Louis Malcmacher DDS MAGD Printer Friendly Version

Perfect Imperfections
by Dr. Louis Malcmacher. DDS MAGD

In past years, in our minds we have separated cosmetic dentistry from the traditional dental treatment. But now, in essence it is all one and the same. We see this routinely in every general dental practice. Let’s take a brief look at the history of cosmetic dentistry based on this thought. 

At one time, cosmetic dentistry was thought to be just for those “elite” dentists who would only make a “perfect” smile for patients. There was, and still is, discussion in dentistry whether or not this should become a specialty unto its own. Associations and organizations were created solely dedicated to cosmetic dentistry, and these were important in communicating to the dental industry that cosmetic dentistry was here to stay. There are still so many courses that are dedicated to the perfect smile, and this certainly helps elevate cosmetic dentistry to the position that it is in today.

But where were patients in all of this? In the past, cosmetic dentistry was not only for elite dentists, but also it turns out for elite patients. How many patients can really afford the “best dentistry,” when “best dentistry” is defined by bright white teeth in a perfectly straight smile? What about cosmetic dentistry for the general dentist who has everyday patients? That has certainly been the key to integrating cosmetic dentistry into mainstream dentistry. Products like Cristal Veneers by Aurum Ceramics with their no/minimal preparation approach appeals greatly to dentists and patients alike. Are the cosmetic results perfect? The bigger question really should be, do they need to be perfect? Many patients are happy with certain aspects of their smile and only want the teeth made white with minimal change in size and shape. Many patients are more than pleased with results when the teeth inclination and the midline may not have been perfect.

The question that I want you to think about is this - are perfectly straight and white teeth really esthetic, either by themselves or at all? One of the first lessons we as dentists learned in the dental school denture lab is this: when setting the teeth in wax for a try-in, don’t make the teeth look too straight, because perfect looking teeth look unnatural and fake. Now here we are doing exactly that in patient’s mouths in the name of cosmetic dentistry. 

Now that we are entering the realm of total facial esthetics with the advent of Botox and dermal fillers in dentistry, we have taken a fresh look at facial esthetics - which integrates the teeth with all the soft tissues around them, like lips and cheeks. We have finally stopped disassociating the teeth from the rest of the face. In other words, we need to stop being so teeth-centered and if we really are going to go ahead and give our patients great looking smiles, we need to consider all of the soft tissue around the mouth and indeed the entire face. What we really know about total facial esthetics is that people’s faces are not perfect and in fact, some of the most famous beautiful people in the world have faces that are characterized by slight imperfections.

Now, if we go ahead and put perfect teeth into an imperfect face, is that really esthetic? The answer is obviously no, perfect teeth many times look very fake because unless the patient has a perfect face, these can stand out abnormally. They may look great in the retracted photographs that dentists adore, but in a full face photograph - which is the view that really matters to people other than dentists - these perfect teeth may not fit in at all. 

Most esthetic smiles and faces that you see and admire every day fall under the term I like to use called perfect imperfections. In other words, rarely does a perfect smile fit into a person’s face. It’s the little characterizations such as a slight rotation, a slight inclination of a tooth, a little bit of gradual shading and the characterization of the surrounding soft tissue depending upon the patient’s facial features which will look much more esthetic than trying to force perfect teeth into a imperfect face. This is what total facial esthetics has really come to teach us.  You need to look far beyond the teeth to get patients a great looking smile. We need to view the full face of the patient in order to give us direction as to what the teeth should look like and what is truly esthetic for each individual patient.         

Dr. Louis Malcmacher is a practicing general dentist in Bay Village, Ohio, an internationally known lecturer, dental consultant and author, and is President of the American Academy of Facial Esthetics. Interested in knowing more about how to truly enjoy dentistry? Click here.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here. To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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