Aesthetics

Aesthetics is not only a very broad overarching concept, it is also as individual as the viewer. Whether we perceive something as aesthetic has cultural as well as familial and personal influences. Why we bother with it at all is the fact that we want to feel accepted and embraced by our environment and by groupings. So it can happen that a certain “image of beauty” is also conveyed or influenced by certain current and time-limited ideal concepts.

What does this mean for dentistry?

Teeth not only provide a good reflection of a person’s health, but are a certain status symbol. Untreated decayed or not healthy looking teeth suggest a lack of care and or a socially weak background. More precise backgrounds are not known to the observer and are irrelevant from an aesthetic point of view. This means that we scan our counterpart within a very short time and draw certain conclusions. Is that superficial? Yes, it is superficial in any case, but it is also a completely normal instinctive behavior.

Within a very short time, we decide whether we find our counterpart likeable or not. Mouth and teeth have a direct influence and lie in the natural course of our gaze. That means we scan the eye, mouth, nose and hair within seconds.

When do we find a smile likeable?

• The teeth appear “healthy

What does healthy mean? Color and shape indicate that they are intact and untreated. No discoloration, no dark spots. The teeth are relatively straight, which we associate with good functionality. Why do we find this attractive? Because it is evolutionarily designed that way and we filter potential partners through such patterns.

• So the color of the teeth has a great influence. Bright clean teeth reflect light and shine. This is generally perceived as positive and well-groomed. Too bright, however, can appear artificial.
• There is a certain degree of symmetry. Tests have shown that 100 percent symmetry is perceived as artificial and rather unpleasant. That means we don’t have to be completely symmetrical to look attractive.
• The smile appears genuine and the facial expressions are visually consistent. A smile without involvement of the eye muscles is perceived as less cordial and artificial.
• The shape of the teeth plays a very important role. Here, however, there are only conditionally transferable rules. Because sometimes the shape of the teeth is significantly larger than ideal and yet we perceive the whole thing as positive and beautiful. So be careful with generalized images of beauty, because these do not have to look equally good on everyone. There are many examples where, viewed purely objectively, not everything is right, but we still find the smile/the entire face/appearance beautiful.
• We perceive a face as younger if the tooth length is “correct”, i.e. not worn and the enamel edges are intact. If you see 2-3mm of tooth when the upper lip is relaxed, it makes the face appear younger. In men, it can be a little less. On the other hand, if there are a lot of lower teeth and no upper teeth, it makes both man and woman look older. The upper lip gets “longer” with age, the perioral tissue slackens, and so you may see less of the upper teeth.
• How much gum you show when you smile also has an influence on the appearance. If you see a lot of gums when you smile, this may be due to a very mobile upper lip and/or the bony structure. In this case, it is called a Gummie Smile. However, not every gummy smile is equally unaesthetic; it all depends on the degree of expression.

Red-white esthetics is also called the gum-to-tooth ratio. Is the course of the gum even? Irregularities can be harmonized: in this case it is called gingivectomy and or surgical crown lengthening. (Gingivoplasty) In periodontitis, the relationship of gum to tooth is completely disturbed, as the disease is accompanied by bone loss and gum recession. Patients often suffer from the dark triangles that form as a result. Again, there are reconstructive options to reduce this. This can be done either by direct composite restorations or indirect restorations. In some cases, additional periodontal surgical treatment to cover the recession can make sense.

So how do you approach rehabilitation or cosmetic treatment?

• Is the function correct?
• Will orthodontics be necessary to establish function?
• What aesthetic considerations are important to you as a patient?

Example: it must be functionally pretreated, but you want to keep your anterior gap in any case. Or you are unsure and would like to possibly close the gap, then this must be visualized in advance.

• When it comes to esthetic procedures, and this is always the case when treating the anterior teeth, good planning is indispensable.

What is Smile Design?

It deals with the idealization of the smile: tooth shape, tooth size, red-white esthetics, incisal edge progression during smiling, buccal corridor, alignment of bipupillary line to the incisal edge progression and, of course, tooth color. This can be done digitally using photos and can also be “tried on” in the mouth using model analyses and so-called wax ups. However, this is only possible if no major orthodontic pre-treatment is necessary. If more than digital visualization is desired or useful, 3D models of the teeth can also be printed. It is important for all procedures that are not medical but purely cosmetic that you do not do them for the wrong reasons. For this, planning and diagnostics are useful and we can discuss to what extent which treatment makes sense for you and what effect is achieved.