Index / Cosmetic
Smile design
You see the result
before anything
is permanent.
A smile is designed, not improvised. The proportions, the length, the gum line and the way the teeth meet are worked out on paper and in a trial you actually wear, and only then is a single tooth touched.
Why people come here
- He teaches occlusion and full-mouth rehabilitation to other dentists
- Fellowships in three academies — FAGD, FACE and FICOI
- The complex cases other practices refer out
- A written, itemized plan before anything is scheduled
The premise
Porcelain is the easy part.
The hard part is deciding exactly what the finished teeth should look like and whether the bite will let them survive. Both answers come before the drill.
There is a version of cosmetic dentistry where the patient says they want whiter, straighter teeth, the dentist prepares ten of them, and everyone finds out together what the result looks like at the fit appointment. It works often enough to stay popular. When it does not work, the patient has already lost the enamel.
The alternative takes longer at the front end and almost nothing is left to chance. The finished smile is designed first — measured against the face, the lip, the gum line and the bite — then built as a trial you wear out of the office, eat with, and show to the people whose opinion you actually care about. Changes are made to the trial. The porcelain copies the version you approved.
What the design has to answer
- How long the front teeth should be, measured from the lip at rest and in speech
- Where the gum line should sit, and whether it needs to be moved to get there
- What shade reads as natural on your face, rather than simply bright
- Whether the teeth need to move before they are restored, which is usually cheaper and always more conservative
- Whether the bite will destroy the result, and what has to change so it does not
- How much enamel has to be removed — and the answer should be as little as possible
The trial smile
Wear it. Eat with it.
Then tell us what to change.
From the design, a trial version of the new teeth is made and placed over your own without cutting them — or, where teeth have already been prepared, worn as provisionals for as long as the case needs. You see it, you speak with it, you take photographs of it, and you live with it.
This is where the useful objections surface. The teeth are a shade too long. One feels like it hits first. The shape is a little square for your liking. Every one of those is a cheap conversation at the trial stage and an expensive one after the ceramic is bonded.
When you approve it, the trial becomes the instruction to the laboratory. The technician is not guessing at what you wanted; they are copying something you have already signed off on.
The sequence
Six stages, and two of them are yours.
Examination and records
A full examination, a set of standardized photographs, digital scans, shade readings and an assessment of the joints and the bite.
Visit oneDesign
The new smile is designed against your own facial measurements — proportions, midline, incisal length, gum line and shade — not against a template.
LabTrial smile
The design is built and placed so you can see and wear it. Photographs are taken and the changes you want are recorded.
Visit twoGroundwork
Anything the result depends on happens now: aligners to move teeth, gum recontouring to level the smile line, bite work, whitening of the teeth that are staying.
VariesPreparation and provisionals
Minimal preparation of the teeth that are being restored, and provisionals built to the approved design so the trial continues while the ceramic is made.
One visitFit and refine
The ceramic is tried in, checked against the design, the bite is adjusted and measured, and then it is bonded.
Final visitHonest limits
What smile design can and cannot fix.
Not the right tool
Cases where something else comes first
- Active gum disease — that is treated before any cosmetic work is planned
- Decay or infection — porcelain over a problem buries it
- A severely collapsed or painful bite, which is a reconstruction case rather than a cosmetic one
- Large movements of the teeth, which orthodontics does better and more conservatively than ceramic
- A patient who wants a specific celebrity's teeth; the design is built for your face
A good fit
What this process does well
- Worn, chipped or uneven front teeth, especially where the bite is involved
- Teeth that have darkened and no longer respond to whitening
- Old bonding or veneers that have stained at the margins or no longer match
- Small gaps, mild crowding and a smile line that is slightly off
- Short-looking teeth where the gum, not the tooth, is the problem
- A patient who wants to see it before committing to it
Questions
Smile design, answered.
How long does the whole process take?
A straightforward case with no groundwork runs about six to eight weeks from first examination to bonded ceramic. Where teeth need to be moved first, or the bite needs settling, it is longer — often three to six months — because those stages have their own timelines and cannot be rushed.
Will it look fake?
That is a design decision, not a material limitation. Teeth look artificial when they are too uniform, too bright, too flat and all exactly the same length. Modern ceramics copy the translucency and surface texture of enamel well enough that the giveaway is almost always the design rather than the porcelain.
This is also what the trial stage is for. If it looks too much to you at the trial, it gets changed at the trial.
Do you have to remove much tooth?
As little as the case allows, and sometimes none at all. How much is needed depends on where the teeth are starting from — a tooth that is already set back needs almost nothing, a tooth that is crowded forward needs more. Moving teeth with aligners first is often what makes a conservative result possible.
Can I see cases?
Dr. Nosti teaches from his own cases and has published photographic case work in Dentaltown, the Journal of the American Academy of Cosmetic Dentistry and Inside Dentistry. Cases relevant to what you are asking for will be shown at your consultation, with the patient's permission.
Keep reading
Next step
Start with an examination and a straight answer.
A consultation includes an examination, the records the case needs and a written, itemized plan. If what you are asking for is not the right treatment, Dr. Nosti will say so and tell you what is.