What is beautiful, sexy, or hip is always changing. Clothing styles change, body-type goals change, and how people want to look is always evolving. It’s often an expression of the times we live in. When we used to live in an era of overindulgence, our styles and cosmetic concerns were bigger than life and over the top. Now that we live in a more holistic and minimalist culture, our ideas of beauty have shifted to become more elegant and subtle.
Beauty today revolves around natural perfection, and whether that beauty is fully natural or not, it must appear so to be well received. As cosmetic dentists, our challenge is to create the “perfect smile” without anyone being able to tell that it's not original.
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Like your quirky favorite friend, you don’t want boring, uniform teeth in a smile makeover; you want personality. It’s the dental team’s mission to take the good characteristics of a patient’s smile, face, and personality and accentuate them, while changing the unwanted aspects to better support the newly accentuated features. This is a holistic, total-person approach that allows for the most natural results and most satisfied patients. Every cosmetic dentist has their own unique approach, but here’s what my team and I have found yields the best results for our practice.
Step no. 1: Understand your patient
We invest enough time to get to know the patient, their unique personality, and their identity. Like picking out clothes for your friend or significant other, not everyone dresses the same or looks as good in the same clothes, so finding the personality of the individual’s style is the best first step.
Next, we want to listen to what the patient is dissatisfied about, what aspects of their smile and face they don’t like, and what aspects they do like. It is no longer appropriate to use one stock shape and color of veneers on every patient. Instead, the patient’s current teeth and face need to act as a unique mold, as inspiration, and as a starting point for the end goal. We often get our best information when our patient asks friends and family what they like about their smile. Those closest to the patient can point out specific features in their smile that are technically imperfections but are identifying and endearing for their individual personality.
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For example, we often see people with slightly larger canines or slightly rotated lateral incisors that add personality and charisma to their smile. When this is the case, we’ll leave a slight rotation or a slight size deviation in the final result to maintain their unique charm. These slight tweaks are often too subtle to detect, but they maintain the essence of the patient’s previous look when seen by friends and family.
Step no. 2: Maintain as much original structure as possible
Our second step to maintaining the original feel of a patient’s smile is to keep as much of the original structure as possible. When giving veneers to a patient, we take away as little tooth structure as possible. This allows the color of the tooth underneath to give the veneer a hue of the original color, and it’s healthier for the patient to keep their bite and gums undisturbed. We still want a bright smile when we are done, but allowing the tooth underneath to show hints of its original color gives the veneers a much more natural look.
Step no. 3: See the face as a whole
Our last step, which is often the most difficult, is to zoom out and look at the patient’s face as a whole; don’t just focus on the teeth and the smile. The patient’s teeth can usually be moved or made bigger or smaller depending on what is appropriate. Changing the teeth in this manner can give the patient fuller lips, a less gummy smile, cause their chin to protrude more or less, or change the size of the dimple under their lower lip.
The shape of the teeth can also be changed to make the smile soft, youthful, and mature, or strong to match or change the characteristics that the patient already has or desires. Slight color can be placed in the teeth that is not noticeable to the naked eye but makes the skin more or less pale to brighten the patient’s face. Depending on how the patient’s muscles work when they talk and move their mouth, the smile might also need to be broadened to give a fuller appearance. As with all other aspects of the smile makeover, this part is customized to the individual—what would look best with their face and personality and what will align most with their cosmetic goals.
Cosmetic dentistry has evolved from simply using bright-white stock veneers to a subtle art form. With modern technology, we have more options and more control over the outcomes in smile makeover cases. Taking a personalized approach to each patient is the way we can get a truly natural, beautiful result. As with everything else, it’s better to improve the patient’s beautifully unique identity than to substitute it for something that does not suit them.
Editor's note: This article appeared in the June 2023 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.