Extreme Makeover Smile

Everyone talks about extreme makeover and smile makeover these days. It involves the entire face, which evidently includes the jaws and the teeth. Extreme makeover is a term that was created to underline the dramatic changes that can be created with plastic surgery and cosmetic dentistry. An extreme makeover should be a holistic approach that considers the functional aspects of all involved structures.

Anatomy of a smile: the pull of a variety of small,
but very responsive facial muscles.

While all changes to the face have a functional impact, even a minor change within the stomatognathic (chewing) system needs to be based entirely on function. Aesthetics cannot be achieved without function. In fact, any aesthetically pleasing object, except those created in the field of art, evolved within a framework of function and interaction. Beauty is harmony. So, let us talk about how that applies to your teeth and jaws.

What is a smile? We cannot discuss its philosophical and spiritual significance at this point. However, it is important for a plastic surgeon or cosmetic dentist to understand the anatomical, functional, and physiological aspects of a smile.

We have a large group of specialized mimical muscles that contract in certain situations and pull the overlying soft tissues into a smile (see above image). Teeth become exposed. The amount of tooth exposed during a smile varies from patient to patient. A young person displays more tooth surface than an older person. This is caused by two things: the progressive sagging of the upper lip and the attrition (shortening) of the upper incisors.

These signs of aging are the main reasons why many middle-aged individuals decide to 'lift' their smile by lengthening their front teeth with porcelain veneers. They often receive six to ten upper porcelain veneers. However, any dimensional change of the front teeth has to consider stomatognathic function.

The front teeth are vital for the protection of the molars. Front teeth are responsible for the disclosure of the back teeth during horizontal movements of the jaws. Muscles shut off when front teeth are stressed by tooth contact. This natural mechanism protects all oral structures.

This image explains the concept of 'envelope of function'
(blue line). The envelope of function is a key element of
smile design. Ignoring it will cause your new smile to be
unstabil and porcelain restorations to break.

Smile design or smile makeover therefore cannot just focus on aesthetic parameters, but must be created within the 'envelope of function' of the front teeth. When you receive a new smile, it is not just 'painted' into your face. It is integrated in complete functional harmony with the surrounding structures of the skull.

Any master in plastic surgery or cosmetic dentistry fully understands the reason for morphology and aging, such as.''Why does the jaw have an angle?'' or,''Why do eyelids become baggy?'' or,''What do we need to do to rejuvenate a smile?''

Any smile makeover of the teeth has to be based on the physiological relationship of upper and lower jaw. There are many heated discussions regarding the finding of the proper jaw relationship (centric relation) among the dental community. The most predictable results have been obtained by techniques developed by Dr. Peter Dawson in St. Petersburg, Florida.

Your new smile will be permanent and beautiful if all functional aspects were considered.

This image underlines the fact that teeth cannot be altered without consideration of
the relationship of the jaws, which meet at the temporo-mandibular joints. The dental contacts determine the position and relationship of the joints upon closure and need to be in harmony with their physiological position.

The following extreme-makeover smile design is the result of a careful consideration of the relationship of upper and lower jaw. The patient was set into her natural centric relationship prior to raising her bite. This allowed us to create the space necessary to rebuild the worn teeth without changing the most physiological position of the mandibular condyle into the temporal fossa of the skull.
The makeover is truly extreme. However, the final result of this full-mouth reconstruction lead to a much healthier condition of all oral and masticatory structures involved.

Before:

After: