Traditionally the focus of dentistry has been on biological care such as cavities, gum disease and overall oral health. Treatment planning was solely based on these factors and aesthetics was the very last factor, often being not a factor at all. With the new generation of dentistry there is a new shift towards balancing health, function and beauty. A beautiful smile today is more important than in the past few decades as people pay more and more attention to their appearances alongside social influences. Dentists now have more capabilities to create the best smile possible for patients without neglecting function.
As a dentist, my main goal of aesthetic dentistry is to develop a harmonious balance between the masticatory system and the rest of the face. There are key principles of aesthetics dentistry that are important to consider when designing a patients smile.
- Tooth Proportion – size and contrast between teeth and gums
- Patients Desire – what the patients wants
- External Influences – social and cultural
- Dentists own artistic vision and ability
- Communication between the dentist and the laboratory
In the last decade with the development of new equipment, materials and technology, smile design has become more accessible and sophisticated but more importantly predictable. We can now design and visualize the end result prior to any dental work. This also enables easier communication between dentists, patients and laboratory technicians to achieve the best results possible. Now patients can see the end results and customize their own smile based on their own preferences.
Behind the technology is the dentists’ own artistic vision and knowing the basic principles of beauty and following them. Dentistry and art are interrelated in that symmetry, harmony and proportion are key. If these factors are not considered, in most cases you will not have a happy patient. It’s like painting someone’s portrait with perfect features but moving the nose away from the midline of the face. You may have great features but something just looks slightly off. I believe in order to achieve the perfect smile, the following main factors must be considered and incorporated into the smile design:
- Midline of the face – Ideally the midline of the two upper central teeth should be parallel and inline with the midline of the face. It is generally still acceptable if the midline of the teeth are parallel and 2-4 mm away from the midline of the face. To the normal eye this still appears to be symmetrical. However, if the midline of the two central teeth are not parallel to the midline of the face the normal eye will catch the asymmetry immediately.
- Upper central teeth – These serve as a starting point to smile design because every other tooth in the smile line has to be proportional to these two teeth and the position of the teeth also dictate the gingival level. When the mouth is in a relaxed position and open slightly, the ideal visibility of the central teeth is 3.5mm in young individuals. As we age, there is less tooth display because of masticatory functions.
- Patient Sex (Upper Incisors) – For female patients these teeth should be round edged, soft and smooth and for male patients these should be more rectangular and strong.
- Patient personality (Canines) – Pointy and longer cusps appears more aggressive and blunt and shorter cusps appear softer.
These are just basic principles that I believe are essential to consider and/or follow, but there an abundant more that must be considered. Lastly, never forget to factor in the patients desire.
Dr. Keivan Ansarian received his doctorate of dental surgery in 1992 and since then he has had his focus on comprehensive restorative dentistry and implants. He is a member of the ITI and has been involved with the clinical practice of implant dentistry since 2003. He currently resides and practices in Toronto.