiful smile are the lips. They play a vital role in the overall scheme of a smile design. Lips can be crooked; one side may be higher than the other. Uneven lips will reflect poorly on the teeth underneath and cause them to appear disproportionate and mismatched as well.

Are the lips full or flat? Full lips are considered attractive and sexy, while flat lips detract from the overall appearance. The main support for the lips comes from the teeth. If the teeth are worn, abraded, or missing, they will not provide proper support to the lips giving them a "caved in", flat look. We have found that by properly restoring the teeth, that not only is the appearance of the teeth improved but also the appearance of the lips. This can often reduce or eliminate the need for surgical enhancement of the lips with collagen by a plastic surgeon.

Do the lips hide the teeth, meaning that not enough of the teeth show when smiling? This may indicate a problem with the bite. Worn teeth will lead to a collapsed bite that is evident when the lips do not show the teeth when smiling. Cosmetically restoring the teeth will dramatically improve the appearance of the lips, leading to a more pleasing smile.

The next component of a smile is the gingival display, or more commonly known as gum tissue display. Does extra gum tissue show during the smile? This is often referred to as a "gummy smile." A gummy smile will "drown" out the teeth, meaning that the first thing people notice is the gum tissue when they should be noticing the teeth. Is the level of the gums even on the top of the teeth or is the gum tissue uneven, causing the teeth to appear to be different sizes? Is the level of the gum tissue on the top teeth at the same height as the upper lip? This is ideal in the most esthetic smiles. If it is not, there may be too much gum tissue showing. All of these imperfections in the gum tissue need to be corrected prior to restoring the teeth. Failure to correct the gum display will cause an otherwise beautiful smile to appear average. This step is critical and must be properly diagnosed during the information-gathering visit.

Another component of smile design is the condition of the supporting facial muscles. Is the area around the lips full of wrinkles? The bite may be collapsed leading to those wrinkles. A collapsed bite in addition to compromising your smile and lips, will also compromise the facial features. The wrinkles at the edge of your lips are often caused by a collapsed bite. Worn and short teeth often accompany this. Correcting the bite will not only improve the appearance of your teeth and smile but will reduce the amount of wrinkles that you show. If you are considering a face-lift surgery to improve the appearance, consider a consult with a cosmetic dentist to evaluate if restoring the teeth can be of any help.

The final and most important component of smile design is the teeth. Are the teeth crooked, chipped, cracked, dull, discolored, or full of gaps? Are they too large? Are they too small? Any of these imperfections will have a drastic impact on the smile. An attractive person may lose his/her appeal with less then perfect teeth. His/her perception is completely changed in the public's eyes when he/she smiles and shows his/her imperfect teeth. There are simple solutions to improving the teeth. Techniques such as bleaching, bonding, veneers and crowns, and "instant orthodontics" allow anyone to have perfect teeth and, therefore, the perfect smile.

A qualified cosmetic dentist can correct any of the above components of a smile. The most important thing to do is to find a doctor who can recognize and diagnose the individual needs properly. There is much more to getting that perfect smile than simply having your teeth capped, bleached or veneered. Proper diagnosis and treatment planning by your doctor is essential to getting the picture perfect results. 

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