Planning a mouth full of dentistry without first designing the ideal smile is like trying to build a house with no architectural plans. This is why many patients end up with teeth of different sizes and colors, where compromises have been made to “conform” to the existing condition.
The premise of facially driven smile design is that the smile should be in harmony with the landmarks of the face. A very asymmetric face does not necessarily look in harmony with a perfectly symmetrical smile. So, mathematical rules for design need to be placed in the context of the face.
Systematic Smile Design
As such, the traditional rules of smile design need to be considered more as guidelines to help us understand why a smile does not appear to be in harmony. We can design the ideal smile according to the face and then compare it with the existing starting point, taking into consideration the underlying skeletal structure, the lip position and dynamics, and the position and health of the current dentition.
We may decide to deviate from what’s considered the ideal smile, but this can be identified at an early stage and discussed with patients to set realistic expectations before they decide on treatment.
With this approach, the risks and benefits of treatment can be viewed in the context of the desired and achievable end result to ensure valid consent is obtained. If the smile is designed before treatment, this also serves as quality control for all stages of treatment. For example, procedures such as crown lengthening and orthodontics can be calibrated according to the planned end result.
It also helps to take a step back and look at the entire face as if it were an artistic composition. There will be areas of harmony that are pleasing to the eye, and areas of visual tension that are not pleasing. We can then narrow our focus to the smile and any areas of tension to determine what we should change to improve the balance and harmony.
One of the factors we can change is the light reflective surface of a tooth or teeth. In smile design, we learn about the importance of dominant centrals: