Written by Donna Molavi, DDS Monday, 31 January 2005 19:00
Any cosmetic industry, by its very nature and definition, is fashion-based. As in any such industry, fresh new approaches will leave existing trends dated, creating a movement in which the development of the necessary skills is a prerequisite for survival. Aesthetic dentistry is not an exception, and cosmetic dentists cannot hide from the sweep of art and fashion. The perception of beauty changes with history; the beautiful smile of 50 years ago is not a fashionable smile today.
Cosmetic dentistry should take a holistic standpoint, which involves the person as a whole and not just the mouth. If the dental restorative work does not complement the face and the entire personality of the patient, no matter how technically perfect the work is, it will appear false and is a failure.
Today's beautiful smile, as trends dictate, is composed of the teeth being pushed forward and out to the front and sides of the mouth—the filling of spaces with an exaggerated presence of teeth, a dazzling white monochrome canvas with minimal artistry.1 It's the Hollywood "wider and whiter" model, where teeth cease to be teeth, instead taking the role of dazzling enamel mouth jewelry. As this becomes increasingly apparent, it must be questioned as to whether these smiles are truly beautiful. In contrast, are the teeth more of a showcase for expensive dental enhancement work in which the initial aim of a natural look is lost?
The fundamental obstacles in the evolution of cosmetic dentistry are a lack of knowledge and education in art and fashion relating to this field. Cosmetic dentists must learn the true art of beauty and have the artistic perception to see beyond the medical and technical perfection. The key to success is the possession of a sense of fashion and style. The scale for beauty lies in a natural appearance.
By stripping aesthetic dentistry back down to its base elements and purpose, dentists have the opportunity to look beyond the product, but not beyond nature.2 The importance of the role of fashion in smile design and aesthetic dentistry is far greater than restoring teeth with a monochromatic appearance. Our goal should not be changing the shape of the lower one third of our patient's face.3 Each smile should be designed based on the individual's own physical and personal concept as it relates to fashion at the time.
Fashion is beyond the norm, even creating its new norm. Most natural, beautiful smiles do not follow the Golden Proportion of Aesthetic Dentistry.4 Diastema is not necessarily distracting; central incisors that are too wide or too long (bunny look), and rotated laterals do not necessarily need to be corrected.5 To the contrary, these can meet the aesthetic demands of our patients and provide an aesthetically pleasing smile. The attractiveness of a smile is not necessarily the result of a general sense of parallelism and symmetry.6
There are 2 different methods that may be utilized in order to "design a smile." Traditionally, there is the "textbook definition," which adapts a more rigid format. Alternatively, there is "smile design" that may be based on evolving fashions within cosmetic dentistry.
In order to analyze each individual appearance, 2 parameters must be considered: (1) the general concept of the patient (the dentist's view) and (2) the individual concept of the patient (dealing with the individual's color, race, facial and body features, etc).
In analyzing the general concept, the following classification system will be utilized, citing 5 different appearances:
(1) fashionable look:
(2) conservative look
(3) classic look
(4) sexy look
(5) youthful look.
Generally, each individual is classified under one of the above categories, with only one view meeting the aesthetic desire of each individual; this classification provides the basic foundation of the smile design.
To complete this foundation, we need to look at each individual's own concept in relation to the following:
This article presents a study conducted by the author focusing on the influence of fashion in aesthetic dentistry and the need for training in fashion and art in dental education. In the following clinical cases, we analyze each patient's own concept in relation to the general concept and relate this to current dental fashion. This will enable us to put the most appropriate dental design into the right face, resulting in a natural appearance.
Each patient who participated in this study had the purpose of the exercise explained to them, and consent was obtained from them for the use of their photographs in this article.
CASE 1: FASHIONABLE LOOK
Contemporary Fashionable Look (General Concept)
|Figures 1a to 1c. Case 1A: the contemporary fashionable look.|
Individual concept: Patient A is a young woman in her 30s with a contemporary fashionable look. Her presenting dentition had a grey color, and the shape was of a more conservative appearance. The effect of such dentition was that her smile was much older than the rest of her appearance and therefore out of context with her whole concept (Figures 1a to 1c).
Points for consideration in this case: To make a prominent smile, it is not possible to build up the teeth physically, as by doing so we are risking making the upper arch oversized; there is no open space to fill in any direction (buccally, aproximally). To the contrary, by opening gaps and making a clear definition in incisal embrasures, we create a young, energetic look, which is applicable to the patient's entire concept.
Traditional (General Concept)
Individual concept: Patient B is a businessman, suited and with spectacles, in his late 50s, with normal-sized features. His dentition underestimates his traditional and smart look. The fact that his teeth are extremely discolored with a crossbite in 2 teeth has always been a concern for him, so he tries to avoid smiling and has lowered self-esteem.
Two issues for consideration in this case were that the restoration should give both a younger look while rectifying the crossbite.
Younger look. This is achieved by giving moderate definition (steps) in incisal embrasures, which show in rest position. This gives the patient a much more attractive appearance. (Compared to case 1, patient A, steps and definition of the incisal embrasures are remarkably less.)
|Figures 1d to 1f. Case 1B: the traditional fashionable look.|
Correction of the crossbite was necessary in order to create a smarter and more natural look. In order to achieve this, buccal buildup was necessary, thus giving a masculine shape to the dentition. This is complementary to the patient's features and mature look (Figures 1d to 1f).
CASE 2: CLASSIC LOOK
Individual concept: Case 2 is a middle-aged, professional lady with large features, outstanding eyes, very classic eyebrows, and significant cheeks; her mouth is not significant, and this is distracting in her face. There are spaces that can be filled and a crossbite on the left side. The lateral incisors are out of the smile line, and this subsequently creates an unpleasant smile.
|Figures 2a to 2c. Case 2: the classic look.|
To correct the crossbite, it was necessary to build up the buccal aspect. As the patient has a small upper lip, though, the correction was done with considerable care in order to keep the proportion between the size of the lips and the teeth. In this case, the maximum use of 3-D modeling was adopted in order to make her mouth prominent and create "hills and valleys" on buccal surfaces. Significantly deep approximal lines were necessary in order to create the optimum prominent buccal surfaces. This would subsequently catch the light and create a prominence of dentition with minimum physical buildup. The incisal definition was significantly less than in case 1, patient A, which matched the patient's classic ap-pearance (Figures 2a to 2c).
Points for consideration in this case: The maximum concentration in this instance was on the buccal aspect.
CASE 3: CONSERVATIVE LOOK
|Figures 3a to 3c. Case 3: the conservative look.|
Individual concept: This gentleman was in his 50s and had an anterior open bite. He had large facial features, which was advantageous. Restoration with a larger dentition was adopted in order to fill up the anterior part of the mouth so as to make the open bite less significant. The complete closure of the bite was not possible, however. In this case, the minimum incisal definition was created in order to cover the anterior open bite (Figures 3a to 3c).
Points for consideration in this case:
(1) In order to fill the anterior open bite, a minimum (significantly reduced) incisal definition was made.
(2) Maximum thickening and lengthening was achieved by using the advantage of the patient's large features.
The design of the dentition is conservative, which matches with his conservative concept. This case was completed with the use of 6 veneers.
CASE 4: SEXY LOOK
|Figures 4a and 4b. Case 4: the sexy look.|
Individual concept: This attractive lady in her 30s had strong discoloration and old fillings on several teeth. Her features were very fine and delicate, with a pointed nose and high cheeks. Treatment involved making an extremely clear definition, creating gaps and steps in the incisal embrasures, and making pointed canines and very delicate centrals. In this way, a very delicate dentition that fitted with her overall concept was created (Figures 4a and 4b).
Points for consideration in this case: (1) the maximum concentration was applied to the incisal embrasures and (2) no thickening or lengthening was required.
CASE 5: YOUTHFUL LOOK
|Figures 5a and 5b. Case 5: the youthful look.|
Individual concept: This was the youngest patient treated, a 17-year-old youth with peg laterals, extremely small canines, and a large diastema. He was unhappy with the childish look of his dentition. His features were much more mature than his dentition. He had good-size lips and a good-size nose, which are used advantageously to fill all the gaps without his teeth looking oversized (Figures 5a and 5b).
Point for consideration in this case: no thickening or lengthening was required, as the restoration ensured that the patient's youthful look remained.
The following 2 fundamental points must always be considered in any case:
|Figures 6a to 6d. Case 6: cultural considerations.|
(1) Race: In order to achieve the optimum "natural look," consideration must be given to racial issues such as facial features and differing dentition. Figures 6a to 6d show the restoration of a black patient's dentition; the diastema is a common feature in the African race. As the figures show, the restoration with the diastema present fits in perfectly with her own concept and creates a classic look for an African lady.
The perception of beauty varies and is dependent on the historical era as well as the environment and race of the individual. Whatever the scale of beauty adopted, which may be influenced by changing fashion, a natural look has always stood the test of time.
Cosmetic dentistry must consider changing fashions, but emphasis must also be given to the facial features, dentition, age, gender, and racial origins of the patient. Subjective and objective viewpoints are necessary. In order to achieve maximum impact in terms of dental excellence, fashion and art are required in dental education.
1. Rosenthal L. The smile lift: a new concept in aesthetic care, part 1. Dent Today. Apr 1994;13:66-71.
2. Renaldi P. Simplifying anterior aesthetics in the general practice (Case study: treatment modalities for optimum esthetics). Contemp Esthet Restor Pract. April 2001.
3. Rosenthal L. The perceived value of aesthetic dentistry. AACD Journal. Fall 1994.
4. Kaiser D. Principles of esthetics. Principles of Esthetic Dentistry, Course Manual. University of Texas Department of Restorative Dentistry; 1994.
5. Goldstein RE. What your smile reveals. Changing Your Smile, 3rd ed. Quintessence Publisher; 1996.
6. Tipton P. The art and science of aesthetic dentistry, part one. Restor Aesthet Pract. March 2003.
The author would like to acknowledge the following people for their assistance in this clinical study: Professor Nasser Bargi, University of Texas; James Reid, dental technician, TCB Dental laboratory; and Peter Kouvaris, dental technician, J K Dental laboratory.
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