It has been more than 20 years since I coined the phrase smile designer during an interview for a New York Times article. The point of the new name was to move beyond prosthetic dentistry (which means artificial teeth), beyond aesthetic dentistry (where we strive for beautiful teeth), and even beyond cosmetic dentistry (which means changing teeth), to the concept of a facial view, an interaction of the design of the teeth either to enhance or mask the facial features of the patient. With a celebrity-based clientele in New York, my task through the years has been to create the most alluring, dramatically enhancing smiles possible. With a large number of fashion models in the practice, it has been easy to track which smile designs sold more products and which smile designs became more successful.
The entertainer Ray Charles once said, You can't play jazz until you first learn the notes. We've spent several decades learning the notes of cosmetic dentistry. We have been schooled about multiple generations of adhesives and have been taught which composites and porcelains fared better in different situations. To be a smile designer, however, you have to begin “playing jazz,” improvising using the basic notes; ie, our current material— whitening products, composites, porcelains, and orthodontics.
There are smile designers among us who are playing jazz with the mixed media we've been handed by the dental manufacturers. These are the artistic clinicians who realize what smile design is not. It is not adhesive dentistry, it is not materials choices, and it is not necessarily dental morphology. It is artistic design, pure and simple—the abstract, right-brained choices we make to mask or at least minimize the negative features on a face and maximize the positive features on a face to create a winning smile. That smile can be soft, romantic, sexy, athletic, sassy, or any number of things you, the designer, and your client wish it to be. The new role of the smile designer is not just to make attractive teeth, but to create a look, a style, a character.
If smile design is not about making artificial teeth or pretty teeth, or even changing teeth, then what is it?
THE ELEMENTS OF SMILE DESIGN
Smile design is a styling architecture that involves design elements beyond the teeth. It is about matching the smile to the entire face and to the whole person.
We have all read articles and seen presentations where lecturers demonstrate excellent technique in changing the color, shape, and position of the teeth. But often those same clinicians show us retractor smiles. “Isn’t this a great case?” they ask with pride. “Maybe” should be our answer. Let’s move back from the retractors, look at a full-face portrait, and decide if the patient’s face was enhanced by that smile design. As it turns out, without seeing the shape of the full face, without focusing on the facial features, without knowing the patient’s image aspirations, personality, and lifestyle preferences, it is impossible to tell whether that before/after “retractor” case is successful or not.
The single most important element of smile design is not the color, shape, position, or texture of the teeth. In fact, it has nothing to do with the teeth. It is beyond the mouth. It is the shape of the face. To make a set of teeth, be they veneers, bonding, crowns, implants, or dentures, without regard to the shape of the face is to be a dentist and perhaps a good one, but surely not a smile designer.
To begin to think like a smile designer, we need to take 2 steps back. Drop the little dental mirror (the one at the end of a thin metal rod) and pick up the patients face mirror. See how far back a patient needs to hold a standard mirror to see his or her entire face? That’s how far away you need to be. Now look at the patient’s entire face shape. Is it oval-shaped? Is it long? Is it wide, square, or heart-shaped? Does the patient have hair falling forward blocking your view? Ask the patient to hold it or pin it back. If your patient is female and you are not sure of the facial shape, ask her. She will probably know.
Once you know the face shape and choose the appropriate smile design for that shape (as explained in this article), it will make a huge difference in your selection of the position and shape of the teeth. Your patient’s resulting new smile will not only be pleasing in a close-up retractor view, but his or her entire face will have been enhanced.
The key idea behind smile design is that our perception of a face can be optically influenced by design elements on that face. In other words, the same face shape can look different under different circumstances. For example, if someone with a long face wears long dangling earrings, that long face will appear longer. The same will be true if you place 2 long upper central teeth on that long face or if you deepen the smile arch of the upper teeth. The long face will look longer. On the other hand, if the hair is bobbed midface, if the earrings are small, and if the 2 upper central incisors are almost the same length as the upper lateral incisors, the long face appears to be less long. The whole face looks better.
Many of us need to unlearn what we were taught in prosthetic dentistry about designing teeth to match faces. In that antiquarian view from half a century ago, long teeth were placed on long faces and wide teeth were placed on wide faces. Since practitioners were dealing with prostheses and trying to make them as real as possible, it is natural that they were trying to mimic nature. We now understand that to improve a face, we need to spin that idea 360° and do just the opposite. Long upper central teeth are more appropriately placed on wide faces. Short wide teeth look best on long faces. I call this design phenomenon the Principle of Felicitous Opposites.
THE SHAPES OF SMILE DESIGN
Let us continue by identifying the 5 face shapes and determining the best smile design for each. They are (1) oval, (2) long, (3) wide (also known as round), (4) square, and (5) heart-shaped.
|Figure 1. The oval face. This face has long been considered the most perfect face shape in Western society.||Figure 2. The oval face design. A full range of smile designs is possible with the oval face.|
The oval face has long been considered the most ideal face shape in Western society (Figure 1). An oval face is perfectly proportioned and balanced, with the eyes one half the distance between the top of the head and the chin. The sides of the face are soft and slightly curved. With an oval face, we have a full range of smile designs to choose from. This idea is analogous to the current notion that a thin person can look good in most styles of clothing. An oval-faced person can look good with most styles of smiles (Figure 2).
It is our task, then, to create the optical illusion that patients with other face shapes, be they long, wide, or heart-shaped, have some ovality to their faces. How we manipulate the smile to create that illusion is similar to how other facial accessories (hairdos, eyeglasses, earrings, ties, etc) can have an effect on optically changing the look of a face. For example, when choosing eyeglasses, square glasses on a round face can improve it, whereas round glasses on a round face makes the face look rounder. The Principle of Felicitous Opposites is working here to improve the look of a face.
|Figure 3. Horizontal smile arch. The silhouette of the upper teeth should create a “staircase” effect. Our object is to create a horizontal band of teeth on the vertical face.||Figure 4. Radiating smile arch. This will set off the 2 long central incisors as a purposeful design element and will make the entire face look better.|
To produce the smile that will make the long or the round face look more oval, the trick is to have the patient smile with the teeth slightly parted. Now focus on the silhouette of the incisal edges of the upper teeth (the positive space) against the background of the darkness of the back of the mouth (the negative space.) Let’s identify that imaginary line as the “smile arch.” That arch form can be a gentle convex curve, like a Romanesque arch, or it can be flattened completely. Lastly, it can be severely parabolic, like a Gothic arch (Figures 3 and 4).
|Figure 5. The long face can optically be made to appear less long with an appropriate smile design.||Figure 6. The long face design. An ideal smile design would minimize a long face by flattening the upper anterior smile arch and bulking out the upper posterior teeth to create a horizontal band of teeth.|
The long face (Figure 5) is improved by influencing the viewer to look at the face not in a vertical but in a horizontal direction. We accomplish that by flattening the anterior portion of the upper smile arch and slightly bulking out the upper posterior teeth. The lateral teeth should be just slightly shorter than the central teeth, and the cuspids should be shorter still. The silhouette of the upper teeth should create a “staircase” effect (Figure 3). Our object is to create a horizontal band of teeth on the vertical face (Figure 6). It is important with this design not to drop down the incisal edges of the cuspid teeth as you might in a conventional denture setup. If we were to lower the incisal edges of the cuspids after raising the laterals up slightly, we would defeat the illusion of the horizontal teeth cutting across the face.
|Figure 7. The round face: should be optically made to appear less round with an appropriate smile design.||Figure 8. The round face design. An ideal smile design would minimize a round face by deepening the upper smile arch, perhaps with 2 longer central teeth, creating a vertical stripe on the face.|
The round face (Figure 7) is improved by influencing the viewer to look at the face in a vertical direction. We accomplish this optical manipulation by placing 2 long upper central teeth on that face. In a sense, we are placing a vertical stripe on the face. The viewer is drawn to the center of the face to counterbalance the natural tendency to look at its width. In this case, 2 shorter upper lateral teeth followed by longer cuspids are preferred (Figure 4). They will set off those 2 long centrals as a purposeful design element and will make the entire face look better (Figure 8).
|Figure 9. The heart-shaped Face. This face combines the features of the oval face in the top two thirds and the long face in the bottom one third.||Figure 10. The heart-shaped face design. An ideal smile design would enhance this face by minimizing the chin. Flattening the smile arch will accentuate the width instead of the length of the face.|
In the heart-shaped face (Figure 9), the upper two thirds of the face mimic an oval face, but the chin is pointy. Therefore, the bottom third mimics a long face. For this makeover, we need to consider this face more in the long-faced category than the oval-shaped category. The smile arch, therefore, needs to be compressed (flattened) a bit to mask the chin, but not necessarily as severely as when dealing with the truly long face (Figure 10). The design and the effect are more subtle. Once again, however, it is important not to lower the upper cuspids after raising the lateral incisors. That will countermand your design.
|Figure 11. The square face. This face has come into fashion as one of our current images of androgenous beauty.||Figure 12. The square face design. To accentuate a square face, use square or rectangular nonovate-shaped teeth with long proximal lines.|
The square face (Figure 11) is the new player on the beauty scene. In previous decades, the square face was considered the domain of maleness, and the theory was that in women, it should somehow be masked. Styles change, fashion changes, and with so many current female celebrities sporting square faces, a strong case can be made to accentuate the square face in both genders. This is accomplished by fabricating square or rectangular teeth for a square face. Sharp line angles in the upper incisor teeth will echo the sharpness of the jaw line. Long proximal lines between the anterior teeth will mimic the sharp line angles of the face (Figure 12). Conversely, if you or your client wishes to mask the squareness of her face, choose softer, rounder, more ovate incisors.
The manipulation of the smile arch to change the view of the face may be the first element of the smile design, but it is hardly the only critical element. In this continuing series of articles, we will display how individual facial features can be accentuated or minimized with a proper smile design.
Dr. Golub-Evans is a smile designer whose work has adorned the covers of more than 500 beauty and fashion magazines. He is a fellow and past president of the American Academy of Cosmetic Dentistry. He also is a professional fine artist, with works in numerous museums and national galleries. His next solo art show will be at the Brunz-Rosowsky Gallery in Las Vegas, starting May 28, 2004. His next course, “Smile Makeovers With Direct Resin Veneers,” Dec. 5 and 6, 2003, is part of New York University's Master Clinician Series. (For more information, call  998-9771.) For additional course information, contact Jo Ann at The New York Center for Cosmetic Dentistry at (212) 288-4455.
Disclaimer: The author notes that all facial images in this article were digitally produced at the New York Center for Cosmetic Dentistry and are not intended to be representative of any specific individual.