Making teeth look like teeth

What brings you job satisfaction? For some, it is learning a new technique or skill. For others, it might be relating to their patients. Still others might gain satisfaction simply from making a high income. I am a huge believer in the importance of achieving peace of mind as a way of truly enjoying life; and one path to peace of mind is enjoying the work that you focus on 30-40 hours a week for many years. It stands to reason that identifying what you enjoy most about dentistry is essential to maximizing your peace of mind.

4 aspects to running a successful practice

For me, there are four aspects to running a successful, profitable, fee-for-service (FFS) practice that minimizes stress and makes most days very enjoyable. These four areas, as I have written about in the past, are (1) a superstar staff, (2) knowing your numbers business-wise, (3) developing authentic relationships with your patients, and (4) mastering your work through continual CE. I have been thinking a lot about the last of these areas as to how it relates to cosmetic dentistry.

The diagnostic wax-up

I’m one of those weird dentists who actually enjoys doing my own diagnostic wax-ups for my cosmetic cases … and, yes, I still use wax! There’s something about sitting down in a quiet space and slowly developing an ideal arrangement of anterior teeth by sculpting with my own hands. It calms my brain and, when I am in the zone—commonly referred to as “flow”—I lose all track of time. In addition, I learn important information about the teeth that I will be working on: rotations that need to be dealt with, gingival levels that may be asymmetric, or possibly occlusal issues.

Making teeth look like teeth

I got to thinking about this last week as I was waxing up a case. I was replacing the four front teeth of a 70-year-old patient. The old crowns were bulky, misshapen, and canted. I was waxing up new teeth to correct these issues, and the wax-up would be used as a template for the temporaries. But as I was going through this exercise, I was reminded of a mission that I have been on for more than 20 years—teaching the importance of knowing how to “make teeth look like teeth” (MTLLT)!

Additional reading: Complete dentistry is the best dentistry for your fee-for-service practice

Now, on the surface this probably seems like a self-evident, rudimentary concept of being a dentist. But MTLLT is a highly complex and layered discipline enabling the dentist to create completely lifelike, totally natural-looking teeth. Dental anatomy is touched on initially in the first year of dental school and then never brought up again.

We all know the basic shapes of a central and lateral incisor and canine. The central is the focus, with the lateral being smaller, and the canine shaped either with a pointed or flattened tip. Most of us depend on the lab to fashion a diagnostic or cosmetic wax-up for the more refined shaping of the front teeth. And in today’s virtual world, computer software can provide an adequate proposal for any tooth arrangement you may be considering.

Essentials for cosmetic dentistry

Nature is simplistically complex and attempting to accurately mimic it can be a lifelong pursuit. When asked, most dentists would say that of course they know the contours of front teeth. But it is the three--dimensional intricacies of a natural central, lateral, and canine that make the difference. Understanding the all-important symmetry of the trimodal geometry of the cervical third of both centrals, the line angles that reflect light and give the illusion of width, the point angles that are created by the line angles merging—this knowledge is essential to real job satisfaction if you are going to provide cosmetic dentistry. I have heard it said that when replacing the facial surface of an anterior tooth, getting the shape correct is actually more important than nailing the shade. Hmm … let’s agree that both are essential to blending an artificial restoration with natural teeth.

My point is that the more you learn and review (or layered learning, if you will) the complex shapes of teeth—the lobes, the secondary and tertiary anatomy, etc.—the happier your patient will be and the happier you will be knowing that you helped create their smile. And this knowledge is called upon more often than you would think. I said before that this is essential information if you want to provide cosmetic dentistry. But anytime you work on front teeth, be it implants, simple bonding, complex layered bonding, or porcelain veneers/crowns, knowing how to MTLLT will make your final restoration more lifelike and will elicit from your patient that wow reaction. Talk about job satisfaction!

An everyday example is finishing or “finessing” a set of maxillary temporary veneers or crowns. Usually made from a diagnostic wax-up, it is virtually always necessary to tweak the contours, edges, and embrasures to make them look like teeth. And, similarly, even when bonding the final restorations, it is not unusual that upon evaluation, you can see that something is just not right, but what? Again, having a deep understanding of ideal dental anatomy makes the answer obvious and the needed fix simple. All this leads to decreased stress and increased job satisfaction.

Let’s face it—the hardest thing about running a profitable FFS practice is having fewer patients to work on. You’d better be able to provide the highest level and most exquisite cosmetic dentistry in your area. And knowing how to MTLLT is an essential component to delivering consistently excellent restorations.

Where to go to learn how to MTLLT

So, where can you go to learn how to MTLLT? These courses are hard to come by, because there’s not much demand for this information, or so I’ve been told. But I encourage you to seek out a waxing course, a dental anatomy course, or even a layered bonding course that touches on tooth shape and contours. Like any other discipline, it calls for layered learning and a commitment to be the best. If you have trouble finding a course, email me and I can point you in the right direction. However you go about it, I guarantee that increasing your ability to MTLLT will greatly increase your job satisfaction. And that, in my estimation, is priceless! 

Editor's note: This article appeared in the April 2026 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.