Get more for you money! Shop Berman Instruments
Dentist preferred. Value driven. Start saving!
  1. Home
  2. /
  3. Clinical

Understanding Balance and Harmony in Smile Design

Published on: Sep 26, 2023
 By: Dr. Elaine Halley
Share Article

A smile is beautiful when it is seen in the context of expression within an individual’s face. As dentists, we often focus on the tooth-by-tooth detail, but sometimes, it pays to take a step back and consider the entire expression.

I would like to refer you to an excellent article in the Journal of Cosmetic Dentistry by Drs. Michel Rogé and François-Marie Fisselier1. Referencing the art world, the authors discuss perceptual forces, which explains how we perceive relative harmony and balance of all the aspects that make up a smile.

By definition, harmony denotes a state of balance among forces influencing and even opposing one another. When describing the harmony of a smile, we are describing visual shapes that exert forces on their neighboring shapes.

Follow Guidelines, Not Rules

The textbook definition of the perfect smile is built from very subjective data. Many times, the studies ask laypeople to rate the attractiveness of a smile based on images of the teeth without the context of the face. When the studies are repeated using videos of expressions rather than stills of teeth, the results are different. Therefore, we should consider all the “rules” of smile design as guidelines, or benchmarks to fall back on when we are analyzing and problem-solving. We must not hold them as rigid criteria.

Instinctively, if we consider a smile in the context of the face and personality, we know if there is harmony or something causing visual tension. The difficult part can be putting the exact problem into words.

What to look for:

  1. Parallelism. When the long axis of the front teeth are all parallel, we are close to uniformity which is boring and unnatural.

  2. Attraction. When the long axes are angled toward the midline, we have a sense of attraction. In smile design, we ideally like the long axis of the central incisors to be vertical and parallel, with the laterals and canines angled toward the midline. Now we understand why this looks pleasing; it is the sense of attraction.

  3. Repulsion. Conversely, when the long axis of objects is angled away from the midline, we get a sense of repulsion. So, if we have some teeth in a smile that are angled away from the midline, it is visually displeasing.

In the following diagrams, rectangles represent the upper six anterior teeth:

For example, in this case the centrals are parallel with color differences and the laterals are distally inclined. This causes visual tension in the smile composition:

While the argument could be made that the buccal corridors are also slightly narrow, some whitening and porcelain across the four anterior teeth provide a more balanced smile:

Facial Flow

When these artistic principles are applied to the smile in the context of the face, there is another published paper that can help us understand how facial asymmetry can work with us or against us.

The authors discovered that few faces have an exact midline2. Many have a curve, meaning the glabella, nose and chin point are not in a vertical line but can be a convex or a concave curve. They found that if a deviation from the ideal (like a midline position, for example) was toward the inside of the curve, then visual balance occurred. However, if the asymmetry was on the outside of the curve, it added to visual perception of disharmony. The authors named this concept facial flow.

For instance, the following case had a significant midline shift that would have taken complex orthodontics to fix. The patient also had asymmetries of the lip. Using the facial flow concept, it was noted that the midline shift was in harmony with the facial flow.

After a digital smile design test drive, the resulting treatment plan involved no treatment for the central incisors. Instead, it called for simply widening the smile of the upper lateral incisor to the upper second premolars.

Final Thought

While tooth-by-tooth details are important, the overall smile is best evaluated in a wider context.

_______________________________________________________________________________

References

1. Rogé, M., F.M. Fisselier (Winter 2017). "A New, More Personal Vision of Esthetics." Journal of Cosmetic Dentistry 32(4): 88-105.

2. Silva, B. P., E. Mahn, K. Stanley and C. Coachman (2019). "The facial flow concept: An organic orofacial analysis-the vertical component." J Prosthet Dent 121(2): 189-194.

Dr. Elaine Halley graduated from the University of Edinburgh in 1992. She is a past president and accredited member of the British Academy of Cosmetic Dentistry and a fellow of the International College of Dentists. She is a board member for the UK Digital Dental Society and has an MSc with distinction in Restorative and Aesthetic Dentistry. She is a Digital Smile Design Master and UK instructor and a clinical Key Opinion Leader for Optident, Ivoclar Vivadent and Align Technology. She teaches the Full Certification Invisalign course for Aligner Consulting. Elaine has an award-winning private practice, Cherrybank Dental Spa, in Perth, and has recently been appointed clinical director for the Pain-Free Dental Group, which has practices across Scotland.

"Smile Analysis" by Dr. Elaine Halley

Help your patients to smile with confidence. This non-formulaic focus on Smile Design offers a “how-to” approach to patient communication surrounding the art of smile analysis, the treatment planning process, and case presentation. Read it again and again as you master each step of smile creation at your own pace.

Honed over 30 years in her award-winning dental practice, Dr. Halley brings you her system for Smile Analysis, complemented by an array of case studies that allow you to test your skills before trying them in the clinic. This tried and tested method will transition your dental practice from a single-tooth method toward full-mouth care. Packed with “how-to” checklists, red flags, and decision points, this book will guide you through a step-by-step process, including how to incorporate technology, in the most understandable guide to better smiles available today.

Berman Instruments

At Berman Instruments, we fully believe in the importance of dentists helping dentists. We carry this motto through everything we do. It’s reflected in our pricing and mission as a company. Meet my friend Dr. William Nudera, a fellow endodontist who also believes in helping our dental community.

You May Also Like

2024-01-09

Let's Talk About Mock-Ups

by The New Dentist

In Dr. Amanda Seay's practice, mock-ups play a significant role, serving two distinct purposes. First, they are instrumental in showcasing possibilities to our patients and promoting dentistry. Second, they are essential for evaluating shade, layering, and overall treatment outcomes after a patient has accepted the proposed plan.
2023-12-12

Does Tooth Wear Matter?

We often think of tooth wear as a natural part of aging; teeth flattened by attrition, incisors shortening with age and teeth developing wear facets. Isn’t it just a function of time and circumstance in the mouth?
2023-11-07

Enhance Your Treatment Predictability with Dr. William Nudera

by Dr. William J. Nudera DDS, MS

Conventional endodontic education often oversimplifies the process, boiling it down three steps: shaping, cleaning, and sealing the root canal system. This broad approach doesn't account for the complex subtleties that are vital for mastering the art of endodontics.