Whenever we perform cosmetic dentistry, the objective should always be to give the patient teeth that look like an ideal version of themselves—enhancing, not altering, their natural beauty. To achieve this, several key factors need to be considered when designing a smile.

Matching the Smile to the Face

A smile should complement the patient’s facial structure. Our faces are naturally asymmetrical due to growth patterns, the way we chew, lifestyle habits, and even how we sleep. These subtle, almost imperceptible asymmetries shape our appearance over time. If we place a perfectly symmetrical set of teeth into an asymmetrical face, it creates visual tension that draws the eye in an unnatural way. The result can feel artificial rather than harmonious.

To prevent this, we focus on the angulation of the premolars and canines, particularly the premolars, which sit further back in the dental arch. Their angles shift depending on facial development, and as cosmetic dentists, we must replicate this natural positioning. By ensuring the new teeth follow the face’s natural progression, we create a result that looks like it evolved with the patient’s aging process.

Achieving the Right Cheek and Lip Support

Another critical aspect of smile design is ensuring proper cheek and lip support—without overcompensating. In younger patients, particularly young females, adding cheek support can widen the lower third of the face, which is typically unnecessary. However, as people age, especially post-menopause in women, fat loss in the skin and bone resorption in the upper and lower jaw can cause a loss of facial width. In these cases, we can restore some of that lost volume by subtly enhancing the smile, maintaining the illusion of the patient’s original face shape.

Lip support is equally important, and achieving the perfect result requires designing the smile directly in the patient’s mouth. When dentists rely solely on a laboratory to create teeth, the shape and volume may not align perfectly with the desired lip support. Hands-on customization ensures that the final result enhances the patient’s overall facial harmony.

Designing Individual Tooth Shape for a Personalized Look

The shape of each tooth plays a crucial role in crafting a natural smile. Every patient has unique dental characteristics that should be respected and recreated. For those missing teeth, we can reference their lower teeth or even their relatives’ teeth to guide the design, ensuring the new smile remains true to their genetic blueprint.

Beyond individual tooth shape, the edges and embrasures (the small spaces between teeth) contribute significantly to the smile’s character. Small embrasures and sharper edges create a more aggressive, bold look, which some patients prefer. On the other hand, softer edges and more curved embrasures produce a youthful, feminine appearance. Understanding a patient’s personality, goals, and desired aesthetic allows us to design teeth that not only complement their face but also align with their identity.

The Art and Science of Natural Smile Design

Facially driven cosmetic dentistry is as much an art as it is a science. It requires years of experience, a deep understanding of natural dental anatomy, and the ability to visualize what a patient’s teeth might have looked like under ideal conditions. When we design smiles, we are, in a sense, rewinding time—imagining how a person’s teeth would have naturally developed if everything had gone perfectly. This approach allows us to create smiles that are both beautiful and authentic, giving patients the confidence of having “perfectly natural” teeth.

By focusing on facial harmony, tooth shape, and individualized design, we ensure that every smile we create enhances not just a patient’s appearance, but their entire sense of self.

Photo by Andrea Piacquadio

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Bad breath is a very common problem that is often left untreated because patients can feel awkward bringing it up or don’t know that they have it because they were never told. While it’s something most people deal with from time to time, persistent bad breath might point to more significant issues in your mouth. Chronic bad breath is more than just what you eat and whether or not you brush. Let’s take a look at what might be causing it and how you can remedy it.

What Causes Bad Breath?

Bad breath, also known as halitosis, can be caused by any or several of the following factors:

1. What you eat: Certain foods, like garlic and onions, have strong odors that linger in your mouth. These odors can come from direct contact with your tongue and mouth, or can be created once the food is starting to get digested.
2. Bacteria: Everyone’s mouth is filled with bacteria, but the type of bacteria and the amount of bacteria can cause displeasing odors. When bacteria is allowed to build up on your teeth, gums, or tongue it often leads to bad breath. The bacteria produce gases that can create an unpleasant smell. Once this build up is in place, a simple thorough brushing with toothpaste and mouthwash is not sufficient to get rid of the bacteria and smell.
3. Dry Mouth: Saliva plays a crucial role in keeping your mouth clean by washing away food particles and bacteria. If your mouth is dry, perhaps from dehydration or mouth breathing, bad breath can become more noticeable.
4. Gum Disease: Gum disease, or periodontal disease, happens when plaque—a sticky layer of bacteria—builds up on your teeth and gums. This can lead to inflammation of the gums and loss of bone. The inflammation in both gingivitis and periodontists will lead to bad breath. Known as “peri breath”, there is a distinct foul odor that is omitted when people have puffy inflamed gums.
5. Cavities: Cavities develop when bacteria produce acids that erode the enamel of your teeth. The bacterial build up in cavities along with the decaying tooth structure can cause a bad taste and smell.
6. Medical Conditions: Sometimes, persistent bad breath can be a sign of other health issues, like a sinus infection or digestive problems. If your bad breath doesn’t improve despite good oral hygiene, it might be worth discussing with a healthcare professional.

Addressing Gum Disease, Cavities, and Tooth Infections

Gum Disease

• Gingivitis: This is the initial stage of gum disease and is usually quite mild. It causes the gums to become red, swollen, and sometimes bleed when you brush. Gingivitis often leads to bad breath due to the bacteria and inflammation in the gums.
• Periodontitis: If gingivitis isn’t treated, it can progress to periodontitis. This more severe form of gum disease causes the gums to pull away from the teeth, creating pockets that become infected. This can result in tooth looseness, discomfort, and worsening bad breath.

Cavities

• Cavities occur when acids from bacteria erode tooth enamel. The decay in the cavity as well as the bacteria build up often leads to bad breath and other dental issues.

Tooth Infections

• An infected tooth or gum can lead to an abscess, a painful and foul-smelling pocket of pus. These infections need to be addressed promptly to prevent further problems. Bad breath is not the main concern when treating infections, cavities, and gum disease; but, it can be a helpful diagnostic tool to let patients know that they should see their dentist.

Tips for Maintaining Fresh Breath

Here are some simple steps you can follow to help keep your breath fresh:

1. Brush and Floss Regularly: Make sure to brush your teeth at least twice a day and floss daily. This helps remove food particles and plaque that can contribute to bad breath.
2. Stay Hydrated: Drink plenty of water to keep your mouth moist and help wash away food particles and bacteria.
3. Use Mouthwash: Mouthwash can help kill bacteria and freshen your breath. Choose an alcohol-free mouthwash to avoid drying out your mouth.
4. Visit Your Dentist Regularly: Regular dental checkups and cleanings are crucial. Your dentist can identify and address issues like gum disease, cavities, and infections before they become more serious. Even if you brush and floss daily, you will get mineral and bacterial build up on your teeth that needs to be removed with the hard instruments that a hygienist uses.

Taking care of your mouth is key to maintaining overall health. If bad breath persists despite good oral care, it’s a good idea to consult a dentist or healthcare provider to get to the bottom of the issue. Keeping your mouth healthy can make a big difference in how you feel and how others perceive you. If you have any questions or concerns, don’t hesitate to reach out for help!care professional for further evaluation. Taking care of your mouth plays a big role in your overall well-being, so don’t hesitate to seek help if needed.

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What is Tooth Sensitivity?

Tooth sensitivity, can occur when the inner layer of the tooth or the root surface of the tooth becomes exposed or when a tooth becomes damaged. This exposure can lead to discomfort when consuming cold or hot foods and drinks, or even during brushing and flossing. Sensitivity can range from barely noticeable to severe, impacting daily life and dietary choices.

Causes of Tooth Sensitivity

Several factors can contribute to tooth sensitivity:

1. Gum Recession: Gum recession can expose the tooth roots, which are more porous than enamel and less protected. This exposure can lead to increased sensitivity, particularly to cold temperatures and sometimes brushing.
2. Cavities: When a cavity forms, it creates a hole in the tooth that can expose the inner layers, leading to sensitivity. Similar to recession, the porous surface of the tooth is not a fan of being touched and can cause sensitivity. Unlike recession, if cavities are left untreated, they can progress and potentially reach the tooth’s nerve, causing significant pain.
3. Cracked or Damaged Teeth: Cracks or fractures in a tooth can expose the dentin or even the nerve, resulting in sensitivity. Cracks can also cause inflammation in the ligament of the tooth that can lead to sensitivity to cold or to biting.
4. Recent Dental Work: Procedures such as getting a crown can also cause temporary sensitivity. The tooth’s internal layers are often left exposed until the final fitting, leading to discomfort, especially during the fitting appointment.
5. Bruxism: Grinding or clenching teeth, often during sleep, can damage teeth and ligaments, leading to heightened sensitivity. Biting trauma on teeth will also exacerbate any of the previously mentioned causes and sensitivity is often a combination of factors.

Managing Tooth Sensitivity

There are several approaches to managing and alleviating tooth sensitivity:

1. Dental Treatments:
   • Fillings: For cavities, getting the tooth filled is essential. Untreated cavities can worsen and cause severe pain.
   • Dental Bonding: For exposed roots or sensitive areas, a dentist can apply a composite resin to cover the sensitive surfaces.
   • Gum Grafting: In cases of significant gum recession, surgical procedures can restore gum tissue and reduce sensitivity.
2. Toothpaste: Specialized toothpaste for sensitive teeth can be effective. Look for products containing:
   • Stannous Fluoride: Helps to block the nerve pathways in the dentin.
   • Potassium Nitrate: Coats the outside of the dentin to block pores and reduce sensitivity.
   • Natural Alternatives: Toothpastes with arginine and calcium carbonate can also help by sealing exposed dentin pores.
3. Dietary Adjustments: Reducing the intake of acidic foods and drinks can help prevent further erosion of enamel.
4. Brushing Habits: Use a soft-bristled toothbrush and avoid brushing too aggressively. Ensure to brush twice a day with a fluoride toothpaste.
5. Night Guards: For those who grind or clench their teeth, a custom-fitted night guard can help protect teeth from damage and reduce sensitivity.
6. Regular Dental Check-ups: Regular visits to the dentist can help catch problems early and provide professional advice on managing sensitivity.

When to Seek Professional Help

If tooth sensitivity persists despite using specialized toothpaste and making lifestyle changes, it’s important to consult a dentist. Severe or persistent sensitivity might indicate more serious issues, such as deep cavities or significant gum recession, that require professional intervention. Any sort of pain or sensitivity in the mouth can be a sign of a much larger issue so it is always prudent to see a dentist to figure out the true cause.

Conclusion

Tooth sensitivity can significantly impact your quality of life, but understanding its causes and implementing appropriate solutions can provide relief. By maintaining good oral hygiene, making dietary adjustments, and seeking timely dental care, you can manage and reduce tooth sensitivity effectively. Some generalized sensitivity can never be fully removed but it will can often by mitigated with the right steps. Always consult the best dentist near you to get advice!

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What Are Night Guards?

Night guards are custom-fitted dental appliances designed to protect your teeth from the effects of grinding and clenching that occur during sleep. These devices act as a buffer, preventing direct contact between your teeth, which helps to mitigate the wear and tear that can lead to cracks, chips, or other forms of dental damage. Certain night guards that are made by dental TMJ experts also reposition the jaw to help with TMJ symptoms and joint degradation.

Why Night Guards Are Important

1. Protection Against Wear and Tear: Even if you don’t grind your teeth excessively, it’s very common to grind to some extent during the night. Our teeth were not designed to endure 70, 80, and 90 years of modern living, and as we age, natural wear and tear become more problematic. Night guards provide a protective barrier that absorbs the pressure, reducing the risk of tooth damage and potentially avoiding the need for extensive dental work such as crowns, root canals, or implants.
2. Reduction in Dental Work: By preventing the physical contact between teeth during grinding, night guards help to preserve the structural integrity of your teeth. This proactive approach can minimize the need for restorative dental treatments down the line, saving both time and money.
3. Management of TMJ Symptoms: For those suffering from temporomandibular joint (TMJ) disorders, night guards can offer significant relief. TMJ disorders often manifest as headaches, jaw pain, and muscle tenderness, particularly in the morning. Night guards designed by a dental TMJ expert can help realign your bite, reducing muscle tension and alleviating associated pain.

Types of Night Guards

1. Standard Night Guards: These are the most common type, designed primarily to protect teeth from wear and tear. They are usually made from durable materials and can be custom-fitted by your dentist or purchased over the counter. When it comes to using night guards solely for tooth protection, specialized ones from your dentist are not required. Professionally made night guards are often more comfortable and will therefore get more frequent use, but any night guard that provides a protective barrier for your teeth will work to protect your teeth.
2. TMJ-Specific Night Guards: For those with TMJ issues, a specialized night guard is necessary. These are custom-designed to address bite alignment and muscle relaxation. Unlike standard night guards, TMJ-specific appliances are tailored to realign your bite and reduce stress on the jaw muscles and joints. These cannot be adequately substituted by over-the-counter options and require professional dental input for optimal results. Not night guards made by dental professionals are suitable for TMJ disorders. Make sure that you find a dental professional that has extensive training with TMJ disorders to ensure that you are getting a night guard that is properly made to address muscle and joint issues.

Retainers vs. Night Guards

If you’ve previously undergone orthodontic treatment and have clear retainers, you can wear these retainers as a substitute to a night guard for tooth wear prevention. Retainers can offer some level of protection by creating a plastic-on-plastic barrier that is suitable for light to moderate grinders. Plastic retainers are generally not designed to absorb the same level of impact as a night guard so for heavy clenchers a plastic retainer may not be sufficient. If your primary concern is protecting your teeth from grinding, a retainer may suffice. However, if you’re dealing with TMJ symptoms, a custom night guard designed specifically for your needs will be more effective.

Conclusion

Incorporating a night guard into your dental care routine can have profound benefits, from protecting your teeth against everyday wear and tear to alleviating symptoms of TMJ disorders. Whether you opt for a standard or TMJ-specific night guard, the key is to address these issues proactively to ensure long-term dental health and comfort. Consult with your dentist to determine the best option for your needs and make night guards a regular part of your oral health regimen.

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Understanding Facially Driven Cosmetic Dentistry

Traditional cosmetic dentistry often focused solely on improving the appearance of the teeth without considering how they contribute to the overall facial aesthetics. These teeth will often look beautiful in an up-close photo but can look off and out of place when seen in motion and seen with the entire face. However, facially driven cosmetic dentistry takes a comprehensive approach, considering factors such as facial symmetry, lip
support, gum display, and even the patient’s unique facial proportions. By analyzing these elements, dentists can create smiles that complement the patient’s facial features, resulting in a more balanced and attractive appearance.

The Role of Facial Analysis

Central to facially driven cosmetic dentistry is the concept of facial analysis. Dentists trained in this approach carefully evaluate the patient’s facial features, including the shape of the face, the position of the lips and eyes, and the symmetry of the smile. Analyzing the patients gonial angles, lengths of mandibles, and relationship between the lower third and the upper two thirds of the face gives the clinician vital information for creating a smile that belongs.

Customized Treatment Plans

Based on the findings of facial analysis, dentists develop customized treatment plans tailored to each patient’s unique facial anatomy and aesthetic goals. These plans may involve a combination of dental procedures, such as orthodontics, porcelain or composite veneers, jaw surgery, and gum contouring, aimed at achieving optimal harmony between the teeth and surrounding facial structures. Additionally, dentists may collaborate with other specialists, such as plastic surgeons or dermatologists, to address any non-dental factors that may impact the overall facial appearance. When patients seek cosmetic dental work, they are trying to improve their smile as a whole, and sometimes it is necessary to bring in other specialists to change the lips, cheeks, neck, etc., to give the patient a result that they are happy with.

The Importance of Harmony with Asymmetry

Facial symmetry is not present in nature. Fully symmetrical faces do not exist in nature and do not look as esthetic as natural faces that are asymmetric but are perfectly balanced and in harmony. Beauty in faces, art, or nature doesn’t come from symmetry but rather from balance – beauty is a chemical reaction within us, not mathematical formula that needs to be equated. In the context of cosmetic dentistry, achieving harmony involves more than just aligning the teeth; it also involves balancing the size, shape, and position of the teeth relative to the surrounding facial features. There are various techniques, such as smile design software and mock-up procedures, but the important factor is to have each side balance the surrounding facial frame to enhance the patient’s natural beauty.

Lip Support and Smile Design

The relationship between the teeth and lips is another essential consideration in facially driven cosmetic dentistry. Proper lip support is crucial for a youthful and attractive smile. Careful assessment of the position of the lips at rest and while smiling helps determine the ideal tooth display and contour. Techniques such as lip repositioning and smile design allow dentists to optimize lip support and create smiles that frame the face beautifully. Regardless of the treatment planning approach, lip support can only be truly determined in the mouth and should be analyzed and adjusted in a intraoral mockup.

Gum Contouring for Enhanced Aesthetics

While often overlooked, the appearance of the gums has one of the largest impacts on the overall aesthetics of the smile. Uneven gum display, or unhealthy gums, can detract from an otherwise beautiful smile. Through gum contouring procedures, the gingival line can be reshaped to achieve better balance and proportion between the teeth and gums.

Patients often think that their issue is a gummy smile when really the issue is that the gingival display is uneven, and the proportions of the teeth are not in harmony. When everything is in balance, a “gummy smile” can be more esthetic than a smile without any gingival display. It is again important to be in balance with the face, if the patient has a very long lower third of their face, they usually should have a gummy smile, and by fully taking it away it will look slightly off when people look at them.

The Psychological Impact

The benefits of facially driven cosmetic dentistry extend beyond mere aesthetics. A confident smile can have a profound impact on an individual’s self-esteem and quality of life. When someone has a beautiful smile that they feel is their own they become more confident, and it can change so many aspects of their life. Research has shown that people with attractive smiles are perceived as more successful, trustworthy, and approachable. It is partially from how others perceive but it is also from the internal change that occurs and the different energy that people put out when they feel confident and beautiful. When people tell stories about how their lives were changed from their new smiles, it is never about compliments that they received on their teeth but about how their relationships and life improved because of the confidence and energy that they had – and this is only possible when they are given a smile that looks like their own.

The Future of Facially Driven Cosmetic Dentistry

As technology continues to advance, the field of facially driven cosmetic dentistry is poised for further innovation. Emerging techniques, such as computer-aided smile design and virtual reality simulation, promise to revolutionize the way dentists plan and execute cosmetic procedures. While all of these tools make smile design and cosmetic dentistry more accessible to dentists, it is crucial to learn the art of making smiles match the face, because the technology can get us extremely close, but the only way to create a magical result for the patient is to in the mouth, by hand, to make all of the small necessary tweaks.

Conclusion

Facially driven cosmetic dentistry represents a paradigm shift in the field of aesthetic dentistry, emphasizing the importance of considering the entire facial structure when designing smiles. By analyzing facial features, customizing treatment plans, and prioritizing factors such as symmetry, lip support, and gum aesthetics, dentists can create smiles that not only look beautiful but also enhance the overall facial harmony of their patients. With the ongoing advancements in technology and techniques, the future of facially driven cosmetic dentistry holds tremendous promise for delivering even more stunning and natural-looking smiles.

References:

1. Coachman, C., & Calamita, M. (2017). Digital smile design: a tool for treatment
   planning and communication in esthetic dentistry. Quintessence Publishing Company.
2. Sarver, D. M. (2004). The importance of incisor positioning in the esthetic smile: the
   smile arc. American Journal of Orthodontics and Dentofacial Orthopedics, 126(3), 322-
   327.
3. Kokich, V. G., Kokich, V. O., & Kiyak, H. A. (1999). Perceptions of dental
   professionals and laypersons to altered dental esthetics: asymmetric and symmetric
   situations. American Journal of Orthodontics and Dentofacial Orthopedics, 115(5), 540-
   546.
4. Peck, S., Peck, L., & Kataja, M. (1998). The gingival smile line. Angle Orthodontist,
   68(5), 91-100.
5. Ahmad, I. (2012). Anterior dental aesthetics: the impact of facial and dental
   proportions. Journal of Orthodontics, 39(Suppl 1), 10-14.
6. Magne, P., & Belser, U. C. (2003). Novel porcelain laminate preparation approach
   driven by a diagnostic mock-up. Journal of Esthetic and Restorative Dentistry, 15(2), 76-
   84.
7. Spear, F. M. (2009). Interdisciplinary esthetic dentistry: implications for treatment
   planning. Journal of the American Dental Association, 140(1), 42S-47S.
8. Mangano, F., Gandolfi, A., Luongo, G., Logozzo, S., & Inchingolo, F. (2017). Digital
   impressions in dentistry: a comprehensive review. Dental Materials, 33(11), 1369-1388.
9. Farias-Neto, A., Martins-Júnior, P. A., do Nascimento, L. E., de Oliveira, A. E., & da
   Silveira, A. A. (2020). The smile arc in different facial types and its correlation with facial
   attractiveness. Journal of Esthetic and Restorative Dentistry, 32(1), 100-104.
10. Fernandes, A. B., & Quintão, C. A. (2019). Smile analysis in orthodontics: a
    systematic review. Dental Press Journal of Orthodontics, 24(4), 36-44.
    
    Written By: Jason Cellars DDS
    jcellarsdds@ gmail.com
    714-848-4247

Bio: Dr. Jason Cellars is a cosmetic dentist in Southern California who is known for his holistic, patient-centered approach dentistry. He takes pride in serving his community with a commitment to excellence that shows in his patients results and experience.

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Minimally invasive dentistry (MID) has emerged as a paradigm shift in dental practice, focusing on preserving healthy tooth structure and promoting patient-centered care. This literature review aims to explore the benefits of MID across various aspects of dental treatment, including prevention, restoration, and patient outcomes.

1. Preservation of Tooth Structure

One of the fundamental principles of MID is the preservation of natural tooth structure. Unlike traditional invasive procedures that often necessitate extensive removal of healthy tissue, minimally invasive techniques aim to conserve as much of the tooth as possible. According to Banerjee et al. (2017), preserving tooth structure not only maintains the integrity of the dentition but also reduces the risk of complications such as pulp exposure and postoperative sensitivity. By saving as much tooth structure as possible we can create both stronger restorations and stronger underlying tooth structure.

2. Enhanced Patient Comfort

MID techniques are associated with reduced trauma and discomfort for patients compared to conventional approaches. In a study by Raskin et al. (2020), patients undergoing minimally invasive procedures reported less postoperative pain and shorter recovery times. This enhanced comfort can lead to improved patient satisfaction and compliance with treatment recommendations. The less underlying structure that is taken away, the less inflamed the underlying nerve and tissue will be, leading to healthier results and a reduced risk of sensitivity and complications.

3. Improved Aesthetic Outcomes

With advances in materials and techniques, minimally invasive approaches can achieve excellent aesthetic results while preserving natural tooth structure. Research by Peumans et al. (2015) demonstrates that conservative restorations, such as resin composites and porcelain veneers, provide durable and esthetically pleasing outcomes, enhancing patient satisfaction and self-esteem. When it comes to cosmetic dentistry, the most beautiful results come when we are able to enhance what the patient already has or used to have, and this is best done from a minimally invasive approach.

4. Longevity of Restorations

Minimally invasive restorations have shown promising long-term clinical performance. A systematic review by FDI World Dental Federation (2018) concluded that adhesive techniques and conservative restorative materials exhibit comparable or superior longevity to traditional amalgam and crown restorations. This longevity is attributed to the minimal removal of tooth structure and improved bonding interfaces.

5. Prevention of Secondary Caries

By preserving more tooth structure and utilizing adhesive techniques, minimally invasive restorations help reduce the risk of secondary caries. According to Schwendicke et al. (2016), conservative approaches minimize the creation of microleakage pathways, thereby decreasing the chances of recurrent decay and the need for future interventions.

6. Cost-effectiveness

Despite initial concerns regarding the cost of materials and equipment, MID has been shown to be cost-effective in the long term. A health economic analysis by Kassebaum et al. (2015) found that minimally invasive approaches result in lower overall treatment costs due to reduced need for retreatment and preservation of tooth structure, highlighting the economic benefits for both patients and healthcare systems.

Conclusion

Minimally invasive dentistry offers numerous benefits across preventive, restorative, and economic dimensions. By prioritizing the preservation of natural tooth structure, enhancing patient comfort, and improving clinical outcomes, MID has the potential to revolutionize dental practice and promote the long-term oral health of patients. Further research and education are essential to promote the widespread adoption of minimally invasive techniques and maximize their benefits for both clinicians and patients.

References:

1. Banerjee, A., Watson, T. F., & Kidd, E. A. M. (2017). Dentine caries: take it or leave it? Dental Update, 44(1), 4-16.
2. FDI World Dental Federation. (2018). FDI policy statement on minimally invasive dentistry. International Dental Journal, 68(1), 3-4.
3. Kassebaum, N. J., Smith, A. G. C., Bernabé, E., Fleming, T. D., Reynolds, A. E., Vos, T., & Murray, C. J. L. (2015). Global, regional, and national prevalence, incidence, and disability-adjusted life years for oral conditions for 195 countries, 1990–2015: a systematic analysis for the Global Burden of Diseases, Injuries, and Risk Factors. Journal of Dental Research, 94(3_suppl), 16S-27S.
4. Peumans, M., De Munck, J., & Van Landuyt, K. (2015). A 13-year clinical evaluation of two three-step etch-and-rinse adhesives in non-carious class-V lesions. Clinical Oral Investigations, 19(8), 2025-2032.
5. Raskin, A., Eschbach, S., & Scheffel, D. L. (2020). Minimally invasive dentistry reduces postoperative pain: a systematic review and meta-analysis. Clinical Oral Investigations, 24(4), 1225-1234.
6. Schwendicke, F., Göstemeyer, G., & Blunck, U. (2016). Directly placed restorative materials: review and network meta-analysis. Journal of Dental Research, 95(6), 613-622.

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Starting with the End in Mind

Before diving into treatment planning, it’s imperative to have a clear vision of the desired outcome. The first step must always be to design the smile and to design the smile based off of the patients face. Only after you have done this can you start to treatment plan and figure out how to best get to this result. A successful cosmetic case isn’t just about fixing teeth; it’s about creating a smile that seamlessly integrates with the patient’s facial features, enhancing their natural beauty rather than overpowering it.

This initial design phase is where the line is drawn between dentists who dabble in cosmetics and cosmetic dental specialists. While many may offer cosmetic treatments, those who specialize and excel understand that crafting a smile goes beyond technical proficiency; it requires a keen eye for aesthetics and harmony. Once you have created beauty and movement in the smile and the face you can engineer a treatment plan to get you there, but you first must design the beauty and that is the most important and most challenging step.

The Power of In-Mouth Smile Design

The only way to truly see how a smile will fit in the face is by sculpting the smile directly in the patient’s mouth using flowable composite. This method provides invaluable insights into how the teeth interact with the lips and facial movements. Human beauty is dynamic, and designing smiles based solely on photographs cannot capture the same level of movement and harmony as in-mouth design.

During the initial consultation, the smile design journey begins. Full-face photographs are taken as a reference for the patient before and composite is added. Flowable composite is then applied to the teeth to create the ideal shape, size, and position of the teeth. No etching or bonding agents are used at this stage, only airdry the teeth, and focus solely on creating teeth that fit and enhanced the patients face and smile.

If you need to adjust the gingival height you can place the composite over the gums to give the appearance of a higher gum line. If teeth are too long or need to be cut back, use a sterile black marker to blackout the parts that you plan to take away later.

Once the smile design is complete, take another full face photo to show the patient along side the original. Initial and final videos can also be taken to show the patient how their new smile will look when they talk and move. It is important to not let the patient look in the mirror and to only compare the photos and videos because this rough smile design will not hold up to scrutiny up close and that is not the intent.

Developing the Artistic Skill

In order master smile design, you must hone their artistic abilities. Contrary to popular belief, artistic talent is not innate but can be cultivated through practice and repetition. When you learn how to draw, you will train your eyes to see deliberately, and will develop the ability to see and design beautiful smiles that harmonize with the individual’s face.

Begin by sketching teeth and faces, focusing on nuances such as tooth inclination and the prominence of central incisors. While there are guidelines to follow, the key is to practice and observe how different design elements impact facial aesthetics. Watch some how to draw videos to learn how to draw an “ideal” face and smile. Once you have mastered the draw the “ideal” take picture of your patients or celebrities and practice drawing their faces, their teeth, and play around with how different teeth and smiles effect the face.

Practical Application and Mastery

Once comfortable with sketching, transition to practicing on models using flowable composite. Practice designing smiles according to different facial structures, aiming for both speed and accuracy. Have your lab print you some extra models and take different face photos and design the models with flowable to fit the photos that you are looking at. This will take a lot of practice and patients, but the control you will have to deliver amazing results every time will be more than worth all of the effort.

Your goal is to be able to mock-up any patients smile in about 4 minutes. This takes practice and persistence. Do not get discourages if you don’t see progress right away, this is a skill that anyone can learn but is very difficult to get a grasp of. If you become frustrated with the amount of time and effort that you are spending, take solace in the fact that once you do have this skill mastered that you will possess the skill that only the beset cosmetic dentists have. And once you have this skill mastered you too will have the skills to create smiles like the best.

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Our natural teeth possess a unique blend of strength, functionality, and beauty that cannot be fully replicated by even the most sophisticated dental interventions. Veneers, while beautiful and amazing when needed, can never fully emulate the intricacies and vitality of our original teeth. We often turn away patients who are wanting veneers when they don’t have any cosmetic issues that are noticeable enough because it isn’t worth it when considering the preciousness of natural teeth.

This is why we cannot understate the importance of adopting robust preventative measures to safeguard our natural teeth for as long as possible. Fundamental practices like diligent brushing and flossing twice a day serve as the frontline defense against decay and gum disease. By maintaining proper oral hygiene, individuals can mitigate the risk of dental issues that may compromise the integrity of their natural teeth.

Prevention and maintenance is also important for protecting against tooth wear and chipping. Nightly wear of a retainer or nightguard is crucial to prevent future fractures, cracks, or wear in your teeth.

Our teeth were originally designed to only need to last for around 40 years of wear and tear. However, with advancements in healthcare and lifestyle changes, our lifespans have doubled and more. And extra care needs to be given towards keeping your teeth safe and protected to allow them to stick around for entirety of our ever extending lives.

Preventative dentistry isn’t merely about preserving our smiles; it’s about safeguarding our overall well-being. Oral health is intricately linked to systemic health, with poor dental hygiene being associated with an increased risk of various medical conditions, including cardiovascular diseases and diabetes.

By prioritizing preventative dentistry, individuals can mitigate the need for extensive and often invasive dental procedures in the future. This not only spares them from unnecessary discomfort but also helps in minimizing the financial burden associated with extensive dental treatments.

While dental advancements continue to evolve, our natural teeth will forever remain unparalleled in their functionality and aesthetics. Thus, embracing preventative dentistry is a critical step in keeping our teeth with us and healthy for the long haul. By doing so, we not only preserve our natural smiles but also promote overall health and well-being throughout our extended lifespans.

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To wrap or not to wrap, that is the question. This question is where the most disagreement occurs between cosmetic dentists. Wrapping is where the preparation extends through the interproximal contact, and it is utilized quite often and has merits. Some respected cosmetic dentists still use this method, the main reason being that it makes seating the veneers very simple. While there is nothing wrong with wrapping, and has its uses as we will discuss, I do not use in unless needed because it takes away too much tooth structure. It is important to clarify that “too much”, is our own opinion and philosophy. I say this because the research shows that wrapping your preparations does not weaken the tooth or the veneer in any way and is structurally and biologically sound. That being said, we would rather save as much tooth structure as possible. If I were to have veneers, even though they are permanently bonded, I wouldn’t want small teeth underneath. I make a point to show my patients their prepped teeth since they have anxiety about this, and they always sigh relief when they see that their teeth are the same side and still look like their teeth. It is comforting to know that your natural teeth are still preserved underneath so that is what we prioritize with our prep design.

The preparation process commences after finalizing the smile and teeth’s shape and size. Rather than prepping teeth based on their current size, it’s crucial to work from the final desired outcome. Porcelain typically requires 0.4mm to 0.6mm facial reduction and 0mm to 1.5mm incisal reduction. These reductions must be taken from the veneers’ final position because it is more conservative and often means that you don’t need to take away tooth structure at all. Maintaining thin facial reduction allows the tooth’s natural color to shine through, giving the veneers vitality and a life-like look. Enough incisal reduction is important for incisal translucency. If no translucency is desired then no incisal reduction is required, and no more than 1.5mm of reduction should be left because it will weaken the final veneers.

After facial and incisal reduction, a light chamfer margin should be place circumferentially. Gingivally, we place the margin half a millimeter into the sulcus, except for at the papilla where I will leave it at the level of the gingiva. We prefer to not place the margin more subgingival to reduce inflammation. Interproximally, we push the margin to the contact point. If the teeth have a narrow contact point, pushing the margin here will break the contact just enough for light to pass through, which is ideal for the impression or scan as well as for the ceramist. If the teeth have a broad contact point, we leave the margin at the most facial part of the contact point and break the contact with a sanding strip. It is important to keep the
insertion point for the prep from the facial so that it can remain as conservative as possible. If you are reducing incisally, create a sharp 90 degree angle on the incisal palatal junction, and smooth all of the facial angles.

That is the design for an ideal tooth. But often we don’t have the right gingival contour, or there is a rotation in a tooth, or there are spaces that we are closing. With each of these variations, we need to alter our preparations accordingly:

• Gingival Contour: If the gingival contour is off, place the margin more
subgingival where needed so the gums can heal around the new margin. The main
place we see this are on the maxillary incisors when the zenith is too far mesial. If this is the case, place the mesial margin 0.5mm – like normal – and place the distal margin proportionally to that, which will make it more subgingival on the distal.
• Black Triangles: Black triangles usually result from gingival recession and
can be a large source of insecurity for many people. When black triangles exist, extend the margin interproximally to make a wing. Wrap the wing fully
interproximally, keeping the wing cervical to the contact point of the tooth. The interproximal margins should also be placed 1mm to 1.5 mm into the sulcus to allow for a better emergence profile.
• Diastema: When diastemas are present and there is a full space between two
teeth the interproximal preparation is extended interproximally on that side. This is the one time that we do wrap the prep, but it is not necessary to remove tooth structure, a margin just needs to be created on the interproximal and the tooth needs to be shaped so that there is a clean path for insertion. The margins should be placed subgingival in the papilla, like with black triangles, to allow for a more
natural emergence.
• Short or Fractured Teeth: If you are adding more than 1.5mm of length to the
tooth, we don’t add the extra with porcelain. If extra length is needed for cosmetics and function, we add the length with composite, and then reduce to 1.5mm or less and add the porcelain from there. This will give the desired length without compromising the strength of final veneer and tooth.

  There are more nuances to the process and many more scenarios that need specific adjustments. However, this is a general approach to veneer tooth preparation and the philosophies that we use to create beautiful long-lasting veneers while saving as much tooth structure as possible. This isn’t a comprehensive step-by-step guide to take you to cosmetic expertise, but hopefully it has clarified some of the obscurities and is at the very least a good start.

Photo citation
Fava, Joseph. “Porcelain Therapy: Veneers vs Jacket Crowns, the ALARA Principle for Prosthodontics.” Oral Health Group, 15 Nov. 2015,
www.oralhealthgroup.com/features/1003918624/attachment/fava-fig-1d/.

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What Is Holistic Dentistry?

Holistic dentistry is an approach to oral care that recognizes the interconnectedness of the mouth and the rest of the body. It seeks to promote not only healthy teeth and gums but also overall physical and emotional well-being. Holistic dentists go beyond the traditional methods of diagnosing and treating dental issues. They consider the whole person, considering the patient’s lifestyle, diet, and emotional health.

One of the core principles of holistic dentistry is the belief that the mouth is a window to the body’s health. Any oral problems can be indicative of or contribute to broader health issues. For instance, gum disease has been linked to heart disease, and poor oral hygiene can exacerbate diabetes. A dentist in Reading takes a preventative and proactive approach to dental care, addressing the root causes of dental problems rather than just the symptoms.

The Benefits of Holistic Dentistry

1. Minimally Invasive Treatments: Holistic dentistry places a strong emphasis on minimally invasive procedures. This means preserving as much of the natural tooth structure as possible. By doing so, it reduces the need for aggressive treatments like root canals and extractions. This approach aligns with the idea that a healthier mouth is a mouth with its natural structures intact.

2. Biocompatible Materials: Holistic dentists prioritize the use of biocompatible and non-toxic materials for dental work. This means avoiding mercury amalgam fillings and other potentially harmful substances. Instead, they opt for safer materials like composite resin fillings. This is especially important because the materials used in your mouth can leach into your body, affecting your overall health.

3. Individualized Treatment Plans: Holistic dentists recognize that each person’s dental health is unique. They create individualized treatment plans that consider your specific needs, including your diet, lifestyle, and overall health. This personalized approach can lead to more effective and comprehensive care.

By: Dr. Jason B. Cellars DDS – Cosmetic and Holistic Dentist

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