The Process of Smile Design and Analysis

Increasingly, patients seeking treatment present with the primary concern of an esthetic enhancement to their oral condition. Many articles have been written and courses taught over the years on concepts of smile design to develop a treatment plan to get an esthetic outcome for the patient.1-7 Esthetic or cosmetic dentistry has become one of the main areas of dental practice emphasis and growth for several years. These terms (ie, esthetic and cosmetic) have almost become synonymous in our dental nomenclature. The literal definitions of these terms are very different. Cosmetic means to do “something superficial to cover a defect or deficiency” and secondarily “serving to beautify the body.” The second part of this definition has a very large cultural component to this, ie, beauty is in the eye of the beholder. There is also an implication that something “cosmetic,” while deemed “beautiful,” is obvious to the observer that a facial or dental characteristic has been enhanced—eg, using make-up to accentuate a facial feature. According to the Merriam-Webster dictionary, the definition of esthetics, on the other hand, is “responsive to or appreciative of what is pleasurable to the senses” or “pleasing in appearance.” Thus, cosmetics and esthetics are somewhat inseparably intertwined, but esthetics also encompasses appearances that do not have a “cosmetic appearance.” Timeless human esthetics implies a sense of beauty, a pleasing impulse, naturalness, and a youthful appearance relative to one’s age. The goal for esthetic treatment should be an enhanced but natural appearance that imparts a vibrant and believable appearance to the patient. This should be our goal in dental esthetics: a result that would be considered “bright, beautiful, but believable.” This may entail the use of cosmetic procedures as already stated but, just as importantly, it blends the functional and biologic requirements of the patient into a durable and longlasting result. The treatment should be as conservative as possible and allow the patient future options as new technologies are developed. This article will focus on historically accepted smile design concepts and present research of smile parameters that will help the reader to design their esthetic treatments. It is very important to note that smile design concepts have been presented in a very static manner, ie, specific measurements for form, color, and position of esthetic dental elements. This is fine for basic information transfer of smile design principles, but it is critical to understand the esthetics is not a finite point; in fact, esthetics can be a broad zone. We like to refer to this as “the esthetic zone” for a given patient. Thus, we will give from our evaluations what we believe are zones or “ranges”of esthetic values for smile design.