The Search for a Classification of Smiles – Why It’s Important When Considering Cosmetic Dentistry in Toronto
Understanding the different types of smiles is important when asking for yours. Dentists know this – and now, it’s available for your interest also. You will find this information valuable as you determine what the best course of action for you is – whether it’s porcelain veneers, crowns, bridges, dental implants, or any other cosmetic dentistry procedure.
Here’s an excerpt from my book, A Guide to the Perfect Smile, for your reading enjoyment.
“Not that long ago, to do the above was a major, and in most cases unattainable, challenge. As discussed in chapter one, until the 1990s, dentists did not really understand how to classify smiles so that they and their patients could talk the same language. Figuring out the types of smiles and which ones fit which patients, and coming up with methods for actually creating these smiles, was very difficult. By the 1990s, dentistry had a definition of the smile that finally took into account the underlying reality with respect to the face. But there remained a need for greater sophistication in analyzing and codifying different smiles and different aspects of smiles.
At this point in my own department, I was strongly affected by a paper written by the plastic surgeon R.T. Manktelow (along with J.L. Paletz and R. Chaban) and published in 1993 in Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. This paper, “The Shape of a Normal Smile: Implications for Facial Paralysis Reconstruction,” dealt with how the angle of a smile can change. Think of lips in their resting state where the meeting of the lips is somewhat horizontal. As the smile begins, the corners of the mouth begin to shift. The degree to which they do so and at what angle, with the lips going upwards, is what creates the smile. This gave me a better insight, surgically, into why there is such a range in the way lips “behave” in a smile: how much they move and the angles at which they move. I saw that instead of trying to boil everything down to statistics and analysis on an individual basis, it made more sense to organize all these into patterns.
I also went back to a paper by L.R. Rubin, published in 1974, also in Plastic and Reconstructive Surgery. Rubin, also a plastic surgeon, was instrumental in trying to understand smile patterns. In his paper, “The Anatomy of a Smile: Its Importance in the Treatment of Facial Paralysis,” he noted from surgical experience that there were various patterns to the way people smiled. He classified them as commissure, cuspid, and complex. (Hang on – we’ll get to the description of these patterns in a moment.)
I went on to apply the scientific findings of Manktelow to the insights of Rubin. Because both of these men were plastic surgeons, they broke the patterns they were seeing into lip movements not involving the teeth. I took their approach one step further. I said, “Okay, let’s finish the story. We see how to plastic surgeon is looking at the lips. Now let’s examine how to teeth follow these patterns.”
I began to examine how there were patterns of angles unique to each smile. This is the essential point. By identifying the pattern, one can know the angle of smile that should be occurring but that may not be doing because the underlying teeth are broken or have worn down. Fixing the teeth so they follow the angles of the smile pattern creates the right smile architecturally. This was the answer. If I had to pick one thing in my life that I got right, this would be it.
Because the commissure smiles was the most common pattern of smile, that’s the type of smile most patients were asking for and most dentists were seeking to create. But this decidedly did not work for patients whose smile patterns were not commissure.
Rubin didn’t understand why the exact same surgery used to correct the smile of a car accident victim or patient who had had a tumor removed yielded such different results. He, too, was trying to build everyone into a commissure. Plastic surgeons would lift the muscle and replace it and put it back the same way for both patients. Sometimes it worked well and the patient would feel that the surgery was very successful. But other times a patient undergoing this same surgery felt their smile was not right – in fact that the surgery had made them look as if they weren’t smiling properly. Perhaps one side of the face was smiling and the other side seemed to be leering.
After doing further research, however, Rubin was able to identify that the way a person’s smile works is similar to the way a person’s walk works. Two people of the same size and with similar physiques and even speeds of walking nevertheless can walk in very different ways. They may have different gaits: different speeds at “takeoff,” length of strides, angles of keens and feet, and so on – a kind of walking signature. Some people begin their walk slowly and then pick up speed; some start off fast and maintain their speed. Some take quick short steps; others cover ground with big, strong strides. John Wayne had a characteristic way of strolling onto the movie screen. You instantly knew who it was even if you couldn’t see his face. You can even tell a whole family by the similarities of their walks.
In the same way, two people with the same basic facial characteristics may have very smiles. Some begin their smiles with their mouths closed, while others are half-way into their smile from the beginning because their mouths are already partly open. Some show little gum because their smiles are gradual and modest. Others show a lot of gum, and fast, because their smiles go quickly from liftoff to orbit.
People can alter the way they smile, but they will almost always revert to their natural smile. That’s how their facial muscles do it. It is fundamentally unchangeable.”