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Great Expectations — Perceptions in Smile Design

Is what you get what you want?

By Dear Doctor magazine and Dr. Gerard Chiche


Blueprints for Success

Provisional restoration.
Figure 1: An example of a “provisional restoration” — a try-out smile to assess changes in size, shape, color, speech, biting function and more before final changes are made.
Final restoration using veneers and crowns.
Figure 2: The final restoration replacing the provisional materials with permanent porcelain veneers and crowns.
Photos provided of Dr. Richard Whalen

It doesn't matter if you're having a total “smile-makeover” or just changing one tooth, the ability to preview the change to your appearance may be critical to your ultimate happiness. Computer imaging is a great tool to allow you to visualize a potential change before your dentist even touches a tooth.

A second way a dentist can help us see ourselves before work begins is to actually make a mock-up of the proposed dental work in white tooth-colored wax on models of your mouth. A third way is to build up your teeth with tooth-colored composite resin, which is yet another way of changing tooth shape, size and aesthetics.

Another great tool in dentistry is the “Provisional Restoration” [Figures 1 and 2]. This has become a critical tool in testing the understanding between the dental professional and patient. A provisional restoration allows time for adaptation, to see if the proposed smile changes work for you and if they are compatible with gingival (gum) health, phonetics (speech) and biting function.

If the provisional restoration works, the final restoration is guaranteed to work. The essential difference between the provisional and the final restoration is the materials from which they are made. The final porcelains are more durable and longer lasting than the plastics generally used for the provisional restorations.

The dentist will take impressions of the provisional restoration and communicate all of the relevant information in that blueprint to a “dental technician.” Arguably, the most beautiful, lifelike tooth replicas are made of porcelains, in which case it is the ceramist — a dental technician skilled in the art and science of bringing these glass-like materials to life — who is entrusted with this responsibility.

Shades of Difference: Is What You See What You Get — Or Want?

The only way that you as a patient can ensure a positive answer to this question is to communicate fully with your dentist from the outset. By merging your own perceptions of what you want and need with your dentist's keen eye for what works aesthetically, you'll have a much better opportunity to achieve the smile you want and expect.

Questions to Ask Yourself

Dentists appreciate it when you can describe what changes, likes or dislikes you have regarding your smile. Can you describe the changes, whether subtle or large, that you would like? For example, it's a good idea to take pictures and magazine images with you on your first appointment to better describe to your dentist how you think you'd like your smile changed. Please remember that these pictures should be used as general guidelines; you are not looking to have someone else's smile. Images of how you'd like to look (or once looked, with the help of past photos) provide helpful information to your dentist. You should take time to ask yourself a few questions so you can more accurately communicate to your dentist what changes you would like to make:

  1. What do you like or dislike about your teeth regarding color, size, shape and spacing?
  2. Are you pleased with how much your teeth show when your lips are relaxed and when you smile?
  3. Do you want teeth that are perfectly aligned and are “Hollywood White” or more natural looking with slight color, shape and shade variations?
  4. Are you happy with the amount of gum tissue you show when smiling?

The answers to these and other questions will give your dentist an understanding of your perceptions and vision and help him/her create the smile you want and deserve.