Understanding the Language of Smile Design

It was certainly an honor to be selected to refine the American Academy of Cosmetic Dentistry Guide to Accreditation Criteria. This guide was first introduced in 2000, where it defined the criteria recognized as the gold standard in esthetic dentistry. This same criteria is used for credentialing dental esthetics by the AACD.

The goal behind updating the Smile Design guide

How we compartmentalize and organize our thinking is crucial to our success. In the original guide, the concepts of smile design were certainly recognized and outlined individually. However, their synergistic relationship to each other was not illustrated.

My goal in updating the guide was to approach these concepts beginning with a broader vision that then progressively narrows so that we can then understand the interactions of each of these criteria to each other. The title of this revised collection of accepted standards of smile design is the Contemporary Concepts of Smile Design.

In this guide, we begin with the concepts of global aesthetics, which have to do with the orientation of the teeth to the face and the lips that encircle them. If we think of the teeth as players on a stage and the soft tissues that encircle them as the curtains, we can now have a vision of the orientation of these players, which gives us a starting point for our smile design.

From there, we narrow our focus to macro esthetics, which has to do with the shapes, contours and proportions of the teeth to themselves and to each other.

Finally, we get to our finest observations, which start to make teeth look like teeth and that’s micro esthetics. Micro esthetics is the fun part that talks about shade, translucencies, textures and luster.

The guide’s new organization allows us to utilize this criteria of smile design to optimize the potential for our patients’ smiles with a focused functional discipline and an omnipresent understanding of the system at large.

Other major changes from the previous version

Beyond the organization of these commonly accepted parameters of smile design, we added some detailed illustrations and clinical examples that help to define each of these visual criteria.

An important concept to keep in mind is that concepts of smile design are not new, and what validates these accepted criteria is the supporting literature that is referenced in the new guide.

How this new guide better helps dentists

A common nomenclature

Having a common nomenclature:

• Provides us with a tool to evaluate our patient’s current conditions
• Allows us to envision the potential for their smiles
• Provides a language to communicate with our colleagues in the dental laboratory

Having this tool is really critical in designing beautiful, long-lasting restorations. Without a common nomenclature and an organized, conceptual approach, there obviously can be no predictability in our communication creating this design.

Understanding the foundation of smile design

Often, the rebuttal to smile design is that, “Well, nature isn’t perfect, and why should every smile be the same?”

I hear this particularly internationally, where the perfect American smile is not necessarily the pinnacle vision of all cultures, because after all in the end, beauty is in the eye of the beholder. The key concept to keep in mind is that although artistry is subjective to creative interpretation, the foundation of universally accepted standards of smile design is paramount.

If we look at the history of art, realists came before the impressionists, who preceded the modern abstract modernartists. We look at someone like Picasso who studied Rembrandt first before he created his own style. The same kind of evolution can happen with smile design. We need to first understand the concepts of biology, structure, and function, and then allow the simple idiosyncrasies of the individual patient to create the uniqueness or the perfect imperfections that we observe in the beauty of nature.

My biggest influence in smile design & esthetics

The first article coining the concepts of dental esthetics appeared in Italian in the early 1970s. What was interesting is that it was about the same time that Dr. Dawson published his first book. Within his book, he defined many of these concepts of global and macro esthetics that are now categorically recognized as those gold standards in dental esthetics. Disappointingly, I don’t think Dr. Dawson was given his due credit for his presentation of functional esthetics. He was certainly on the cutting edge of esthetics so very early.

One of the biggest lessons Dr. Dawson taught me is that true esthetics, as we observe it in nature, is simply the reflection of the relative health of the system. If something doesn’t look right, there’s usually a biological, structural or functional reason why. You need to first understand the concepts of complete care and allow them to modulate your design.

Advice for providing predictable esthetics

My advice for those looking to provide better esthetic dentistry would be simple and this is what I learned from Dr. Dawson; before you get fancy, you have to get better. You have to understand the concepts of complete dentistry, you have to understand the system, and design predictably. I think you’ll be amazed and be proud of how much you can change patients’ lives.

To purchase the new Contemporary Concepts of Smile Design guide, you can visit the AACD website. For additional training in functional esthetics, consider attending Functional Occlusion From TMJ to Smile Design.