In esthetic dentistry, determining the arrangement and contour of the teeth can be a fun process since it allows us to be artists. This concept is really emphasized in removable prosthetics because we have total control of all of the different factors: tooth shape, tissue position and overall arrangement. However, we must always take the patient’s expectations into consideration. Not every patient has the same ideal in mind when it comes to esthetic cases.

In general terms, it’s helpful to know what our options are when determining the overall arrangement, contour and esthetics for the patient.

Age appropriate and natural
Our goal esthetically is to make the restorations fit the patient’s age, personality and gender with color, contour and arrangement. Ideally, the restorations should blend so well that others wouldn’t be readily able to tell if the patient has had any dental work done. I always say the best compliment one of my patients can receive is that they have “a nice smile” and not “who did your dentistry.”

Age inappropriate and natural
Age inappropriate and natural typically means that although the contour and arrangement might fit the patient’s age, the shade is too bright. Shade is typically a subjective component and is chosen by the patient; however, even after educating the patient about age and color, some patients may request a shade that isn’t necessarily age appropriate. For example a patient in their 70s may desire bright, bleach white teeth, but the reality is a typical 70-year-old doesn’t have perfectly white teeth.

“Media-driven” esthetics
This last category may also be referred to as “Hollywood esthetics,” which is essentially teeth that are excessively bright and have unnatural shapes and arrangement. Typically when evaluating to see if your favorite movie star has had dental work done or not, all you have to do is look at the incisal edge relationship of the lateral incisor to the canine and central. It seems that patients often associate “straight” teeth with a “lack of incisal embrasures.” Generally, the only way the incisal edge of the lateral is at the same incisal edge position as the centrals and canines is if the patient had a significant amount of incisal wear on the adjacent teeth. If the laterals are at the same incisal position as the other anterior teeth and they don’t look like they are worn, it generally means that they have been restored.