Smile Evaluation and Design

The Concept of Facial Beauty

Our smile is an important part of our communications system, and, unlike animals such as dogs and chimpanzees which bare their teeth as a sign of aggression, we humans tend to show our teeth when we smile as a gesture of approval, or are perhaps seeking approval. The smile is an essential element of our body language, enabling us to get along with others, and an attractive smile is a great asset since it facilitates acceptance by others rather more readily.


We instinctively recognize an attractive smile or face, but when the concept is analyzed it seems to come down to the properties of symmetry and proportion. A perceived beautiful face is one that is perfectly symmetrical and with all the main features, eyes, nose, and mouth in their correct proportions.


If the nose is too big, then the whole effect is spoiled, no matter how beautiful the eyes, for example. The idea of aesthetic proportion goes back to the time of the ancient Greeks and Romans who realized that there is a mathematical basis for what we perceive as aesthetically pleasing, and the ratio of approximately 1.62 to 1 is known as the Golden Proportion, Golden Ratio, or Phi, which is seen throughout the natural world and for some reason resonates positively with the human mind.


The Californian dentist Dr Stephen Marquardt has made an exhaustive study of beauty in terms of the human face, confirming that the Golden Ratio, or Phi, is present on every level; and using computer analysis of several data bases of faces generally agreed to be attractive, has constructed a “Golden Mask” which is a computer generated framework that illustrates how the various components of the face relate to one other and to the whole in a way that conforms to the Golden Ratio. The Golden Mask is constructed from a series of golden decagon matrices which in turn are formed from golden elements, i.e. lines conforming to the Golden Ratio in a geometrical configuration.


Practical Considerations

A dentist needs to keep the Golden Ratio in mind when seeking to evaluate a case and attempting to restore or aesthetically improve a patient’s dentition or smile since it is fundamental. The dentist needs to view and evaluate the teeth in the context of the whole face before concentrating on repairing or reshaping individual teeth, especially if fixed restorations involving more than two teeth are contemplated.


It is essential to record the general facial features as well as the teeth of a patient before one can work out a treatment plan, so photos, face- bow records, radiographs, and study models will likely be necessary.


It is important also to evaluate the teeth as they relate to the overall face in terms of size, shape, and skeletal relationship. Photographs of the patient’s face and smile are invaluable in explaining what can and can’t be done. If there is a pronounced skeletal discrepancy, or a midline discrepancy, then either this has to be accepted or else orthodontic, or even surgical treatment may be considered before altering individual teeth.


A systematic approach to the evaluation process is necessary in order to ensure that nothing is missed. It is also important, of course to find out from the patient what he or she desires in terms of the finished result, or what the particular expectations are. Patient satisfaction depends on the dentist being able to communicate well and demonstrate an understanding of the patient’s wishes. Some patients may have a mental image of how they will look after treatment and should try to explain that clearly to the dentist so that he knows what the priorities are – it might be whiter teeth, more regular teeth, or a specific problem such as a chipped or broken tooth.


As part of the case evaluation there is also the consideration of the soft tissues and how they frame the mouth, and whether there is a high lip line and gum showing when smiling. A person’s appearance when smiling is of the utmost importance to them and everything possible to enhance this has to be considered. The smiling full face evaluation should check the midline, the occlusal plane, the inter-pupillary plane and distance, facial symmetry as a whole, and facial symmetry in the lower third of the face. The shape and fullness of the lips should be noted, and also the lip line in relation to the buccal surfaces of the upper incisors, both at rest and when smiling and talking. A person needs to show some of their incisor teeth whilst talking, even if it’s only about a third to a quarter of the length of the two central incisors otherwise the impression is that the person has no teeth at all. The position of the teeth in relation to the lips is important in terms of protrusion or retrusion, so that steps can be taken to improve the relationship if necessary.


Study models and wax-ups are essential for most cases involving more than a couple of teeth and help to convey information to the technician as well as helping the patient understand what to expect of treatment. Sometimes a provisional restoration can help to establish the result that is being sought, and slight alterations can be made in the light of constructive criticisms.


The secret to excellent patient treatment and patient satisfaction with their new smile is listening to the patient’s needs and desires and developing a treatment plan to adequately meet those needs. We at Comprehensive Dental Care offers detailed individual treatment plans based of our Comprehensive Dento-Facial smile evaluation. Creating a beautiful restoration is not enough in itself – it needs to fit in with the local group of teeth, the smile, and indeed the overall face. Restorations need to take into account the principles of the Golden Proportion in themselves, and also to be of proportionate size to the mouth and the face. A common mistake with porcelain veneers, for instance, is inadequate preparation and/or over thick porcelain leading to bulky and over contoured restorations looking like horses’ teeth.


When it comes to the teeth themselves any treatment should take into account the relative proportions and shapes of the teeth. The central incisors for example, are normally slightly longer than the laterals, and approximately the same length as the canines. An anterior bridge that fails to take this into consideration, making all the front teeth the same length, is bound to cause disappointment in most cases because it will look artificial and unnatural, even if the untrained eye cannot say exactly why.


The health and appearance of the gingival tissues is also important, both in terms of assuring long term support of the teeth and restorations, but also in terms of appearance. There should be equivalent amounts of gum showing between all the front teeth without irregularities. Close fitting margins on crowns and bridges are absolutely essential of course, to avoid gingival irritation, which, even if only slight, can cause spontaneous gum bleeding and spoil the effect of an otherwise nice restoration.
Dr Sonika Sharma

A comprehensive analysis of the facial features, soft tissues, and teeth should reveal any areas that fall outside the ideal and by how much, so that a decision can be made as to whether or not restorative and cosmetic techniques can adequately overcome the problem. If not it may be appropriate to consider referral to a specialist in orthodontics or surgery.


Pulling together all the relevant information relating to a patient’s present situation and formulating a comprehensive treatment plan to achieve an agreed outcome is time well spent. Indeed, it is absolutely essential.


Principal Dentist Dr. Sonika Sharma provides patient-centered excellence in Cosmetic dentistry! Dr Sharma is a professional member of Australian Dental Association, American Academy of Cosmetic Dentistry and is dedicated to the highest levels of excellence in the art and science of cosmetic dentistry. For more information or to book a consultation, contact the friendly team at Comprehensive Dental Care today