Artistic Communication for the Optimal Smile

Posted Wednesday, September 12, 2007 to PROCEDURES > Smile

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Beverly Hills Aesthetic and Restorative dentist Laurence Rifkin DDS uses a 3-dimensional lip impression system for accurate and efficient smile design to achieve personalized and undetectable natural beauty.

A smile is made up of more than just teeth - the lips and face playa critical role in designing the most beautiful and believable smiles.

Facial harmony is key to the believability and beauty Understanding this concept and knowing how to achieve it is the difference between good and undetectable natural beauty.

One major short-coming of many fabricated teeth is that they are not personalized to the individual patient's face and therefore seem to come out of a mold that is in the technicians hands and not natural to the patient. Additionally, veneers and crowns often have flaws in the alignment to the facial planes and natural curves of the face making them off angle to vertical, horizontal and appear crooked or odd.

The most important goals in aesthetic and cosmetic dentistry is to create restorations that are virtually undetectable and harmonious with each individuals unique face.

In addition, it is beneficial to perform this artistic task in the most efficient and pleasant manner avoiding unnecessary repeated trial placements called, try-ins.

Time is important to everyone and should not be wasted. We have all seen celebrities with gorgeous smiles that make them look like they were born smiling. Chances are they weren't but rather found a cosmetic dentist able to design them a smile that, while perfect, still looks completely natural.

Cosmetic dentistry has come such a long way it is no longer necessary to display metal crowns, silver fillings or simply ugly "worked-on" teeth. Ceramic veneers, crowns, inlays, implants, even teeth whitening all combine to correct crooked or aged smiles so that people can be dazzled by the smile not the dental work.

However, while it is possible, given modern advances in dentistry, to gain a beautiful smile, often the teeth are corrected by restorations that are created by the laboratory in isolation from the patient and the result is a smile that doesn't fit the face because the technician cannot see the patient's face and surrounding lips.

Dentists don't always work in close collaboration with dental technicians who create and build the veneers, crowns or implants that are needed to create a beautiful smile. Communication is paramount between patient/dentist and dentist/technician to obtain optimal results. There is a better way to achieve the optimal and personalized smile that is predictable and efficient.

Here are 8 simple steps to create the perfect smile for each individuals face.

1. Understanding the patient's goals. Do they want a very natural look, or do they want extremely straight, white and extremely uncharacterized teeth? A natural look is recommended rather than a fabricated one that is either too straight or too white and void of all of natures incredible subtle variation. Therefore, it is essential that the patient's esthetic vision be established first.
2. Providing photographic reference for the dental technician to see the minute details of the surrounding teeth for perfect matching.
3. Computer imaging for an initial design. The patient's smile as a digital image is manipulated by the dentist. This is an efficient communication tool not only to ensure the dentist and patient are understanding the desired results, but also for the dental technician
4. Three dimensional aesthetic wax-up of the desired look as a design prototype to make provisional or temporary teeth for the patient to preview in the mouth.
5. Provisionals are made so the patient can see and test for the bite, phonetics and aesthetic results. They see the near final result in acrylic and can make their wishes known before committing to the definitive ceramic restorations.
6. Once provisional restorations are perfected, a copy is made of the acrylic provisionals that the patient has accepted. From this copy another negative mold called an index is made to guide the ceramist to precisely duplicate the perfected acrylic provisional restorations. Thus, the predictability of the final outcome is greatly assured without the potential negative surprises.
7. A lip replica impression is taken of the patient's smile. This allows the smile (now silicone replica) to be put back in the face and is the ultimate communication device for the dental technician to fabricate the optimal dental structures that are in harmony with the face.
8. Final finesse with the laboratory technician, such as shine, texture and color touch-ups are made for a custom finish which obtains the optimal blend of the restorations with the natural teeth to develop the most beautiful natural looking smile and not detectable dentistry or that "Fake look".

Lip Impression System

The lip replica is the most realistic communication device there is for creating the best smile for an individuals face. Better than photographs and computer images because it is a three dimensional working reference and is directly placed next to the teeth just like the patient's actual mouth. Without it, the laboratory that makes the teeth doesn't have the patient's facial reference to align the teeth with the vertical midline of their face, the horizontal line and the curvature of the lower lip when smiling. It also provides the information on the lip size and fullness to evaluate the size relationship potential of the restorations to be placed.

This system is utilized for any patient that requires both the front and side parts of the mouth to be restored. It is very apparent when we see people who have had just their front six teeth restored. It can create disharmony with the flow of the mouth because the side teeth appear smaller, darker and thus the difference now points out the new front six teeth as new. Therefore, it is often necessary to include the side two to four teeth, totaling ten to really perfect the smile harmony.

The system is incredibly simple. An impression is made of the lower third of the face in a similar fashion that a movie studio will do special effects masks for a particular actors face and custom fit this character. We can take an impression within minutes of any soft tissue capturing the infinite array of lip and face variations.

There is a bite fork and a small tray that holds the impression material. The patient breaths through their nose while the impression of the lower third of the face is being taken, which takes about 3 minutes. The smile line, the width of the smile, curvature of the lips, fullness of the lips, center of the lips called facial midline and the horizontal line between the two corners of the mouth, plus the front part of their teeth are all captured in the impression and re-created in silicone replica. This is enough information for the laboratory to utilize during fabrication when they are building the ceramics. They can place the ceramics on the teeth, shaping them and checking the relationship between the ceramics and the surrounding soft tissue frame - the face.

Before this system was introduced, the patient would have to go through a "try-in" and possibly a few of them when the restorations come back from the laboratory to produce the desired result.

Now it is a "custom finish" appointment because there is predictability that the teeth are aligned with the face. This reduces the amount of wasted time and unnecessary modifications of the ceramics

Now more time can be dedicated upon improving the subtleties of the restorations; the texture, color, form reflection and finish to make the restorations "believable".

This is true smile design, putting the teeth back into the smile and the smile back in the face rather than treating the teeth like they were in isolation.

With an eight step system of aesthetic steps and a three dimensional system of facial communication for laboratory fabrication, beautiful, undetectable and natural smiles can be created that are in harmony with the face and the lips wasting less time because of optimal communication between the dentist, patient and laboratory technician.

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