Great Expectations — Perceptions in Smile Design

The Patient’s Perspective

an analysis by Dear Doctor magazine

Does your dentist see what you see — and vice versa? Can you really communicate how you want to change your smile?

Perceptions in smile design.

While beauty is definitely in the eye of the beholder, a person’s own perception of what looks good is an important factor in achieving a satisfying result when enhancing someone’s smile. Most of us understand that we want our teeth to look wonderfully bright and natural, but not like ultra-white “Chiclets” all in a row.

While there are several ways modern dentistry can alter the appearance of a smile by changing teeth, ranging from composite resins to porcelain veneers and crowns, this article discusses how you as an individual perceive what looks natural and what doesn’t — and how to go about communicating with your dentist what you want to change in your teeth and smile.

Perceptions and the Art of Dentistry

Does your dentist see what you see — and vice versa? Can you really communicate how you want to change your smile? These are important questions — so let’s start by examining what information is available to us from research on this important issue. Recent studies address this critical subject regarding communication between the public at large as a non-professional group and dental professionals, who may or may not “get” what you are trying to say about what you see and want to change in your smile.

One study set out to determine the differences in perceptions of lay persons and dental professionals. The study looked at variations in tooth size and alignment and their relation to surrounding gums and other facial features that make up a smile. The results are very enlightening because they show that there are varying levels of differences, which can actually aid the dentist artistically when making specific treatment recommendations.

There is no doubt that dentists look at smiles differently than non-professionals — which actually makes perfect sense. Dentists as a group are (and should be) more discerning of issues such as crown (tooth) length, midlines (how the teeth line up with other facial features) and gum-to-lip distance, to name a few.

According to the same study, lay persons place more importance on other features of facial aesthetics. For example, individuals rated mouth expression and lip shape as more noticeable than other “strictly dental” characteristics.

Vive La Difference

The art of “making smiles” lies in the dentist’s ability to integrate the individual’s personal perceptions of what is important and what he or she considers necessary to be aesthetically pleasing. It is the dentist as artist who must incorporate natural elements of dental anatomy and scientific knowledge into smile design. You must have confidence and trust that your dentist hears what you’re saying and that you are able to communicate what you want to look like. Indeed, trust is critical in this relationship with something as important as your smile, which is now in the hands of a dental professional.

Part of building the necessary trust is to accept that there will always be differing levels of perception between patient and dentist; minor variations in areas of smile analysis and design need not be an important concern to you. What is important, though, is for you and your dentist to understand what gets communicated in this encounter.

With a professionally trained and experienced eye, your dentist will actually see more dental possibilities than you do. It is therefore the responsibility of the dentist to inform and educate you so that you’re better able to make your own personal choices.

On the other hand, the old axiom “If it ain’t broke don’t fix it” is also a good principle to follow, at least aesthetically speaking. In other words, if you’re happy with certain characteristics of your smile, leave well enough alone.

 

Blueprints for Success

Provisional restoration.
Figure 1: An example of a “provisional restoration” — a try-out smile to assess changes in size, shape, color, speech, biting function and more before final changes are made.
Final restoration using veneers and crowns.
Figure 2: The final restoration replacing the provisional materials with permanent porcelain veneers and crowns.
Photos provided of Dr. Richard Whalen

It doesn’t matter if you’re having a total “smile-makeover” or just changing one tooth, the ability to preview the change to your appearance may be critical to your ultimate happiness. Computer imaging is a great tool to allow you to visualize a potential change before your dentist even touches a tooth.

A second way a dentist can help us see ourselves before work begins is to actually make a mock-up of the proposed dental work in white tooth-colored wax on models of your mouth. A third way is to build up your teeth with tooth-colored composite resin, which is yet another way of changing tooth shape, size and aesthetics.

Another great tool in dentistry is the “Provisional Restoration” [Figures 1 and 2]. This has become a critical tool in testing the understanding between the dental professional and patient. A provisional restoration allows time for adaptation, to see if the proposed smile changes work for you and if they are compatible with gingival (gum) health, phonetics (speech) and biting function.

If the provisional restoration works, the final restoration is guaranteed to work. The essential difference between the provisional and the final restoration is the materials from which they are made. The final porcelains are more durable and longer lasting than the plastics generally used for the provisional restorations.

The dentist will take impressions of the provisional restoration and communicate all of the relevant information in that blueprint to a “dental technician.” Arguably, the most beautiful, lifelike tooth replicas are made of porcelains, in which case it is the ceramist — a dental technician skilled in the art and science of bringing these glass-like materials to life — who is entrusted with this responsibility.

Shades of Difference: Is What You See What You Get — Or Want?

The only way that you as a patient can ensure a positive answer to this question is to communicate fully with your dentist from the outset. By merging your own perceptions of what you want and need with your dentist’s keen eye for what works aesthetically, you’ll have a much better opportunity to achieve the smile you want and expect.

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