The short version
- A designed smile that looks designed has failed.
- Six measurements decide it, and none of them is the shade.
- The reference is the face, not the teeth in isolation.
- Perfectly parallel, identical teeth are the commonest tell.
- The shade is chosen last and chosen to suit the face.
- Reference point
- The face
- Key teeth
- The central incisors
- Framework
- AACD, Seattle 2013
- Decided by
- Examination
A designed smile that looks designed has failed.
The difference between one that reads as natural and one that reads as dental work comes down to a short list of measurements, and they are what a cosmetic dentist is actually looking at while you are talking.
Dr. Mike Koczarski set this framework out at the American Academy of Cosmetic Dentistry’s 2013 meeting in Seattle. It is the standard way the work is thought about.
1. Incisal edge position
The central incisors are the two upper front teeth, and they are the most visible teeth when you speak and when you smile. Their length and position set everything else.
How much of them should show is not a single number. It depends on the shape of the mouth and face, and it differs between a relaxed expression, a normal smile and a wide grin.
Getting this wrong is the single commonest reason veneers look like veneers.
2. The midline
The front teeth should line up with the midline of the face, not the midline of the mouth or the jaw.
This is why a cosmetic dentist looks at the face rather than at the teeth alone. A set of teeth that is internally perfect but canted relative to the face reads as wrong without the viewer being able to say why.
3. Axial inclination
Teeth are not vertical. The front teeth sit close to upright, and the further back they go, the more they incline.
Reproducing that progression is what stops a row of veneers looking like a fence. Perfectly parallel teeth are the signature of work done without attention to this, and once you have noticed it you cannot stop noticing it.
4. Gingival architecture
The gum line is part of the design, not the frame around it. The height and contour of the gum over each tooth decides how the tooth emerges and therefore how long it looks.
Where the gum line is uneven, evening it is sometimes the whole treatment rather than touching the teeth at all. See gum contouring.
5. Embrasures
The small triangular spaces where adjacent teeth separate at the biting edge.
Nobody pictures them when picturing a good smile, and they are one of the clearest tells. Teeth with no embrasures look fused. Teeth with well-shaped ones look like separate teeth, which is what they are.
6. Proportion and symmetry
The teeth should relate to each other in size and shape in a way that is close to symmetrical without being identical. Real teeth are not mirror images, and a smile built from mirror images looks manufactured.
Color belongs here too, and it is decided last. The shade has to suit the face rather than being as white as the material allows. Porcelain holds whatever shade it is made in, which is why the choice is deliberate rather than default.
Every choice is decided at the chair
None of the six can be picked off a menu. They are decided by looking at one patient’s face and teeth together, and by asking what that patient wants.
Dr. Back sculpts individual smiles to face shape, age, sex and personality. That is the work; the materials are how it gets executed. The method she uses to establish what you want before any of it begins is in co-designing a smile with the patient.
You also see the design twice before it is permanent: once as cosmetic imaging at the consultation, and once as temporary veneers you wear home. See what happens at a veneer appointment.
Booking a consultation
Sarasota Smile Design is on Clark Road in Sarasota, a short drive from Nokomis, Osprey and Venice, open Monday to Thursday.
Call 941-927-5411, or see smile makeovers.
