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.
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 excessive 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.
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.
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.