The steps involved with creating a new smile can vary considerably between patients depending on what their needs, desires and the condition of their teeth, jaw joints and gums.  For example take the two cases below which were both treated several years ago.  The first one is rather straight forward the teeth are not badly broken or crowded.  There is some wear on the front teeth through the enamel but the posterior teeth are in fairly good shape.  The benefits of restoring this patients smile was to restore the worn down front teeth to their original lengths close gaps as well as permanently prevent further darkening of the teeth due to staining and enamel wear which allows more of the darker dentin color of the teeth to show through. Also note that the width of her upper arch is pretty ideal it has a nice broad U shape rather than the narrow or V shaped arch that is so unappealing.  Below are photos of esthetic problems that need to be addressed when creating a beautiful smile with cosmetic dentistry, orthodontics and even dentures.  The first picture demonstrates the unaesthetic results from creating or not fixing a narrow arch.  Prince William got some straight teeth from his orthodontic treatment but not a great smile.  The reason why?  The smile on the right is much more appealing because the smile fills the frame of the lips.  There are no large empty spaces between the teeth and the cheeks when he smiles big.  Prince William’s orthodontic treatment created large gaps between the cheeks and the teeth when he smiles because his orthodontist extracted first premolars to relieve crowding rather than expanding the width of the arch.  Prince Williams’s treatment resulted in a child size smile and dental arch in an adult size face, hence the large gaps.

Another important factor in creating a beautiful smile is having the proper amount of upper front tooth display.  Unesthetic smiles can result if there is to much tooth display so that exceesive gum tissue is shown in a full smile. A gummy smile can result from excessive downward growth of the upper anterior teeth and the supporting bone as well as a short upper lip which does not extend down enough to create an esthetic draping over the gum tissue. 

For most gummy smile problems the correction is not complicated and may involve recontouring the gums around the teeth, changing the shape of the teeth and/or orthodontics.  Some people have a normal esthetic tooth display for a posed smile but when engaged in a lively conversation and break into a full smile the upper lip has exceeive mobility resulting in excessive gummy display.  For this esthetic concern there is also an uncomplicated solution.

The reverse problem of a gummy smile is not showing enough teeth which will prematurely age your smile.  This kind of problem can be fixed either through orthodontics, if the teeth themselves are in good shape, or through restorations to replace and restore broken down or worn teeth to their ideal length.  Below is a chart summarizing the research that has been done to document what happens to the amount of upper front tooth display as we get older.

These aging changes, causes and effects are summarized below.

                                                                          THE AGING PROCESS

l  More of the mandibular incisors will show

l  There is a reduction of lip tonicity

l  The upper lip becomes longer and hides more of the maxillary incisors

l  The drooping of the lower lip will gradually expose more of the mandibular incisors

All of these factors combine to create the changes as described in the chart above.  Whether a smile is being changed and improved via orthodontics or cosmetic dentistry, a clear vision of where things need to end up before beginning is critical.  Below is an example of what not to do when creating a better smile.  In this case the orthodontist was more concerned about the excessively deep bite of the front teeth and treated this case by intruding the upper front teeth to correct that problem but did not consider the effect that would have on the smile.  As a result the smile on this young boy was prematurely aged as you can tell when comparing the amount of tooth display results to the aging chart above.  Additionally this case resulted in  a flat anterior tooth smile arc, aesthetically the smile arc of the upper front teeth should follow the arc of the lower lip and extend just long enough so that in a natural smile the teeth are within 1 mm of touching the lower lip. 

Over intrusion of the maxillary incisors in a young orthodontic patient. The pre-treatment maxillary incisor position should not have been changed vertically. The end result displays too little of the maxillary incisors and the smile arc is too straight

Other poor aesthetic results in orthodontics or in cosmetic dentistry are caused by not paying attention to tooth and root angulations.  In the case below the orthodontist has retracted the upper anterior teeth to close spaces that were left from where the first premolars (bicuspids) were extracted. The upper anterior teeth are tipped back towards the tongue creating an extruded front tooth result and a concave tooth profile rather than the normal convex curvature.  This type of tooth arrangement will also lead to a flat or even concave facial profile.

There are many other factors involved in creating a beautiful smile such as tooth size and shape.  Both of these must be balanced with the patients facial features, size, sex and age.