Insights · Dentofacial Harmony
A beautiful smile is only half the face.
A beautiful smile is only half the face. After more than 25 years practicing prosthodontics, that is the idea that now guides nearly every aesthetic decision I make.
Introducing Dentofacial Harmony
Dentists are trained to see teeth. We study their shape, shade, position, wear, and proportion. When a patient wants a more attractive smile, our tools let us make teeth whiter, straighter, longer, and more even.
Facial aesthetic specialists see the same patient through a different lens. They evaluate the lips, cheeks, chin, facial proportions, muscle movement, and volume.
Both perspectives are valuable. But somewhere along the way I came to recognize a gap between them.
Dentists can become so focused on creating beautiful teeth that we overlook the face around them. Surgeons and injectors can carefully evaluate the face without considering the dental foundation beneath it: the bite, the position of the teeth, the height of the lower face, wear on the teeth, and how the upper and lower jaws relate to one another.
These structures are not independent. The smile shapes the face, and the face frames the smile.
That realization led me to the approach I call Dentofacial Harmony: evaluating dental aesthetics and facial aesthetics together, as one face, rather than as two separate specialties.
Most importantly, it changes where treatment begins. Not with a procedure, but with a diagnosis.
The smile shapes the face, and the face frames the smile.
When the tool becomes the treatment
Every practitioner works with the tools they know. A dentist can change teeth. An orthodontist can move them. A periodontist can reshape gum tissue. A surgeon can reposition bone. An injector can relax a muscle or add volume.
The problem begins when the tool determines the treatment instead of the diagnosis determining the tool.
Consider a patient who wants a fuller lower lip. If her lower jaw sits back relative to her upper jaw (what dentists call a Class II relationship), the teeth and jaw may simply not be supporting the lip from behind. An injector can add more and more filler, but the result never looks quite natural, because filler is treating a structural problem as a volume problem. For the right patient, orthodontics, restorative dentistry, facial treatment, or a combination will produce a far more natural result.
Or consider a patient who feels her lower face has aged: thinner lips, deeper lines at the corners of the mouth, a chin that seems to have crept forward. Sometimes the cause is worn, shortened teeth. When the teeth lose height, the lower third of the face closes up, and the lips and soft tissue fold accordingly. Restoring the teeth restores the support. No amount of filler can do that.
Case study · Full-mouth rehabilitation
A patient of mine. Years of tooth wear had shortened his teeth and collapsed the height of his lower face: thin, inward-turned lips, a deep fold beneath the lower lip, and a chin that had rotated up and forward. He had no facial injectables and no surgery. Full-mouth rehabilitation restored the height of his bite, and the lower face followed. The lips regained their fullness, the fold beneath the lower lip softened, and the chin settled back into proportion.
His teeth were the diagnosis. Everything else was the result.
The question should not be, “How much filler does this lip need?”
It should be, “Why does this lip look this way?”
A gummy smile is not a diagnosis
The same principle applies to a gummy smile.
If too much gum shows, the obvious dental solution seems to be removing gum tissue. But excess gum display can have several causes: extra gum tissue, an upper lip that lifts too high when smiling, the position of the upper jaw, short tooth proportions, or a combination.
If lip movement is the primary cause, removing gum does not correct the problem and can leave the teeth looking too long. If extra gum tissue is the cause, treating only the lip is equally incomplete.
So the question is not, “How do we treat a gummy smile?”
It is, “Why does this patient have a gummy smile?”
That is the difference between treating what we see and understanding its cause.
Diagnosis first, treatment second
The teeth, bite, jaws, lips, muscles, chin, cheeks, and soft tissues all contribute to the appearance of the lower face. Even the height of the lower face when the teeth come together (the vertical dimension) influences facial proportion and support.
A concern that looks facial may have a dental component. A concern that looks dental may be driven by facial anatomy or muscle movement.
The right treatment may involve dentistry, surgery, a neuromodulator, dermal filler, or a combination. Sometimes the best treatment is very little treatment at all.
The objective is not to perform more procedures. It is to make a better diagnosis so that we perform the right one.
Dentistry needs to evolve
Dentistry has made extraordinary advances in materials, implants, and digital technology. Our ability to create beautiful teeth has never been better. I believe our aesthetic education should now evolve beyond the teeth.
Dentists already study the anatomy of the head and neck extensively. Facial analysis, dynamic smile analysis, muscle function, and soft tissue support should become a more integrated part of dental training. Not to turn every dentist into an injector, and not to give every patient more treatment, but to give dentists a fuller understanding of the structures they are already treating.
One face
Dentistry has become very good at creating beautiful teeth. Facial aesthetics has become very good at treating the face. The next evolution is bringing the two together.
Patients do not see separate specialties. They see one face.
That is Dentofacial Harmony.
Diagnosis before treatment.Harmony before perfection.The right solution for the right problem.
Related Care
Dentofacial Harmony Full-Mouth Rehabilitation Smile Design Veneers
Begin With a Conversation
The right solution for the right problem.
The right aesthetic plan begins with understanding what is creating the concern.
This article is general information, not medical advice. Individual results depend on individual anatomy, diagnosis, and treatment. For guidance about your own smile, please schedule a visit with Dr. Shay.