Cosmetic dentistry has made enormous strides in the pursuit of natural-looking teeth. There comes a point, however, where incremental improvements in texture result in diminishing returns. Much like how modern video games and movie CGI look worlds apart from how they did 20 years ago, the differences are much less apparent when looking at those released five or even ten years ago.
Incremental improvements are still possible, and in fact desirable, when it comes to the teeth in isolation, but the greater trajectory of digital smile design as a process is becoming more holistic. Planning has expanded to include the dynamics of lip and mouth movements during speech before any treatments begin.
Design Informed by Facial Analysis
Fixed teeth proportions do not work for every face. This observation is not particularly novel, but it does represent an issue cosmetic dentistry has struggled with in the past. Creating a bespoke smile, whether that involves porcelain veneers, implants, or a full-mouth reconstruction, takes time and resources from both the client and the provider. Many who seek treatment are concerned about their long-term oral health but have a particular short-term goal or event in mind, and look for clinics that promise expedience, making the traditional means of custom smile design unsuitable.
Digital smile design dramatically reduces these sources of friction and introduces new opportunities, such as using facial aesthetics and ratios to guide treatment. Scans of the client’s face and mouth gathered during consultation and examination, as well as videos and photographs they provide, fuel a virtual before-and-after, an interactive concept stage that can help the dentist better understand their patient’s expectations and personal preferences.
Harmony is gauged through:
- Facial proportions
- Resting and moving lip positions
- Phonetics
- Smile lines
- How the incisal edge presents
Captured with sensors set on the jaw and 3D intraoral scans that feed into CAD/CAM software.
Planning With Data
Rather than chasing an objective sense of balance, such as the Lombardi, Ward, and Méthot proportions outlined by early dental academics, the main purpose of gathering this data is to improve communication with the client and streamline subsequent workflows.
Digital wax-ups and occlusal assessments allow the patient to see their new smile in motion, offer feedback, and voice any concerns, but crucially, give adjacent dental teams a detailed account of the patient’s oral health. These scans form the baseline of the treatment plan, and as the cosmetic dentist maps out which procedures will take their client from where they are to where they want to go, they can share this data with orthodontists, periodontists, and anyone else who will play a role in the transformation.
When it comes time to perform restorations, having plans informed by facially driven digital smile designs helps ensure consistency. Minimally invasive dentistry has evolved into a prominent philosophy within the industry, in part because it means less pain and inconvenience for the patient, but also because altering even damaged tooth structures can affect how a smile looks and behaves. Digital models powered by facial data can simulate these scenarios and predict changes, allowing the practitioner to refine their treatments to address genuine dental issues while conserving as much healthy enamel as possible.
The Trial Smile
It is here that the digital becomes physical, as the draft is created from wax-ups and models and tested in real-world conditions. Similar measurements (jaw sensors, oral scans, etc) can be taken once again, alongside visual observation and patient feedback, to iron out any morphological discrepancies in performance that were overlooked during planning. Perhaps the tooth length affects occlusion and feels unnatural, or its width makes the buccal corridor stretch uncomfortably. Through facially driven design, these refinements to the blueprint smile are supported by data.
Aesthetics, phonetics, morphology, and patient preference all meet in modern cosmetic dentistry, with the end smile matching expectations, thanks to the communication and demonstration opportunities that facially driven design provides.
An Approach that Empowers Dentists and Their Patients
Patient expectations have pushed dentistry to move towards a more personalised and collaborative model of care. Formulaic treatments and template smiles are more cost-effective, but as research within the industry and on broader consumer bases has shown, people are willing to pay more for tailored treatments.
Facial dynamics and mouth movements are rarely static, and facial-driven smile design is turning this natural element of behaviour into a driver of positive outcomes. Patients and their dentists are more informed, and treatments become more holistic as a result.