I see courses daily advertising smile design; I see programmes sold to aid smile design, but what exactly is smile design and is it that easy?
So I will take you back to 1993 – the year I qualified from Manchester University with BDS (Hons), and I fitted some crowns/veneers, which was my knowledge of smile design. I knew I should listen to the patient, I should take photographs, I should take models of the teeth, I should articulate the bite, and I should consider not only the hard tissue (the teeth) but the soft tissues (the gums and the lips) also – so in reality all those factors are still considered.
However, now the demand for a ‘smile design’ is much more common, and the technology used to create an ‘artificial simulation’ is easy see Smile Cloud, 3 Shape and other programmes. It is relatively simple when on a computer anyway. However, dentists forget that to produce that simulation; you also need the experience and vision of how that virtual smile is to be created.
So back to 1995 and beyond – how did I learn smile design in practice?
I learned what I could simply through practising, recognising my strengths and learning from when things went wrong. For example, I could eyeball ‘a centre line’. I could visualise ‘golden proportion’, and even today, I still pick up my pencil and draw to communicate to my technician the shape of the teeth myself and the patient have decided upon – it is called practice.
So smile design, in my experience, is about strategy; it’s about ‘saving’ teeth or tooth structure where you can by minimally drilling’. It’s about accepting, in most cases, the occlusion and ensuring that a conservative approach is applied, so veneers and crowns don’t fracture, the midline does not open as incisal guidance is incorrect, and most of all, the patient is comfortable.

In all clinical cases, I begin by taking photographs. I explain to the patient about colour, shape and proportion length. I explain if I see a misproportion of the lips, a high smile line or no buccal corridors. I explain this to the patient in simple language.
We then discuss how we will achieve this, the cost, the risks and most of all, the longevity – even teeth don’t last forever.
We then often go to a prototype. For example, those teeth that click in or are made of PMMA – it’s a cheaper, robust material that can provide a trial before you finish.
It’s then down to material, the finishing touches. Do they want a ‘youthful smile’ with natural transparency and a little veneer?
Do they want a particular colour?
Do they want a straight smile or, as God provides, a little character?
After all that, the smile design finishes with the fit.
All of these cases went through the following:
- A consultation with photos and x-rays
- Consent – explained all
- Procedure and preparation – we drill when we have to
- Temporisation – temporary restorations fitted
- Finish – final restorations fitted.
At the end of it all, a ‘virtual smile’ becomes a ‘real smile design’.
The result is a happy patient, and a smile customised to them.






At Tracey Bell, we design, create and fit smiles daily, but it is never as easy as it looks. Virtually – preparation, strategy, delivery and practice – all 28 years of it!
It makes it a ‘tad’ easier.
Back to blog