The two main factors that go into a smile design are 1) the facial characteristics of the patient and 2) the image aspirations of the patient. The design should complement the face, accentuating attractive features and de-emphasizing less desirable ones. Besides this, it should project the image that the patient wishes to convey to people he or she meets.
Complementing Existing Facial Characteristics
Let’s say that a patient has an attractive nose or lips. We would like, in that situation, to draw attention to the center of the face. We could do that with central incisors that are more prominent, longer, or just larger. On the other hand, let’s say that a patient has a long face, maybe a little longer and more narrow than we would like. In that case, we may want to create, with the smile, a strong horizontal line which will help the face look wider.
Projecting the Image Aspirations of the Patient
The teeth can also help the patient project certain personality characteristics. The foundation of this concept lies in nature. When we are young and our teeth have just erupted in the mouth, they are of varying lengths.
Here is a photograph of a teenage model. You can see that her front teeth are of varying lengths, with the central incisors being the longest. This is how the smile of most young people appears.
As we age, the teeth generally wear down to where they are even in length. Below is a photograph of an older person, and you can see how the lengths of the teeth are even, creating a strong horizontal line.
Thus, when the central incisors are longer, it conveys those personality characteristcs we associate with youth: boldness, sexiness, warmth. When the teeth are of even lengths, it tends to convey the characteristics we associate with maturity: sophistication, intelligence, moderation.
You will also notice in the smile of the teenage model that the edges of the front teeth have little bumps on them. These bumps are called mammelons and they are present in teeth when they first erupt.Here is a closeup of young lower front teeth showing them more prominently. These will wear down with time, so this is another way to help convey youth in a smile. We would not want to make them this prominent in a set of porcelain veneers, but they can be placed more subtly to create a younger feel to the smile.
And, of course, there is a continuum here. The smile design doesn’t need to be either very young or very mature, but it can be any blend of the two characteristics. If you check out my main smile design page, we call the middle design sporty—conveying a casual image that is between bold and sophisticated.
Here is the form that we would give to patients who wanted a smile makeover or who had any major work to be done that included front teeth, including complete dentures. Click the image to see an enlarged version. We would use this to evaluate the image aspirations of the patient, and I would blend the input from this form with my own judgment of what the patient’s facial characteristics required when I suggested a smile design to the patient. You’ll notice that it includes a couple of questions that don’t really address image aspiration. It asks about the color they want. The darkest anyone would ever want was a natural color, which would be the current color of their teeth. From that they would tell us how white they wanted their smile to be. The extreme of the scale, “1” on this form, we would call “ballistic white.” With the form, we would give them a book of smiles that were categorized by the smile design categories I discuss on my main smile design page—sophisticated, sporty, or sexy. They would pick a smile from that book that they found attractive and that represented what they wanted for themselves.
If all of their choices were in harmony and agreed with what I felt their facial characteristics required, that made the smile design decisions easy. If there were any discrepancies, I would discuss those with them. For example, if they indicated they wanted to appear conservative and sophisticated, but also young, and let’s say they chose a sporty smile design as their favorite, then I would discuss all the implications of their choices until I could figure out exactly what they wanted.
I found this form very helpful and would not approach a smile makeover case without it being filled out.