Larry Rosenthal, DDS, discusses the role of dentistry in facial aesthetics and overall health.
Q: Has the role of aesthetic dentistry changed in regard to facial aesthetics?
A: Yes! Aesthetic dentistry is now the quarterback of both health and beauty for the lower third of the face. For years, cosmetic/aesthetic dentistry was viewed as a simple solution to whitening and lengthening teeth, and widening the smile. The dramatic shift has been toward enhancing overall facial aesthetics as well as facial support via the teeth. This can be done both horizontally and vertically. We call this “The Smile Lift.” The dentist should be the first consult regarding facial aesthetic enhancement because it sets the stage for the lower third of the face, which is the most dynamic, moving part of the face.
Q: What is the public perception of aesthetic dentistry today?
A: To review, 30 years ago it was only about color and shape. These days, it involves everything from tooth whitening to creating total facial enhancement and structural support changes. Building out the smile by horizontal expansion and subsequent width as well as increasing the vertical dimension height can be achieved non-surgically. Although surgery is always an option, we choose the least invasive treatment as possible. Various dental procedures including orthodontics and/or restorative treatments, such as porcelain veneers/crowns or implants, can dramatically enhance the health and aesthetics, as well as the overall facial beauty, of a patient. The current reality in dentistry is that treatment options can be less invasive, less time-consuming, and virtually pain-free and can deliver instant gratification. The public now knows that the results of these procedures can be sustainable for upward of 20 years.
Q: What advice do you have for recent dental graduates who are interested in developing their knowledge and skills in the aesthetic arena?
A: First of all, find a mentor. Second, follow your passion. Understand that this is not only dentistry, it’s also artistry. Third, pursue excellence and do not accept mediocrity. Understand it is a lifelong process and does not happen overnight, and realize it may take 5, 10, or more years to achieve. Since it is an art form, study people’s faces—both their flaws and their attributes. Start by creating a vision for yourself of what changes you can make to enhance a person’s face.
Q: What can dentists do if they want to achieve success and be guided by your successful journey and practice philosophy?
A: I wrote a book called Open Wide(r). It is geared to the public and dentists, as well as the office team. Read it! Display it! Use it as a guide for patient consultations. Also, take elective postgraduate courses in aesthetics, occlusion, and patient management. For example, hands-on courses called the Aesthetic Advantage Continuum are offered at the Rosenthal Institute for Aesthetic Dentistry at New York University. There are 3 levels: basic, advanced, and masters. In addition, we have an option to observe and watch cases over the shoulder. During the course, we discuss our philosophy in regard to patient management; seamless execution; technique; armamentarium preparation design; temporization; cementation; occlusal evaluation; and, most importantly, developing predictable treatment plans.
Q: What do you think distinguishes high-quality dentistry from average dentistry?
A: Several factors—first, adapt your smile design to study; interpret; and, ultimately, enhance the patient’s face to optimize his or her best features. For example, if a patient is long in the face (too vertical), one can widen the smile and then subsequently support and fill out the vermilion border of the lip. This accentuates the horizontal plane vs his or her long vertical plane and often will help cover a gummy smile. The opposite is also true. If a face is collapsed and shortened, vertical height can be gained by raising the bite, which will also help support facial structures, open the airway, and reduce the muscular stress on the dentition. The subsequent result of both the vertical and horizontal expansion becomes a nonsurgical “facelift,” enhancing overall facial aesthetics and beauty.
In Open Wide(r), we discuss the 3 levels of care: health, restorative, and art. You will need all 3 factors at an extremely high level to deliver the best level of care to the patients of your practice. There are numerous criteria. You must have a seamless, predictable technique, as well as your own personal artistic interpretation. Color is always a major factor. Monochromatic chiclets have never been the goal. We use 3 to 5 colors: a gingival color; a body color, which is the brightest; and then the incisal edge with various amounts of translucent hypocalcifications and check lines to stimulate a natural-looking tooth, adding surface texture and creating a varying incisal edge design (the mammelon effect).
The shape, surface texture, and incised edge design can be masculine/feminine, dominant, or softer. These are the issues and ideas that we discuss at length during our lectures. Lastly, the midline is vertical and bisects the midline of the eyes. A cant or slant will negatively impact the face and be noticeable.
Q: Do you have any advice for dentists who desire a higher level of success?
A: The journey is the ultimate reward. If one does not step out of the box, then the goals and subsequent satisfaction can never be attained. It is an exciting time to be a dentist! Public awareness is at an all-time high. Manufacturers are investing millions of dollars in new products and technologies. As a result of simplification and education, the average dentist is far more accomplished today than years ago. Be the best you can be and go for it. Only you can stop yourself from being great. Don’t settle for less! Go for it!
Dr. Rosenthal is a New York City-based dentist and international lecturer. He is the director of the Aesthetic Advantage Hands-On Continuum at the Rosenthal Institute for Aesthetic Dentistry at New York University (aestheticadvantage.com). He can be reached at rosenthalapagrp.com.