The Art and Science of Smile Design

“The simulation of an emotion tends to evoke that emotion in our minds.”

Smile design is defined as the process of creating an aesthetic smile based on scientific and artistic guidelines that have been established over time through accepted practices, perceptions, cultural, and racial standards.

It is a dynamic field that considers facial aesthetics, lip dynamics, gingival and dental aesthetics, and personality, with continually evolving trends. Traditional smile design has focused on the orodental area. Modern smile design, however, requires a comprehensive understanding of the whole patient.

The Subjectivity of Smile Design

When it comes to smile design, subjectivity is key. A purely scientific smile is general, symmetrical, and looks artificial. Applying the same dental library and gingival aesthetics to every patient results in unaesthetic outcomes.

According to the summarized guidelines, no smile is the same, and each smile should have its own identity. In the age of social media, it has become popular for dentists to showcase artificial smiles. What makes a beautiful smile distinct is the integration of organic rules with traditional methods.

Although the term “ideal smile” is used in the literature, it can be argued that no smile is ideal, and “beauty is in the eye of the beholder.” Without the patient’s comprehensive participation, no smile design can achieve 100% success. Therefore, the first step in smile design is patient communication. In the digital age of dentistry, various applications and software facilitate discussions with patients, understanding their expectations, and exploring possibilities.

Types of Smiles

The literature identifies three types of smiles: the common smile (Mona Lisa smile), social smile (broad smile), and spontaneous smile (complex smile). Smile design should be based on the patient’s spontaneous smile as it reflects true emotions.

Key Aspects of Smile Aesthetics

The main aspects to consider in smile aesthetics are facial aesthetics, lip aesthetics, gingival aesthetics, and dental aesthetics.

Facial Aesthetics

All measurements in facial aesthetics should be made in a natural and relaxed head position, which can be defined as the position where the teeth and lips are slightly apart. Facial aesthetics can be evaluated in terms of facial appearance, profile view, and facial shape. 

These evaluations are analyzed using standard reference lines. It is also suggested that there is a relationship between facial shape and the lines of the upper permanent incisors. The defined facial shapes are oval, triangular, and square.

Lip Aesthetics

In lip aesthetics, the shape, volume, length, mobility of the lips, and especially the lower lip, should be evaluated for the design. Lips are classified as thin, medium, and thick. A long upper lip reduces the visibility of the incisors, which negatively affects the aesthetic smile. A lip lift technique can be used to expose the upper incisors

The current beauty standard is a voluminous lower lip. Additionally, the upper incisor edge should touch the lower lip when smiling; however, a slight gap can still be considered aesthetic.

Gingival Aesthetics

Gingival architecture is the foundation of smile design. The color, texture, and biotype are the fundamental components of gingival aesthetics. The gingival line should maintain the appropriate curvature to match the incisal edges and the smile arc. Moreover, if more than 2 to 3 mm of gingiva is exposed, it is considered excessive.

Dental Aesthetics

The incisal edge position is the most important factor in determining the position of the teeth in smile design. The smile arc refers to the vertical position of the maxillary incisors. The most aesthetic smile is the positive smile, which is defined as the maxillary incisal edges embracing the lower lip. Once the vertical position of the maxillary central incisors is determined, their length and width need to be established.

Gender and facial size play a significant role in tooth dimensions. As asymmetry becomes less noticeable away from the midline, it becomes less critical. The golden ratio is not preferred in the relationship between maxillary anterior teeth as it does not naturally occur and narrows the smile. Unless requested by the patient, all diastemas should be closed.

Buccal corridors should be narrow, medium, or wide and definitely considered in the design. Studies show that a midline deviation of 3 to 4 mm is not noticeable to the average person. Research indicates that brighter tooth color significantly enhances the attractiveness of a smile. 

Historically, the anatomy of restorations depended on the laboratory technician producing the case and their comfort level. Digital dentistry has introduced endless possibilities for dental libraries, shapes, and molds.

The following all contribute to the aging of a smile and should be avoided during smile design:

  • Flattened incisal edges
  • Smaller incisal embrasures
  • Smoother surface texture
  • Prominent mandibular appearance
  • Increased crown visibility
  • Increased overjet 

The Importance of Accurate Diagnosis and Digital Smile Design

To create an aesthetic and ideal treatment plan for smile design, an accurate diagnosis is required. Digital smile design is a planning tool that aids treatment, strengthens diagnosis and treatment planning, and increases patient acceptability of the treatment.

In earlier 2D smile design programs, the obtained image was conveyed to the technician, who made measurements according to the digital rulers in the program and transferred the measurements to a plaster model to complete the design.

Today, advanced 3D design programs allow for the calibration of intraoral scans and photographs to create a design, produce a 3D model, and transfer the design to the mouth with a mock-up. Digital technology has enabled us to enhance our capabilities between stages and offer a more predictable result with better quality control.

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