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Dallas Cosmetic Dentist Dr. Mark Sowell Explains Extreme Smile Makeovers

What is an Extreme Smile Makeover and can I afford one?

Often I get an email asking me how much are porcelain veneers? The question is really, how much will it cost me to have an extreme makeover or enhancement? The next question is what is an extreme smile makeover? It is a media term to generate excitement and implies the transformation of an unattractive smile into the classic large, bright and bleached white beauty pageant or Hollywood smile. A smile enhancement can mean the same thing for some people and for others it can be much more limited in scope, it all depends on the look the patient is looking for.

Therefore, without seeing the patients smile in person or in photos, it is impossible to know. Let me explain why. A smile is highly variable and unique to each person. A similar question would be to ask a home remodel contractor what is would cost to remodel your home without him seeing your home. A walk through and inspection would be needed. To have new lighting the electrical panel and wiring must be good for example. Let’s review what I must know before I can tell you what an extreme makeover may cost.

The first thing I must see is your biggest smile. I am looking to see if you display both your upper and lower teeth and if your upper gums show? If you want a dramatic color change beyond what bleaching will provide and you have a large smile that displays your upper and lower teeth, you may be looking at treating both your uppers and lowers that display. If you show your gums, you may need leveling your gums or a gum lift to get an attractive result. If you have a wide smile you may show 12 upper teeth when you smile or you may show as little as 8 teeth. Younger patients normally need less treatment to get a great result. Older more mature patients have more structural damage from time, large fillings and clenching and grinding. Besides an attractive smile, we need a healthy smile so that it holds up for a long time. The next thing we look at after the shape of the lips, smile and the display of gums in the smile is the position of the front two teeth. Are they the right length, are they long enough, and are they out in the smile enough? Once their position is ideal, the ends of the upper teeth should form an arch or curve parallel to the lower lip and create a Full horseshoe shape from one corner of the lip or smile to the other. This allows the teeth to reflect light evenly and not have any dark areas (shadows) in the smile.

An attractive smile is determined by several factors. The shape of your lips and symmetry is like the frame of a picture. Next, the gum display is like the matting around the portrait. Finally, the teeth are the subject of the portrait and must be ideally centered into the picture in all three dimensions. The shape of your lips and symmetry is like the frame of a picture. The symmetry and harmony of your smile comparing the left side and right side with your nose being the dividing line, the color of your teeth, and their position in your mouth under your lip and the amount of teeth displayed during a smile all contribute to the impact of your smile on people’s perception. As a cosmetic dentist I can affect all these elements except the basic shape of the lips. When I do a smile make-over I am using all these elements to the patient’s best advantage to achieve the optimum result.

I start with a mental image of an ideal smile for a patient from my years of experience. This picture is based on research on people’s perception of beauty. But not all people want the beauty queen Hollywood smile. Most of the time people are not sure what they want, they just know they want an improvement or enhancement. I must find out what they think they want, and then show them what they would look like with that improvement. Then, on a photo of the patient I draw the enhancements that I see that they have not mentioned and ask them if they would like to see the photo. I believe patients should know all their options and have a picture of the finished result before they start. This is a process where I get to know what the patient understands and wants. Some patient know what they want, but often patients get focused on one thing in their smile they do not like and develop a blind spot for other potential improvement areas. Once the major defect is corrected they suddenly see the other areas they had not seen before. If they want to see what I am talking about I show them the drawing and offer to create two computer images, one with the smile enhancements they requested and one with the additional enhancements that I see. This way the patients can explore all options before they start and are not disappointed with the results if they selected limited enhancements, as this can often require their enhancement to be redone to make the desired additional improvements.

This process eliminates disappointment as the patient and I basically know the end result before we start. This is the starting point to get a general idea of the scope of the treatment desired. From here a ball park fee can be discussed. A picture speaks a thousand words. Now the patient can choose. From here we have many additional diagnostic aids you will hear about from mock-up in your mouth to wax-ups on models to prototypes. I use all these diagnostic aids once the patient and I have a good idea of what will make the patient happy in the end and what the fee would be. From there it is just putting icing on the cake.

Once the patient has chosen, we use all abovementioned elements to achieve the optimum result, starting with an evaluation of the gum display on extreme smiles. I will raise, lower or level the gums so that the patient shows the appropriate amount of gum in their smile and a horizontal line connecting the tops of the teeth will be approximately parallel to the upper lip if needed. Next, I will look at the position of the two front teeth in the smile. Are they centered in the portrait and do we see enough of them to be proportionate to their face? Do we want to bring them out to make the lip go up higher in the smile to display more teeth and make the teeth brighter as they will be further out to reflect light and brighten their smile? Do we want them to go back in the smile and can the bite from the lower teeth accommodate this? Are they a clincher and grinder and how will this affect the muscle memory of the lower jaw during grinding or chewing? How will the length and width affect the tightness of the upper lip, lower lip and s, v and f sounds? All of this is evaluated in the mock-up or prototypes to insure maximum comfort. Once the ideal position of the upper two teeth are established for esthetics and function then we look at the length of the rest of the upper teeth, and position them on an arch approximately parallel to the lower lip, to give a pleasant youthful appearance. As we get older we tend to grind down our upper front teeth making them appear shorter than the rest of our upper back teeth in our smile, this is called a reverse smile line. Then I evaluate the harmony and symmetry of your smile comparing the left to the right side with the midline being between the upper two front teeth. This we call the arrangement of your teeth, making them proportionately ideal to your face and to each other. Next, I look at the facial arch of the upper front teeth. Do you have a nice horseshoe shape from corner of the mouth to corner of the mouth? If you do not your arch may have shadows in the corner of the mouth areas causing your upper back teeth to look darker as they are in a dark shadow with no light to reflect off them. Thus, they may be the same color as your front teeth and may have even had them bleached, but to no avail, they still look dark in your smile. Do you have big lips which look great, but cast a shadow over your teeth? This could make them look darker, so we may want to bring them out. But if you have a tight upper lip this would not be recommended. Finally, I look at the color of your teeth. What is your skin tone? The darker the skin the more contrast you have and whiter your teeth appear. Blue eyed blonds tend to have very pale skin tones and thus their teeth always seem to have a yellow tint and usually need whiter teeth shades to compensate and not appear yellow. There are hundreds of details that a good cosmetic dentist learns involving art, light reflection, surfaces, textures, contrast, esthetic illusions, etc., but it would probably put you to sleep and they do not apply to everyone. The main thing is if you have a particularly difficult case you need to make sure you use someone who has the training, artistic gift and experience to use all these elements to your advantage.

Once all these esthetic elements are considered I produce a computer image of what I think would be the most attractive smile for the patient based on what I know about their personality and style. Then I produce another image with the enhancements they requested. The patient then reviews both images and we go over them together. We could talk for weeks, but it is the comparison of these images that turns the switch on for many patients and they see things they did not see before. Some still want limited enhancements, others want change, but for all there is no buyer’s remorse as they understand and can visualize their options before they start. Now the patient can understand why we cannot quote them a fee over the internet or phone. The smile is a very personal thing where the public sees every detail of the treatment every day, much like your skin, eyes and nose. Your smile has the power to make you look ten years younger or older beyond your years, more so than any other esthetics enhancement procedure. It can mimic nature and make the person appear as they were genetically blessed with a beautiful smile and teeth, or it can scream fake and artificial. Especially in today’s dental environment where much of the porcelain work is being exported offshore (overseas) to reduce labor costs. Many dental labs have closed as dentist are more often sending their work to large labs which charge low prices and in turn send the work to Asian countries to fabricate the porcelain by technicians who make as little as $50.00 per month. The dentist never meets or communicates with these offshore technicians and in my experience the results speak for themselves. Unfortunately, highly skilled labor is high, as this work requires tremendous training and talent as it is an art work. Patient’s who do not do their research and shops by price only are the most vulnerable to this situation. I always recommend patients ask to see pictures of the before and after cases of the doctor’s work, to ask how many cases they do per month and ask about the level of training they have in cosmetic work. 80% of the dentistry done in the US is said to be one and two tooth dentistry on back teeth. Excuse me for getting off on that topic, let’s get back to our patients choosing what smile enhancements they want.

Once the patient has made their choice of the look they would like we also discuss the health of their mouth to include the biology, structure and function at their consultation appointment. What good is an attractive smile that does not last a long time? Finally, treatment is decided and appointments, fees, and financing are discussed. We offer interest free third party financing which helps patients get the result they want at an affordable monthly payment. Now with all the practical matters addressed we go on to treatment. We incorporate mock-ups (bonding material shaped into teeth by me, like a free hand sculpture on the patients teeth) and photos taken to confirm live the look the patient wants. Models of the teeth and mock-ups are taken to fabricate the prototypes. Prototypes are the first set of teeth made which we can alter in the mouth after we have placed them. Here is where we fine tone the style or shape of the teeth and color. They are a test run of all the design choices we have made. While the prototypes are being made we often will treat any gum disease that is present, alter the gums or bleach the teeth if needed. Next, we will reshape the teeth and fit the prototypes. The patient will wear these prototypes for 2-5 days and return to give me feedback on the color selected, arrangement, style, shape, size, etc. Once the changes are made on the prototypes and the patient sees what they want we take photos, models and sometimes have our onsite ceramist see the patient for any special needs or requests. Now the ceramist starts the detailed art work of creating a smile in porcelain that will require an enormous number of hours of labor to deliver a beautiful life like result. On average in a couple of weeks depending of the amount of work done, the patient returns to have the prototypes removed and the permanents tried-in. The patient then approves the final smile. If I or the patient wishes any changes to be made, again my onsite ceramist will be there to make the changes on the spot. Then the beautiful final result is bonded permanently in place. Through this process the patient gets to evaluate all their options and modify it as they discover the look they like the best by wearing it in their own mouth. So often they make changes from what they thought they initially wanted. That is why our system is so important as it allows for patients to self discover the look they love the best.

About the Author

Dr. Sowell and his entire team strive to offer unparalleled expertise in the fields of cosmetic, restorative and implant dentistry in Dallas. They understand that enhancing the health, function and appearance of your smile is a major decision. That is why Dallas dentist, Dr. Sowell and his dental care team are so dedicated to your well-being, both inside and out.

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