Smile Design

Smile design is not a single procedure but a planning approach. The colour, length, shape and alignment of the teeth and the gum line are assessed together with the lips, the midline of the face and the overall proportions of the face. The aim is not "the same white, straight teeth for everyone" but a smile that suits the person's face and looks natural.

Once the design is agreed, one or more methods are used to achieve it: teeth whitening, porcelain veneers, porcelain inlays or crowns, gum contouring, and in some cases orthodontics or implants. For some patients whitening alone is enough; for others, several methods are planned together.

An important principle: the least possible intervention on healthy teeth. Once tooth tissue is removed it does not grow back, so if the same result can be achieved with less preparation, that route is preferred.

• People who are unhappy with the colour of their teeth
• People with gaps (diastema), chips, wear or irregular shapes in their front teeth
• People who want to replace old, stained fillings or crowns
• People whose teeth look out of proportion with their face
• People whose gum line looks uneven when they smile

Gum disease and decay are treated before any cosmetic treatment. If there is severe clenching, crowded teeth or a bite problem, these are assessed separately during planning; sometimes orthodontics or a night guard is needed first. Teeth whitening is postponed during pregnancy and breastfeeding.

1. Examination and discussion. The teeth, gums, bite and jaw joint are examined. What you would like to change and your expectations are discussed in detail.
2. Photographs and digital records. Facial and smile photographs are taken, and the teeth are scanned with an intraoral scanner or an impression is taken.
3. Design. The photographs and the scan are combined on a computer. The shape, length and proportions of the teeth are planned to suit your face, and a before-and-after view is prepared.
4. Trial smile (mock-up). The design can be applied over your teeth with a temporary material. This way you see the new smile in your own mouth, in the mirror, not just on a screen, and judge it while talking and smiling. Changes are made if needed.
5. Treatment. The chosen method is carried out according to the approved design.

The on-screen design and the trial smile show the goal; the final result may differ slightly depending on the structure of the teeth and the material chosen.

Veneers are porcelain shells about 0.3–0.7 mm thin (close to a contact lens) that are bonded to the front surface of the tooth. They are usually made from glass ceramic (for example E.max). They are used to change the appearance of teeth with discolouration, gaps, wear and chips, or irregular shapes.

The process:

1. The design and trial smile are approved.
2. A small amount of tissue is removed from the front surface of the tooth, in most cases staying within the enamel layer. In some cases very minimal preparation or no preparation may be possible; this depends on the position of the teeth.
3. An impression or digital scan is taken; temporary veneers are made in the meantime if needed.
4. The colour and fit of the veneers made in the laboratory are tried in, and then they are bonded to the teeth with special adhesives.

Because veneers are porcelain, they resist staining; however, they can chip or come off. A night guard is recommended for people who clench their teeth. With good care they can last many years; they may need replacing over time.

In most people the natural colour of teeth is slightly yellowish. Discolouration can be external (tea, coffee, smoking) or internal (root-canal-treated teeth, some medicines, age-related change). Before whitening, a scale and clean is done and the cause of discolouration is identified.

• In-office whitening: The gums are covered with a protective material and a whitening gel is applied to the teeth. The procedure takes about 1 hour and can be repeated if needed.
• At-home whitening: Custom clear trays are made; the whitening gel is used at home in these trays for the times set by the dentist. Results are usually seen within 1–2 weeks.
• The two methods can also be combined.
• If a single root-canal-treated tooth has darkened, whitening it from the inside may be an option.

Things to know: whitening does not change the colour of fillings, crowns or veneers, so if you have fillings in your front teeth they may need replacing after whitening. You may have temporary sensitivity during and for a few days after the procedure. The result is not permanent; depending on diet and smoking, some colour returns over time and whitening can be repeated when needed. Avoiding tea, coffee, cola and smoking in the first days after whitening helps preserve the result.

For back teeth that have lost a lot of structure due to decay or fracture, porcelain fillings made in a laboratory or digitally can be used instead of a conventional filling. The tooth is prepared, an impression or scan is taken and the porcelain piece is bonded to the tooth.

A porcelain inlay or onlay preserves more healthy tooth tissue than a full crown; it is tooth-coloured, so it looks natural and resists staining. Whether it is suitable depends on how much sound tissue is left in the tooth; with very large losses, a crown may be needed.

• Veneers and porcelain restorations: Chipping or coming off; staining at the edges over time; rarely, temporary sensitivity after bonding. Removed tooth tissue does not grow back, so they will need replacing in the future.
• Whitening: Temporary tooth sensitivity and temporary gum irritation; not reaching the expected shade (especially with some internal discolouration); the result fading over time.
• General: A gap between expectations and the result. This is why the design and trial stages are not rushed; permanent treatment does not start until the result has been approved together.
• Clenching, uncontrolled gum disease and poor oral hygiene shorten the life of cosmetic treatments.

• Daily brushing and floss or interdental brushes
• Not biting hard objects with veneers and porcelain restorations (pens, nails, nut shells, packaging)
• A night guard if you clench your teeth
• Rinsing with water after staining drinks
• Regular check-ups and professional cleaning, at least once a year