Creating Beautiful Smiles

Posted Tuesday, September 11, 2007 to PROCEDURES > Smile

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Laurence Rifkin DDS explains how to gain fuller lips & the optimal smile through advanced & comprehensive esthetic dentistry.

Aeal Renaissance in Art has occurred in our world. "Living Art" made of flesh and one, not bronze, marble and paint, is today's new medium. Medical and dental science continues to learn how to manipulate living tissues just as the artist takes the chisel or the brush in hand and creates a composition that pleases the eye and heart. It is important to avoid the results of "patchwork" facial and dental esthetics. Faces that have had cosmetic surgery and dentistry performed by excellent practitioners individually may not always be as beautiful as desired due to the lack of a cohesive plan between professionals for the optimal look.

In other words, the sum of separately improved facial features that were not planned and integrated to create a "total esthetic look" may not give the optimal result as compared to a more comprehensive approach.

The comprehensive approach to facial esthetics is one of total facial analysis and the potential "team" integration of multiple treatments. This approach achieves a more harmonious and naturally beautiful face and smile.

Today's esthetic dentist must be knowledgeable in all the various dental and medical cosmetic disciplines in order to provide optimal comprehensive functional and esthetic patient care. The combined effort and education of the esthetic potential of both the plastic surgeon and general dentist achieves the optimal results.

Beauty and the Face

Beyond the health and functional foundation of all dental and medical treatments is the realm of facial beauty. The face takes the highest position in importance to human beauty, probably due to its function in communication and a portal to intimacy and human bonding. The face receives the most visual attention and gaze time. Its appeal may be positive or negative or both. Facial expression can be the key to validating the spoken word.

Think Facial Beauty

Dentists have a greater impact upon the face than most people realize. Consequently, we should keep in mind the overall facial esthetic composition of our efforts and what the patient presents with, before undertaking a patchwork approach to isolated esthetic enhancements. Every esthetic dentist and orthodontist, plastic surgeon and esthetic dermatologist should understand facial proportions, angles and measurements.

Facial type, gender, age, racial norms and patient preferences are the details of harmonious and natural beauty. As a dentist and with other medical facial esthetic surgeons we must 109k at the patient's face first in multiple views to observe these details before proceeding to the teeth. Photographs are more useful than mounted stone models alone, especially in esthetic communication to the patient.

Comprehensive Facial Analysis

Working with plastic surgeons, oral surgeons, dermatologists and other dental specialists for complete facial analysis is the "finesse" in developing the optimal smile and beautiful face.

The best approach is to think like an artist. The artist thinks in terms of composition. Each therapist must look at the entire face for harmony, symmetry and proportion.

Support is controlled by restoring lost bone, optimizing teeth positions and idealizing the teeth sizes when they are not. Volume is controlled by adding self and synthetic tissues and materials to the most esthetic size.

Harmony is the most important quality of facial features. There are infinite combinations of different yet compatible facial features. Proportion and balance can be described in mathematical ranges but for natural beauty, the element of minute subtle variation is the key to esthetic perfection. Excessive mathematical symmetry can lead to a "fabricated look". Faces are more like flowers than mechanically created structures and embody natural variation or the perfect imperfections.

Therefore, the face must be treated like an artistic composition which integrates the elements of mathematical proportion and nature's gift of subtle variation to achieve a cohesive and believable masterpiece.

Lip Fullness

The overall lip shape and facial profile is the result of the underlying support as well as the amount of lip tissue available.

In certain situations, a change in teeth position or surface anatomy can enhance the position, fullness or shape of the lips thus creating a more youthful and sensual appearance.

By either correcting the shape of one's arch of teeth through dental orthodontics or restorative treatments such as laminate veneers or crowns the support of the lips can be subtly changed to create a sense of greater fullness of the lips.

Such is the case with the above patient who displayed an asymmetric smile and upper lip line as a result of crowded misaligned teeth and an asymmetric arch. Many lip/smile asymmetries are the result of tooth form or position asymmetries.

The change in the upper lip fullness and symmetry is dramatic in this case by only placing four porcelain laminate veneers on the center four teeth. This was accomplished by changing the lip support through the change in the surface contour of the teeth and the arch form support draping of the lip. There was no other treatment performed on this patient's face or lips.

After the underlying support for the lips is established by dental restorations or orthodontic procedures, then the augmentation procedures should be considered including grafts and injectable materials including fat and collagen. Communication between the dental and surgical team is essential to diagnose and sequence this popular esthetic goal.

Facial Harmony

The importance of teeth to facial harmony is so important that a unique technique utilized "by the author enables the laboratory technician and dentist to create the most natural of teeth that are in the correct position and arrangement in the face. This technique utilizes artistic sculpture techniques that re-create the soft tissue frame of the lips, cheeks and chin to harmonize the teeth with the individual patient's face for optimal harmony As such this technique avoids the common errors that one sees when closely observing smiles that were created hastily and without adequate facial references or planning. Errors such as:

• Slanted or angled teeth that are not vertical with the face and facial midline.
• Teeth that are not level with the horizontal lines of the face such as those lines created by the two pupils, etc.
• Teeth that do not follow the natural curvature of the lower lip when smiling.

Smile Rejuvenation

With time whether one is young or older, color, chipping and the obvious presence of excellent yet unesthetic older materials like gold can be seen when one smiles. This above patient in her 60s displays these esthetic blemishes. Observe the general aged appearance of the smile by the top photo followed by the rejuvenation of the smile in the bottom photo.

The re-establishment of a youthful and natural smile that is in harmony with each individual's unique face is essential to achieve an optimal rejuvenated result. Utilizing the newest non-metallic dental materials and metals covered completely with tooth-colored materials eliminate the evidence of any dentistry, re-creating a natural appearance.

Note: The dramatic rejuvenation of the smile by the elimination of metallic gold inlays is followed by the placement of whiter veneers and all ceramic crowns.

Repair of Fractured Teeth

Today, no longer do you need to see that "black line" at the gum line of dental crowns. Current high strength ceramics and glass fiber reinforced composite resins have replaced gold and metal-ceramics restorations to achieve strong, long-lasting and undetectably beautiful teeth replacements.

The above is an example of two teeth that were fractured in a minor accident, yet required the utmost attention to esthetic detail once repaired.

Note: Following teeth whitening, only two teeth were restored with an all porcelain crown and a porcelain laminate veneer to achieve a "natural and undetectable" correction of these two fractured teeth. (Dentistry by the author and da Vinci Dental Laboratory)

Eliminate Spaces and Chips

Bonding and porcelain veneers can perform miraculous changes in one's smile and feeling of youth.

Spaces can be closed and chips disappear when carefully designed and fabricated laminate veneers are placed as in the above patient's mouth. Note: the closure of spaces, overall whitening of the teeth, elimination of the worn and chipped look and excellent health of the gum tissue.

Eliminate the metallic look

Today,the metallic look is passe and unnecessary. State of the art dental materials have almost eliminated metals from the mouth. When they cannot be eliminated, they can be eliminated from sight. Silver fillings, black lines at the edges of the crowns are totally eliminated with current materials and techniques that artistically duplicate the natural tooth form and color.

By using all ceramic and high strength resin materials as you can see in the bottom photo above, this patient's mouth was beautified and rejuvenated by the elimination of the metals in the older technology materials of amalgam and metal-ceramic crowns shown in the top photo. This patient's mouth is now youthful, healthy durable and natural.

Replace Missing Teeth

If you should unfortunately lose a tooth, often the best replacement is a dental implant to support a crown. With excellent surgical and restorative reconstruction, the final result looks undetectable.

This type of replacement avoided the need to place a bridge, which would have required the cutting down of two healthy virgin teeth on either side of the replacement tooth.

Conclusion

As you can see the optimal smile is a result of attention to detail from the smallest elements to the grander scale of facial composition. The sequence of treatments can best benefit the patient when an integrated approach between esthetic specialists is employed.

Communication to your dentist, dermatologist or plastic surgeon as to your total esthetic goals is the best start to optimal treatment. Reluctance to tell your dentist about other desired facial improvements and vice versa might compromise the final result. Work with a team approach when looking for the best result and ask the team to communicate as to the integration of individual procedures so that the sequence is optimal.

The most important basis for esthetics is a foundation of health and function.

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