Top tips for smile design

Manrina Rhode outlines how to follow the principles of smile design to create a beautiful restoration for your patients.

Smile design is such an important part of dentistry and something that is so easily overlooked as it’s not really taught at university, which is ridiculous. So let’s talk a little bit about the basics of smile design and how we can incorporate it into our everyday practice to give our patients the results they will really love.

The principles of smile design were created by a really large study that was done a long, long time ago. And in that study, they took a multitude of smiles and they asked the public which smiles they found to be most attractive. Through that, they could come up with numbers and designs that showed what a classic, beautiful smile was.

Creating smiles with ease

Now, because of the smile design rules, it means that we can create beautiful smiles with ease by simply following these rules that I would say work for 99% – not really all – of patients.

It’s also the reason why patients can go for cheaper smile designs in other places – I don’t want to use the example of Turkey, but I’m going to use it. Turkey has some really brilliant dentists, but we’re very aware of the travel tourism that goes on there.

These patients that will go can have their teeth cut down to pegs, and then they’re given these smiles within a day or two that typically all look quite similar. And even though they may not be the most beautiful smile makeovers, they don’t typically look that bad. And the reason why they don’t look that bad is because they follow the principles of smile design. And so just by using these same rules for everyone and cutting them all down to small pegs so they can they always fit, they can create a smile that works for everyone.

What are the smile design rules?

So, what are these rules? The first one is regarding your gum position. Let’s start at the very top of the smile.

Typically, the central incisors should be level, so you want to make sure they’re symmetrical and at the same height. And then the lateral incisors should be just slightly lower than where the centrals are – up to one to two millimeters lower than the centrals.

The zenith is the highest point on your gum margin. The gingival zenith on the canines should be at the same height as the centrals. For the premolars and molars, it then goes slightly lower, and they’re even as they go back, so starting off with symmetry and following the correct design for those gingival zeniths.

With regards to the lip line, we measure where the lip line sits in the smile. If the lip sits at the gingival zeniths or up to two millimeters above the gingival zeniths, it’s a medium lip line. If the lip sits higher than that, it’s a high lip line. If the lips are covering the teeth on a maximum smile, it’s a low lip line.

The centrals really are the centre of the smile and the center of this bit off the face – I would always start wit. The proportion is one to 0.8, so 11 millimeters long and about 8.2 millimeters wide – they’re always longer than they are wide.

The laterals are slightly shorter because the gingival zenith is slightly lower and also the incisal edge is slightly higher, making it a shorter tooth. The canine should be the same length as the central, showing as the gingival zenith being the same and the incisal edge position being level.

Then moving further back in the smile, looking at the incisal edges, the premolars and the molars, if they’re visible, should follow the lower lip.

Basic principles

When you smile, the incisal edges should all follow the shape of the lower lip, coming down and then flat, and then coming back up again. And if that doesn’t happen, sometimes you’ll have a reverse smile line, kind of like a third smile, where the edges go up and then flat and then back down again, or a vampire type smile.

There are various other designs, but typically we want to get to that shape which follows the lower lip, so that we’ve got an ideal smile position.

Then if you look at the breadth of the of the smile, the corner of the smile is called buccal corridors. Ideally you want the smile to show like piano keys with all the teeth showing when you smile. Now, you also want to have a little bit of space between the sides of the smile and the corner of your lip.

If the smile is too full, and you’ll have seen people like that, it looks really fake, like they’ve got a denture or something stuffed inside their mouth. And if the smile is too narrow and there’s too much space there, it’s almost not as attractive. It’s attractive to have a broad smile – but just don’t go too far with it.

By following those basic principles, you’ll create something that’s a really beautiful smile.

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