The Power of Smile Design by Dr Sam Jethwa BDS (Lon) MFDS RCS (Edin) PgDip Clin Ed

Dentaltown UK Magazine - The Power of Smile Design
by Dr Sam Jethwa BDS (Lon) MFDS RCS (Edin) PgDip Clin Ed

“Thank you so much—I can now smile again.”
Hearing these words from a cosmetic dentistry patient fills my team with satisfaction and confidence; it makes us all smile, and it reminds us why we do what we do.

In some cases, the patient will have completed what we consider to be a simple treatment—perhaps some home whitening only, or teamed with some contouring and direct bonding. Or it could be more complex orthodontic, restorative or tooth replacement work, with a large investment in time for both dentist and patient. Whatever the treatment, the patients have felt the work has made sufficient impact on their well-being that they are now no longer embarrassed to smile.

Dentaltown UK Magazine

How can we aim to achieve this emotionally successful result with our patients?
Yes, we need to provide the highest-quality dentistry, utilising the wealth of technology and material available to us to maximise the aesthetic results, while minimising the biological cost. Yes, we need to offer patients an unrivalled customer service experience. But most of all, we need to address their main concern.

Creating a beautiful smile is as emotional as it is technical and, often, the pursuit of cosmetic dentistry is driven by how an existing smile is making someone feel. The American Dental Association in 2014 stated that a great smile was the only feature cited as “very important” by those surveyed on attractiveness. A similar survey by of 5,481 unmarried individuals found that most singles judge their date on three factors: teeth, grammar and confidence.

If we can listen to our patients in great detail, we can fix how they feel about their smiles ... and then we will have delivered life-changing dentistry.

‘Most people do not listen with the intent to understand; they listen with the intent to reply.’

Stephen R. Covey, author of 7 Habits of Highly Effective People

How can we treatment plan for aesthetic success?
The use of simple digital photos will aid this process. The basic smile design principles can be explained to patients manually or using photo-editing software on either a screen or a printed image. This dialogue with visual aids can help us identify exactly how we can help patients achieve their goals for their smiles.

After detailed discussions with my patients, identifying their main cosmetic concerns and educating them on the importance of a healthy foundation, the treatment planning process will commence either at that visit, or after further considerations have been made. Often, opinions will be required from our specialist endodontic and periodontal colleagues before presenting realistic treatment options to patients.

Often I’ll hear, “I would like my smile to be whiter, and more even.”

This can be a difficult concern to correct. The colour is often the least challenging aspect now, with predictable whitening options available to us, but in some cases we will have achieved an overall result that to us is beautiful but to our patient is not quite right. This can be stressful and uncomfortable, and often leaves us feeling inadequate.

In Case A (Fig. 1), an direct composite mock-up (Fig. 2) and a digital mock-up (Fig. 4) can aid in our creation of a trial smile (Figs. 5 and 6). This is one technique we have at our disposal to help us, and our patient, confirm the final aesthetics before committing to final restorations.

Therefore, we are able to tailor each smile to exacting standards and simultaneously guide our lab technicians to produce a stunning result, which addresses our client’s concerns.

This can be planned in a number of ways: Digitally (Fig. 3) or manually, using facially driven treatment planning, or without a wax-up at all and building a trial smile freehand. All options are valid, depending on the specific case, and we’re lucky to have such a wealth of options available. This trial smile will allow us to perfect the aesthetic result, down to colour, texture, length, width, incisal embrasures and, most importantly, our line angles. Line angles can disguise a wide tooth, a long tooth or a square tooth, and can transform a smile from a false to a natural appearance. Subtle corrections to line angles on a trial smile can change the effect of the entire smile design and can be the difference between an aesthetic failure or a success.

As a cosmetic dentist I am able to facilitate a dream, a desire, a goal for my patients, which is more than just a set of nicely proportioned teeth. The skills we have equipped ourselves with can allow us as dentists and technicians to design, create and deliver a life-changing event in the life of a patient—and the importance of this, and what it means to each patient, can never be underestimated.

  • Figure 1. Case A. ‘I hate the dark areas around my old crowns—they’re uneven, and my smile is narrow’.

  • Figure 2. Direct composite mock-up to widen the upper premolars and fill the narrow buccal corridors.

  • Figure 3. 3-D printed wax-up for upper central incisors.

  • Figure 4. Digital mock-up to guide us through the smile design process
    of Case A. Tooth shapes, angulation, and parallelism can be previewed before treatment.

  • Figure 5. Trial smile for Case A from upper 5-5 constructed
    from resin temporary material and direct composite.
    Note line angles and textures have been considered.

  • Figure 6. Trial smile for upper lateral incisors in Case C,
    indicating the position of mesial line angles to re-create
    nature and blend the restored teeth into the smile.

  • Figure 7. Final outcome of Case A.

Coming in Part 2: Occlusal considerations for long-term functional success.

Author Dr Sam Jethwa qualified in 2012 and since has trained in aesthetic and rehabilitative dentistry with thanks to The British Academy of Cosmetic Dentistry (BACD). Jethwa practices in Hertfordshire at The Perfect Smile Studios and has been a Best Young Dentist finalist at The Dentistry and Private Dentistry Awards. He is chairman of The Young Membership Committee at the BACD and is a qualified clinical teacher and mentor for younger dentists.
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