How to create a perfect smile

From tooth length to the position of the lips, this month Manrina Rhode discusses her tips for creating a ‘perfect’ smile.

Today we will be talking about what makes a perfect smile. The first thing I need to say is that the perfect smile is the one done without any restriction. Anyone who’s limiting the way they smile is never going to be as beautiful as someone who is smiling openly. It’s so much prettier, regardless of the imperfections your patient might feel like they have within their smile.

Let’s talk about what creates the perfect smile scientifically and art-wise, and, as cosmetic dentists, how we go about creating that.

Lip position

So, first of all, let’s start with lip position. The lips are the curtains within the theatre, so they mask the outline of the smile. We can have a low, a medium or a high lip line.

A low lip line is if the lips cover some of the tooth tissue. So, look at the two centrals, get the patient to smile. If they’re hiding some of their tooth, then that’s a low lip. A medium lip line is if the lip sits at the upper central incisor’s gingival zenith. Gingival zeniths are the highest point of the gum margin, so either at the gum margin or up to two millimetres higher is a medium lip line – that’s deemed as ideal. A high lip line is anything above that. So, if you’re showing gum above two millimetres when you smile, that’s seen as a high lip line.

So, have a look at that and have a think about what you’re going to do about it. There’s not a great deal you would do about low lip line – there are surgeries that your plastic surgeon can do, or you can refer out or do them yourself. The surgery is a small incision underneath the nose, and then lift the lip. Certainly as we age, our upper lip drops just as everything does. And so that may be a procedure that people want to have to create a more youthful appearance.

Tooth display

Assuming you’re going to keep the low lip line where it is, then you’d want to make sure that there was still enough tooth display.

When lips are at rest, so when a patient licks their lips or says ‘Mmm’ and then stops, you should have between two to four millilitres of tooth display. In a woman, four is seen as ideal up to the age of 40. And then each decade on from that, you could lose potentially a millimetre off it. It is very youthful to show four millimetres of enamel on your incisors at rest.

If they’ve got a low lip line, it may mean elongating their teeth a little bit more than you normally would, so that there is more tooth visible when talking and smiling. Although they may have a longer tooth if you were to lift their lip up, who’s ever going to lift their lip up and see apart from the dentist and maybe themselves? The world, will see a perfect length of tooth.

If they’ve got a high lip line, please refer back to one of my previous videos on treatments of gummy smiles. There are lots of ways to treat that, so have a look at that video.

Creating symmetry

Once you’ve got the lip where you want to have it, let’s start having a look at the teeth themselves.

Around the teeth you have the gums, which are also so important. Too many dentists ignore gum position, and we really want to create symmetry to create a beautiful smile. Symmetry is beauty in nature. The things that we deem most beautiful are the most symmetrical.

You could have an imperfection in your smile, but if you do and you want to keep it, then you should put the imperfection on both sides. If you’ve got a high gum line on one canine, rather than just having one tooth high, lifting the gum on the other side actually looks a lot better, which is interesting. Symmetry is really the key to beauty.

Have a look at composition and have a look at the symmetry there and whether it’s nicely lined up with the level of the eyes, assuming that the eyes are level. And are the gum margins levelling up with the horizon – are they straight?

Gum positions

Once you have seen if things are straight, start looking at the position of the guns.

With the central incisors we have already talked about the position of the gum there and how that relates to the lip. The lateral incisors, the next tooth along, should be just slightly lower – one to two millimetres lower – than the centrals. The canine should be at the same position as the other centrals, and then the premolars could be just slightly lower to work its way back.

So, have a look at the gum position, and if the gum not quite right then you could look at ways to correct that – either yourself or by sending the patient to a periodontist.

Tooth length

Then you look at the the teeth themselves. The length of the central incisors should be 11 millimetres. Length to width ratios are really important; you want the centrals to be longer than they are wide. One to 0.8mm is a really nice proportion and, and then moving back from that the canine should be at the same length as the centrals – the laterals will be slightly shorter. Moving back, the incisal edges should follow the lower lip line.

And then you want to have a look at the incisal embrasures. You should have should have your smallest embrasure between the centrals, and then the embrasures should get slightly slightly larger as you go further back.

So, that should give you a bit of an idea about some principles to put into place to create a perfect smile.

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Visit Manrina’s website here: www.drmrlondon.co.uk.