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Smile Design

Smile Design Before & After

What's in a smile?

When we look at a person, there are key features that we focus our attention on, and the teeth and the smile are up there with the things that people see and the things that people remember. But what is it that makes a smile look good? It is difficult, because beauty is in the eye of the beholder, and different things appeal to different people.However, to make things simpler, there are certain things about the construction and the arrangement of a smile which do seem to float people's boats and cause something which creates a response.

As a dentist, there are many things I look at when I am assessing somebody's smile.We can then work out what it is we are trying to construct. Do we need to move the teeth? Are the teeth in the right place, but the wrong shape? Are the teeth the right colour, or do they need to be lightened? Are there gaps that need to be filled and, if so, how are we going to do it? Are the patient's gums healthy and suitable for smile design treatment? Does the patient clench their teeth at night? These, and other considerations, have to be looked at before we can go ahead with treatment, and explained carefully and fully to the patient.

The first clinical stage of smile design would normally involve the patient having impressions taken of their teeth, or more recently, a digital scan taken of their teeth, either of which are then conveyed to an expert cosmetic dental technician with the appropriate skills and knowledge to be able to carry out the work. Working closely with the dentist, a tooth by tooth treatment plan is developed, where changes to the shape, colour or position of each individual tooth is discussed and planned out. Using modern computer-driven technology, we can use computers to alter the shape, position and colour of the teeth virtually on a computer program, which, in turn, can give us computer-generated, three-dimensional models.These are normally milled using a 3D printer and plastic resin, and delivered to the dentist for analysis.

Using a rather neat trick, in many cases, putty moulds can be made of these 3D prints and then, using a temporary plastic resin, can then be placed in the patient's mouth and then removed a couple of minutes later leaving a very accurate representation of the end product, or the end result. We currently refer to this as the mock-up visit and I have genuinely had patients in tears of joy as a direct result of seeing what their smile could be like. This also gives us the confidence to know that what we are doing is likely to be safe and predictable.

Once the design is agreed on with the patient, and any alterations carried out, we can then decide upon the means. In most cases we will have a fairly good idea about how exactly we are going to make the changes to the teeth during the planning phase, but the mock-up phase does formalise it and, at this point, we can then gain the patient's consent for ongoing treatment.There are a variety of treatments and the modern approach now is to achieve the best possible cosmetic result whilst drilling away, or cutting away, as little healthy tooth material as is possible.

Using modern highly planned and well-developed techniques, it is now possible, for instance, to transform the shape of teeth using what we call cosmetic bleaching and bonding. This involves first lightening the teeth, if the patient wishes, to a lighter, brighter colour and then, in a planned and predictable manner, using the techniques mentioned above, directly placing multi-filler composite resin onto the teeth to mimic tooth material and to give the appearance of an altered shape, which is very difficult for the eye to detect.

This sort of treatment is not taught to dental students at Dental Schools, and is something which a dentist with interest will have furthered their training by going on postgraduate courses to learn the techniques involved.

Cosmetic bleaching and bonding is relatively non-invasive and, with good planning and the correct materials, is now considered to be as durable and as long-lasting as crowns and veneers and less expensive. The only downside to bleaching and bonding is that it is very hard to be able to give intricate complexities of characterisations of natural teeth material, and there are times, in particular cases where the teeth are heavily-damaged, where perhaps bleaching and bonding is not the most appropriate treatment, or is not likely to give a particularly convincing end result.

Porcelain veneers and crowns

There was a time when veneers were all the rage and everybody was having them.When veneers were first developed in the '70s and '80s, the Holy Grail was to do them with no drilling whatsoever.Whilst indeed this was laudable, this tended to make patients look rather buck-toothed, and it was not uncommon to find that the veneers would splinter or break as a result.Further research has shown that some light drilling of the tooth in specific areas helps both aesthetically and also mechanically, giving both a more predictable aesthetic and mechanical result.

Along with any dentist, I will use veneers on heavily-stained teeth where cosmetic bonding is not able to mask the underlying stain, or in multiple teeth where there is significant damage to the enamel and, again, beyond the scope of cosmetic bonding.

Braces

Frequently, we find that to be able to obtain the ideal smile design, we can see that the patient's teeth are in the wrong place relative to each other, perhaps there may be a space in between the top two middle front teeth that the patient wishes to close, or perhaps some teeth are twisted, or rotated. With the explosion in orthodontic treatment that we have seen over the last ten years, it is now possible in most towns in the UK to have orthodontic treatment as part of the smile design sequence. We refer to this as pre-cosmetic orthodontics.

Braces are no longer the all-metal, poorly aesthetic affairs that we can all see in our mind's eye, and modern high quality clear and discreet braces are now available, whose performance are on a par with metal braces and far more aesthetically acceptable.In addition, an increasing number of dentists and orthodontists are now providing lingual braces on the back of patient's teeth. It is now quite common to see people in public-facing jobs, or who have important occasions where they do not want to be seen to be wearing a brace, now having lingual braces.

Summary

Smile design is a massive subject, and in one article it is hard to cover all the bases, but, in summary, the essential principles are:

  • 1)A strong relationship between a patient and the dentist.
  • 2)Excellent planning and time spent with the patient getting to know their needs.
  • 3)Appropriate postgraduate training for the dentist in the techniques required.
  • 4)Time and care spent in the planning phase involving the dentist, the patient and the dental technician.
  • 5)The options can be drawn from a variety of disciplines, but commonly we will want to ensure,
  • a.Dental health, i.e., making sure there is no active tooth decay or gum problems.
  • b.We might possible use cosmetic bleaching and bonding for the more light touch cases.
  • c.For the cases where there is more heavy damage, or bigger changes to make, we might want to use porcelain veneers, or crowns in a planned fashion.
  • d.Finally, in those cases where the teeth need to be moved prior to cosmetic treatment, then there is a wide variety now of orthodontic options open to us, which can help to be able to create excellent results in the long run.

If you would like to know anything about cosmetic dentistry, smile designs, or any other subjects mentioned above, please do not hesitate to contact us.

Richard Hellen, BDS

30 May 2018 

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