A smile is drawn before it is built.
Smile design is not a treatment. It is the stage before treatment, where the shape is decided and you get to see the decision while it can still be changed.
Shape, proportion, and how your teeth relate to your face
Most people who come to me for this do not say they want different teeth. They say they dislike the way they look laughing in photographs, or that one tooth seems shorter than the other and they cannot work out why. Sometimes they are right and it is a length problem. Sometimes the tooth is fine and the issue sits at the gum line, or in the way the lip lifts.
Design starts from your face rather than from your teeth. I photograph you at rest, smiling, and laughing openly, and I film you talking, because a still smile lies. The incisal edge, the edge that shows first, should follow the curve of the lower lip. When it does not, the eye notices before the mind can explain what it saw.
A plan is then drawn over those photographs: how long the front teeth become, where the midline falls, how much space stays between them, how much gum shows above. The plan can change ten times on screen and be erased just as easily, which is not true of a tooth that has already been prepared.
Predictability here comes from one thing only. I separate the decision from the execution, and by the time execution starts the shape has already been agreed by both of us.
These stages spread across two or three visits, depending on how much the plan changes between them.
Four steps, two of which can still be undone
- 01
Records
Facial and intraoral photography, a short film of you speaking, a digital scan. I take the shade as well, tab held against the tooth under the same light, because colour memory is poor in everyone, myself included.
- 02
The plan
I draw the shape over your photograph and lay it onto the scanned model. This is where we talk about length, about the midline, and about how visible you want the change to be. Some people want to be noticed. Others want precisely the opposite.
- 03
Trial mock-up
The plan is carried into your mouth in a temporary material, with no preparation or with very little. You wear it, you show it at home, you eat with it. Whatever bothers you gets adjusted, and if you decide against going on, it comes off and you are back where you started.
- 04
Handover
Only once the mock-up is accepted do we move to definitive restorations, and the approved shape becomes the reference everything is built against. From that point on we are in T-02.
What it cannot do matters more than what it can
Smile design treats nothing. Inflamed gums, active decay or a tooth with a root problem are dealt with first, and the plan waits. A smile drawn over untreated disease is an expense with a short shelf life.
It is not a substitute for braces. Crowded or tipped teeth can sometimes be masked by shape, but the mask has a biological price: more tooth is removed than would otherwise have been necessary. In plenty of situations it is more honest to move the tooth than to cover it. When that is the case I will tell you, even though it means you leave for a colleague for a year.
It is not whitening. Colour can change through restorations, but if shade is your only complaint, smile design is a long road to a problem that has a short one.
It does not stop grinding. If you clench at night, the new shape will wear the way the old one did, only faster, because it is finer. Bruxism is handled separately and beforehand, and it usually stays with you in the form of a night guard.
And it will not make you look like somebody else. I can show you a plan drawn from a photograph you like, but your lip, your face shape and the way you laugh remain yours. Anyone promising otherwise is selling something else.
What people who are afraid to start actually ask me
Can I see it before you begin?
Yes, and that is the reason this stage exists. First on a screen, then in your mouth. Nothing definitive is made before the trial mock-up.
What if I try the mock-up and dislike it?
I adjust it. If you still do not recognise yourself after adjustments, it comes off and you stop there. That is what a trial is for: it has to be able to end in no.
Will you cut my teeth down?
Not at the design stage. For the restorations that follow, it depends on how far the shape has to move. I show you on the model how much is removed, beforehand, and I say so when it looks like too much for what is gained.
How long until I see a result?
Records and plan usually take two visits a few days apart. The mock-up is tried at the second or third. I do not rush this part, because it is the only one that can still be erased.
I am embarrassed about how my teeth look now.
I know. Almost everyone who gets this far has put it off for years and rehearsed what I might say. I do not comment on what I find. I look, I tell you what I see, and I tell you where we could start.