Cosmetic dentistry has been a growing focus within the industry. Patients are looking to their dentists to do more than just maintain their dental health, but also to improve how their smiles and dentition look.
Tenured POS instructor Dr. David Dana, one of the top cosmetic dentists in the field, explains the top aesthetic mistakes that he sees in dentistry and what to look out for when evaluating patients. Avoid patient dissatisfaction with treatment results by following Dr. Dana's tips.
1. Black triangle of the smile
Dentists can make the mistake of failing to look at the archwire shapes of patients. This is a very visible mistake to make with patients who have a wide smile. Failing to think about patients’ arch forms can cause black triangles of the smile. This unappealing look occurs when a wide smile with a narrow or tapered arch form shows black triangles to the left and right of a narrow arch, so you can see too much of the buccal corridor tunnels.
A wide smile (with the right arch coordination) can be a gorgeous asset. Julia Roberts and Kate Middleton both have gorgeous wide smiles. If you see a beautiful smile like this, make sure to treat it properly.
Tip: Make sure you look at your patients’ arch shapes when you are diagnosing them. Arch coordination is an extremely important esthetic consideration for patients with narrow smiles. When you treat patients like these, keep in mind how you can improve or maintain their facial esthetics. Treatment for patients with wide smiles and narrow dental arches will typically include maxillary expansion with dentoaveolar, archwire expansion, and in some cases maxillary advancements and/or lip fillers.
2. Severely concave facial profile
One of my least favorite looks is a severely concave profile of the lower third of the face. This ages people at least 10 years.
Tip: Look at the Esthetic Plane (E-Plane) of the patient before deciding how to treat them. Typically, beautiful resting lips will fall on or just in front of the E-Plane. There are a few additional esthetic measurements that you can also use if you’d like to do a more thorough aesthetic dental and facial analysis on your patient profile. If the patient is already concave before treatment, you probably would want to avoid extracting teeth to prevent a severely concave profile. You should consider orthodontic treatment before any anterior esthetic dental treatment, to properly position the teeth to obtain proper lip support before the dental work starts.
3. Severely convex profile
Severely convex profiles are an opposite error of the previous mistake. Many times dentists choose a non-extraction orthodontic treatment plan for all of their patients. Without a proper facial balance evaluation, non-extraction treatments can cause severely convex profiles and lip incompetency.
Tip: Do not use a one-size-fits-all treatment plan for all of your patients. Look at the Esthetic Plane (E-Plane), count your crowding, and consider ethnic norms of the patient before deciding how to treat them. If patients are already convex before treatment, ask them how they think they look and what they feel would make them look better. You want to help your patient achieve their perception of beauty.
4. Acute nasolabial angle
According to The Rhinoplasty Center, the normal nasolabial angle is 90 to 120 degrees. If you treat a patient which results in too acute of this angle, the facial balance may look “off”. Often these patients will have significant protrusion or incisor proclination. As with the concave profile patient, if you are planning esthetic dental restoration, you should consider orthodontic treatment before any dental work is done to properly position the teeth to achieve the best results.
Tip: Take some time to understand how your treatment affects this subtle, but important aspect of the face. Extraction, expansion, advancement and retraction can affect how your patients look.
5. Everted lower lips
When you have everted lower lips, the lower lip may look like it lacks muscle tone, creating a lip turning outward and appearing droopy or rolling forward. Typically you see this with a deep sublabial fold and sometimes lip incompetence. This is considered an unappealing look as it can be associated with several types of malocclusions, such as deep bite Division 2, Class II Division 1 with excess overjet, and mandibular retrognathism.
Tip: When you know what to look for, you can create a better facial balance with a soft profile. Plan on correcting the malocclusion first. And sometimes with cases with a severely retrognathic mandible, you should consider mandiblular advancement surgery to make your treatment outcome look esthetically ideal.
6. Gummy smile
It is unfortunate when dentists do not know that there are several treatment protocols for gummy smiles. Severe gingival display causes many patients to be self-conscious.
Tip: Understand what factors are causing the gummy smile before deciding your treatment plan. Some treatment options can include cosmetic crown lengthening, gingivectomy, orthodontic skeletal anchorage, orthodontic temporary anchorage devices (TADs), Botox, and orthognathic surgery.
Exceptional dentists give their patients more than just white teeth, or even straight teeth. Although finessing your esthetic results can take some studying and experience, I hope that this guide helped to enhance your diagnostic skills to better consider patients’ dental and facial harmony.
What esthetic mistakes have you seen or made yourself? Share your comments or tips below.
