Now, here is where we will get into some of the technical aspects which make a smile look “natural”. As stated before, many people say they want a perfect smile, but many don’t know that a perfect smile is one in which character is present. Rather than teeth that are laid out much like keys on a piano, a natural smile will have some variation in the way the teeth are positioned. All of this gives the smile its own unique character which is personal to you.
I had the chance to catch up with Donald J. Yancey CDT, for some information on what makes a smile look natural. Don is one of the lab technicians involved in designing and creating my new smile from Ivoclar Vivadent, using the Phonares teeth and Ivobase processing. I have attended two of the classes that he and Rick Rought, another amazing lab technician behind my new smile, teach in Sarasota. I have seen them teach professionals how to make dentures and, trust me, it’s so interesting to watch and see what goes on behind the scenes. This attention to detail is something many of us would never have even thought about, so hopefully this information will give you a little more insight into what goes on when making a set of high quality, highly esthetic, natural looking dentures.
A natural looking smile must have:
1: The proper positioning of the anterior teeth
Proper tooth positioning is a critical part of a natural looking, properly functioning denture. If the teeth are placed too far out, too far in, too long, or too short, it can not only end up looking off, but it can also affect your lip support, speech, and the fit of your denture. The dentist obtains measurements by doing Phonics. When they have you count from 50-59, the edge of your two front teeth should just touch the inside of the middle of the lower lip. If you were to pull down your lower lip, you will notice that it is two different colors. The tips of your central incisors (two front teeth) should touch right where those two colors meet when you count from 50-59.
Esthetically, the position of these teeth are very important. Sometimes, patients have two challenges with their upper lip. Either the denture teeth are set too far out, which causes the upper lip to protrude, or, too far in, which decreases lip support and causes a “sunken” appearance or a “disappearing” upper lip. Remember, upon first getting extractions, swelling and other factors can contribute to the “monkey lip” appearance. I had it, as well as many others, and it’s very normal. Once the swelling subsides and the gums shrink, this appearance should correct itself. If not, it could be that the teeth aren’t positioned properly.
Another common problem is the “Cheshire Cat smile”. This happens when too many teeth are showing when you smile. In a natural smile, you will notice two little triangles of empty space at the corners of your mouth when you smile wide. When all of the teeth fill this whole area out, it gives a crowded appearance, which is unnatural.
2: The proper positioning of the posterior teeth
Placement of the back teeth is just as important. Not only can improper placement of the posterior teeth affect speech and cause joint pain and headaches, but it can also affect the overall appearance of your smile. Sometimes it can cause an uneven smile in which the smile slants, causing more teeth to show on one side as opposed to the other.
3: High quality material
Materials matter. Low quality teeth tend to have a flat, lifeless appearance. A high-quality tooth will mimic natural teeth, not only in shape and color but the way the light transmits through the tooth. Natural teeth vary in color from one tooth to another. A high-quality tooth, such as the Phonares teeth, will mimic this.
Surface texture of the teeth is also very important. Highly glossed teeth look fake due to the light bouncing off of them. By adding surface texture, the teeth absorb the light and look more natural
Low quality teeth aren’t able to withstand normal wear as much. Over time, the teeth wear down and become flattened on the edges you use to bite with. High quality teeth withstand normal wear and tear much longer. When you speak, everyone sees the lower top surfaces of your back teeth so if they look like natural teeth, no one will suspect you are wearing a denture.
In a low-quality denture, the gum area which meets the necks of the teeth often times looks very flat and sometimes, even translucent. Proper waxing of the necks of the teeth will mimic natural tissue. In nature, we have varying heights and thickness of tissue around the teeth so varying the wax looks natural when a person smiles, especially if their tissue shows when they smile.
The gum color in low quality dentures is typically flat and lifeless. Real tissue has variations in color. Using a high quality acrylic resin that has natural tissue color and doing an individualized tinting of the tissue to highlight thin and thick tissue areas will make the tissues come alive, instead on using just a monochrome tissue color.
In nature, no two smiles are the same. Each smile has character which is unique to that person. The slightest variations can have the greatest impact. For instance, varying the edges of the central and lateral incisors (your four front teeth) so they do not have perfect straight edges will make them look more natural. Natural teeth have wear patterns where the opposing tooth has worn a path when chewing. Another way to add character is to pick a tooth which already has a different shape to it. Individual tooth positions can also add character to make the smile appear more natural. Twisting and turning the teeth slightly helps to break up that “perfectly straight piano key” appearance and make them look natural. Placing the incisal (four front teeth) edges at different levels, such as having the centrals longer than the laterals, will give the smile more character, as well. The higher the laterals (the teeth on either side of your two front teeth) the younger the smile looks.
Don’t be afraid of minor imperfections. These imperfections are what will make the smile look as natural as possible.
Let’s take a look at some examples!
As you can see in the smile above, the teeth are all laid out perfectly straight, which gives the smile that unnatural, “denture” appearance.
Now, look at the difference! The first thing which stands out is that the teeth aren’t positioned in a perfectly straight line. Some teeth are higher than others, some are turned, etc. Also, the edges of the teeth aren’t flat. They appear to have some wear to them, as you would expect with natural teeth after using them all of your life to bite into your food.
Another amazing transformation! In the before picture, you see that same uniformity that would appear in a standard, low-quality denture.
In the after picture, there is so much character, you would never be able to suspect that these are dentures. They also make her appear to be more youthful!
In this before shot, the teeth are disappearing behind the lips. This common problem tends to age the patient, a complaint I often here from women.
In the after shot, you are able to see more of the teeth. The shape and position of the teeth take on more of a natural appearance.
And there are my before and after pictures! As you can see, the shade is still bright but it isn’t a flat, white color as with the previous set. The acrylic around the necks of the teeth in the before picture is very thin and translucent. After, the acrylic is shaped around the teeth in a way which mimics natural tissue. Before, it looked like I had a mouth full of teeth— that “Cheshire Cat” appearance that I mentioned, previously. Notice in the after shot, there are triangles of empty space at the corners of my mouth? Before, the teeth had a flat, almost boxy appearance. After, they are softer and rounder, which gives a more youthful appearance. The gum color is softer and more of a natural shade of pink, whereas, before, the color was much darker and had almost a purple tint to it. The new hybrids were also built up in a way which gave me more lip support. Notice how much fuller my lips are in the after shot? Another thing which you may or may not notice is my midline. I actually have a crooked nose. My previous set had a midline which was positioned based off of my nose, which caused it to be off-center to my “cupid’s bow”, which is the dip in the upper lip. After, the midline was positioned under my cupid’s bow, which makes it look a little more symmetrical than it did before.
As you can see, little changes can be all the difference between a couple rows of teeth and a smile which is full of life and character.