Smile Makeover Before and After: What Changes and How Dentists Plan Your New Smile

• Smile makeovers change up to seven smile characteristics: Tooth color, shape, size, alignment, spacing, gum position, and symmetry. Most patients see improvement in 4-6 of these areas.
• Digital smile design (DSD) lets patients see results before treatment starts: Software creates a video or photo mockup of the proposed smile overlaid on the patient’s face. Patients approve the design before any tooth preparation.
• A diagnostic wax-up creates a physical model of the proposed smile: The ceramist or dentist sculpts the planned restorations in wax on a stone model. Patients can see and touch the proposed shape before final fabrication.
• Temporary restorations let patients test drive their new smile for 2-4 weeks: Patients can evaluate comfort, speech, eating, and appearance before permanent restorations are fabricated. Changes are still possible at this stage.
• Final results should be indistinguishable from natural teeth: A well-planned smile makeover looks natural, not artificial. Teeth vary slightly in shade and shape, and the gumline appears healthy and even.

How digital smile design works:

• Step 1: Photography and videography. The dentist takes high-resolution photos and videos of the patient’s smile from multiple angles, including retracted views (showing all teeth), close-ups of individual teeth, and full-face portraits showing the smile in context.
• Step 2: Digital analysis. Specialized software analyzes the patient’s facial proportions, smile line, tooth proportions, and gum position. The software identifies deviations from ideal proportions.
• Step 3: Virtual design. The dentist or ceramist digitally designs the proposed smile, changing tooth shape, size, color, and position within the software. The design respects the patient’s facial anatomy and lip dynamics.
• Step 4: Overlay and review. The digital design is overlaid onto the patient’s photos. Patients see a side-by-side comparison of their current smile and the proposed result. Many systems can show a video simulation of the patient talking and smiling with the new teeth.
• Step 5: Approval and refinement. The patient requests changes to tooth shape, shade, or size. The dentist modifies the design until the patient approves. Nothing is fabricated until approval is documented.

The 8-phase smile makeover planning process:

• Phase 1: Initial consultation (60-90 minutes). Discussion of goals, clinical examination, digital photography, and preliminary treatment recommendations.
• Phase 2: Diagnostic records (30 minutes). Impressions for stone models, bite registration, and facial measurements.
• Phase 3: Digital smile design or wax-up (1-2 weeks). Ceramist or dentist creates visual preview of proposed results.
• Phase 4: Patient approval (variable). Patient reviews design, requests changes, and approves final plan. No clinical work proceeds without written approval.
• Phase 5: Mockup in mouth (30-60 minutes). A trial smile is created directly on the patient’s teeth using composite or acrylic to verify the design in three dimensions.
• Phase 6: Treatment sequencing plan (30 minutes). Dentist outlines which appointments occur when, which specialists are needed (orthodontist, periodontist, oral surgeon), and total timeline.
• Phase 7: Financial agreement (30 minutes). Written treatment plan with exact fees, payment schedule, and financing arrangements.
• Phase 8: Scheduling and preparation (1-8 weeks). Appointments scheduled, foundation work (fillings, cleanings) completed, laboratory notified.

What the wax-up reveals that digital design cannot:

• Physical feel of tooth contours. Patients cannot touch digital images. The wax-up allows patients to run their tongue over the proposed tooth shapes to evaluate comfort and natural feel.
• Laboratory skill assessment. The wax-up serves as a resume for the ceramist. Patients can judge whether the ceramist’s aesthetic style matches their preference.
• Mockup fabrication. The wax-up is used to create a clear silicone stent. This stent is then filled with composite or acrylic and placed in the patient’s mouth to create a trial smile directly on their teeth (no preparation required).
• Communication tool. The wax-up provides a physical reference that the dentist, patient, and ceramist can all examine together. This three-way communication reduces misunderstandings.

Tooth preparation step-by-step:

• Local anesthesia administration. The dentist numbs the teeth and surrounding gum tissue. Most patients receive injections around each tooth being prepared.
• Enamel reduction (veneers). Using fine diamond burs, the dentist removes 0.3-0.5mm of enamel from the front surface of each tooth receiving a veneer. This creates space for the porcelain so the final restoration does not look bulky.
• Tooth reduction (crowns). For crowns, the dentist reduces the entire circumference of the tooth by 1.5-2.0mm. This is more aggressive than veneer preparation.
• Margin placement. The dentist creates a slight ledge (margin) at the gumline where the restoration will end. The margin location affects aesthetics and periodontal health.
• Final smoothing. The prepared teeth are smoothed and polished to remove any rough edges.
• Impressions. Digital or physical impressions capture the prepared teeth, adjacent teeth, and opposing teeth. These impressions are sent to the laboratory.
• Temporary restoration placement. The dentist fabricates and bonds temporary veneers or crowns to protect prepared teeth and maintain aesthetics during laboratory fabrication.

Purpose of temporary restorations:

• Protection. Temporaries cover prepared teeth, preventing sensitivity and protecting against fracture.
• Position maintenance. Temporaries hold teeth in their prepared positions. Without them, teeth can shift, and the permanent restorations may not fit.
• Aesthetics. Patients leave with a functional, attractive smile while waiting for laboratory fabrication.
• Patient test drive. This is the most important function. Patients can evaluate the shape, size, color, and feel of their new smile in real life over 2-4 weeks. They can eat, talk, smile, and brush with the temporaries. Any concerns are noted and communicated to the ceramist before permanent fabrication.
• Design refinement. The dentist may adjust the temporaries based on patient feedback. These adjustments are communicated to the ceramist, who modifies the permanent restorations accordingly.

Temporary restoration care instructions:

• Diet modifications. Avoid sticky foods (caramel, taffy, gum) that can pull temporaries off. Avoid hard foods (nuts, ice, hard candies) that can fracture temporaries. Cut food into small pieces and chew on the opposite side when possible.
• Oral hygiene. Brush normally but floss carefully. Slide floss out sideways rather than snapping it out to avoid dislodging temporaries. Use an antibacterial mouthwash to prevent gum inflammation around temporary margins.
• What to do if a temporary comes off. Contact the dentist immediately. Do not try to recement it yourself. Leaving prepared teeth uncovered for even a few hours can cause sensitivity and tooth movement. Most offices have same-day emergency appointments for temporary recementation.
• Expected sensations. Mild cold sensitivity is normal. Moderate to severe pain is not. Contact the dentist if pain increases rather than decreases over time.

Final delivery step-by-step:

• Temporary removal. The dentist gently removes temporary restorations, cleans the prepared teeth, and checks for any decay or irritation.
• Individual try-in (no cement). Each veneer or crown is tried in individually without cement. The patient evaluates fit, color match to adjacent teeth, and shape. Adjustments can be made at this stage by sending restorations back to the laboratory for modification.
• Collective try-in. All restorations are placed together. The patient sees the full smile. The dentist checks contacts between restorations and bite against opposing teeth.
• Shade verification. The dentist checks the shade of the restorations under multiple lighting conditions (natural light, office light, shade-corrected light). The patient approves the final shade.
• Surface treatment. The internal surfaces of the restorations are etched or sandblasted to create microscopic pores for bonding.
• Tooth preparation for bonding. The natural teeth are cleaned, etched with phosphoric acid, rinsed, and dried. A bonding agent is applied and cured.
• Cementation. Resin cement is placed inside each restoration. The restorations are seated on the teeth. Excess cement is removed. A curing light hardens the cement in 20-40 seconds per restoration.
• Final cleaning and polishing. Remaining excess cement is removed with scalers and floss. Margins are polished. Bite is rechecked and adjusted if needed.
• Post-operative instructions. The patient receives written care instructions, a nightguard if prescribed, and follow-up appointment schedule.