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Approaches to Smile Design Mathematical to Artistic Interpretation ApproAches to Smile Design Mathematical to Artistic Interpretation Brian P. LeSage, DDS, FAACD Luca Dalloca, DMD, CDT, FESCD, FIADFE Illustrations by Zach Turner 126 Spring 2012 • Volume 28 • Number 1 LeSage/Dalloca Introduction With advanced knowledge, techniques, and materials, dental professionals today have the ability to approach smile design cases in a variety of ways.1 Often reliant upon culturally-based philosophies and ideologies, the way in which cases are handled can vary greatly depending on a dental professional’s location.1 There is no better example than the differences between European dentists, who tend toward a more artistic, “whole person” approach to smile design— taking into account age, gender, and replication of that individual’s natural dentition—and dentists in the United States, who tend to CE CREDIT focus more on brighter color, symmetrical/proportional, rules- governed ideal restorations that are not achievable in nature.2,3 Today, however, both sides are meeting in the middle, with European Learning Objectives: After reading this article, the patients requesting a less natural look and American patients participant should be able to: desiring more natural-looking smiles.4 1. Compare criteria and the principles of art and visual Allowing for better insight and knowledge into what it takes perception. to make a restoration truly perfect in the eye of the beholder, the 2. Understand how to use symmetry, asymmetry, and concepts and practice of esthetic dentistry benefit from differing “perfect imperfection” to create a beautiful smile. opinions and, therefore, are in a constant state of evolution.4-6 3. Contrast the different ap- However, the need to develop reproducible restorative results has proaches when applied to treating individual patients. pushed dentists to quantify the smile design process with rules, formulas, and measurements, which may actually inhibit their esthetic perceptions and ability to identify and provide those individual nuances that create natural beauty. Journal of Cosmetic Dentistry 127 …the concepts and practice of esthetic dentistry benefit from differing opinions and, therefore, are in a constant state of evolution Defining esthetics in handles verbal, analytic, symbolic, tem- artistic ability. Through this global ap- Dentistry poral, rational, computing, logic, and proach to the development of artistic linear functions, the right side of the skills, dentists in particular can form It is a common misconception among brain is involved in non-verbal, synthet- associations and reveal intimate struc- some dental professionals that esthetic ic, analogical, atemporal, non-rational, tures that would otherwise go unno- outcomes result solely from a set of well- spatial, intuitive, and artistic functions. ticed.8 However, with familiarity comes defined rules.7 Although it is necessary Individuals often mistakenly believe competency. to understand and follow fundamental that traits of the right side of the brain principles and parameters of what con- are inherited, or that one must have a Applying the Artistic process stitutes esthetic smiles, limiting dental disposition toward artistic and creative to Dentistry professionals to specific guidelines and talents. However, it is well documented quantified measurements would lead in the literature that individuals are giv- The reason dental professionals often to generic, boring, and stereotypical re- en creative potential and have the op- find it difficult to address esthetic cases sults for patients.7 Following a stringent portunity for expression through art.8 is that they do not realize that there is and rigid approach breaches any per- actually no such thing as unesthetic ception of “Mother Nature.” Art as a Skill dentistry; there is only esthetic dentistry. Many publications historically have It has been shown that art is a medium Every case, no matter what the patient attempted to quantify the correct prin- through which individuals develop the presents with, should be addressed as ciples of smile design, but no one has skills needed for the brain to approach an esthetic case. Therefore, when ap- demonstrated the inherent ability to tasks more creatively. A side of neuro- proaching dental care, dentists must put teach the dental professional how to logical function that is all too often suf- aside the belief that the ability to step create a truly natural-looking smile.7 focated by mundane daily tasks, devel- outside of the logical “left-side think- For example, a misconception guiding oping the functions of the right side of ing” and into the creative right side is a many smile design principles is that the brain allows individuals to perceive predisposed, inherited ability.10 components of the smile (e.g., tooth tasks and outside influences in a differ- However, doing so requires knowl- shape and size, embrasure form, axial ent way.8 edge of the psychology of perception inclination, gingival morphology, ar- Artistic ability is a global, or “whole,” and of the manner in which the natural rangement, and silhouette) should be capability requiring only a limited set characteristics of the dental/smile archi- symmetrical, a phenomenon that sim- of basic components that, when inte- tecture influence the overall perceived ply does not occur in nature.7 grated, form a whole skill that, once appearance of the patient. Consider vi- Instead, a more comprehensive ap- learned, allows a person to create art. sual fields (Figs 1 & 2). Although hu- proach is advocated, one that requires This progression, however, requires man perception is an agglomerate of consideration of the philosophies of practice, refinement of technique, and certain aspects of an object, including beauty and art in combination with learning the situations in which the colors, forms, movements, and dimen- fundamental smile design principles. skills should be used.8 Although artistic sions, it is first an interaction between Like the human face and smile, there is talents are referred to as such, they are guided tensions. For any spatial rela- no better example of this than the com- actually perceptual skills that include tion, there is a precise distance that is plementary functions served by each five components (i.e., perception of intuitively decided upon by the eyes. side of our brain.7 edges, space, relationships, lights/shad- The eyes are drawn to the center, as it ows, and the whole, or the “gestalt”).8,9 is the major area of attraction and re- The human Brain— Overall, artistic talent is the abil- pulsion. At this center, all forces are combining reason and ity of an individual to shift the state of balanced and the central position of an the brain into a different mode of see- object is perceived as stable. creativity ing and perceiving. When learning how Additionally, balance is the distribu- Although the left and right sides of the to create art, individuals learn how to tive condition in which each situation brain may appear symmetrical under control the way the brain processes in- reaches immobility; it is achieved when medical imaging, each side functions in formation.8 Shifting the brain to see in all forces of a system are compensating a very specific way.8 While the left side a particular way is the true challenge of themselves. Balance is when the poten- 128 Spring 2012 • Volume 28 • Number 1 LeSage/Dalloca • By looking at the picture for just a fraction of a second it seems that the disc is closer to the center than it appears if we look at it slowly and dispassionately. • This demonstrates that the physical and psychological systems show a very diffuse tendency of transformation to the lower level of tension. TEnSion Figure 1: Human perception is first an interaction between guided tensions. • The disc gives us a greater impression of stability when its center fits with the center of the square. • For every spatial relation there is a precise distance, perceived by the eye. • The center is the place of major attraction and repulsion. • At the center all forces are balanced; this means that a central position is perceived as stable. Figure 2: Eyes are drawn to the center, where all forces are balanced and the central position of an object is perceived as stable. • The position of the disc could be determined and described by mea- surements. • We could then realize that the disc is not central. • This finding is not a surprise—we do not need any measurements to see that the disc is not centered, we can easily see it with our visual judgment viSuAL juDgmEnT Figure 3: The eyes are intuitively able to find balance. Journal of Cosmetic Dentistry 129 tial energy of a system is reduced to its ate the smile in an image in such a way ta, stippling, and striation. With these minimum. With this, every visual situa- that the right and left sides are the same effects, a lighter color goes along with tion is created by a fulcrum and a cen- for both viewers. an increase in value (Table 1). ter of gravity. The eyes, when using the The final characteristic, configura- In comparison, the central incisors right side of the brain, can intuitively tion, determines how an object appears in older dentition tend to be squarer sense to find these factors and balance and the visual weight it commands. and shorter, appearing equal to the lat- from there (Fig 3). Configuration, in general, is the deter- eral incisors and canines. With a 90% One of the most important factors in mining factor in the physical form an width-to-length ratio, mature dentition determining how art can be applied to object takes. It is the external aspect and also display decreased incisal embra- dentistry is the way in which the visual visual weight that allows the eyes to see sures and smooth, higher-shine facial weight of an object in view affects the and capture the prominent features.
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