By Oral & Maxillofacial Surgeon Dr Ali Direnç Ulaşan – Clinical Director & Owner of Milim Dental, Turkey’s first Health Tourism Authorized boutique dental center

One of the most common (and very smart) questions patients ask is:

“How do you actually decide the length and width of my new teeth?”

“Do you just choose a nice shape from a catalogue?”

“What does ‘design’ really mean in dentistry?”

You see terms like “digital smile design”, “smile makeover”, “veneers”, “ceramic crowns” and “implant prosthesis” everywhere online – but rarely a clear explanation of how those teeth are actually planned.

At Milim Dental, we don’t treat design as a filter or a marketing word.

For us, design = a structured, digital, medical planning process that balances:

1. Your face, lips and smile line
2. Your bite, jaw joints and chewing function
3. Your gum levels and bone
4. The materials we will use (ceramic, zirconia, implant-supported bridges, etc.)

In this article, I will answer your question step by step:

1. How do we determine the size and shape of your teeth?
2. What is the role of digital systems like scanners, photos, software and 3D planning?
3. What does “smile design” really mean – beyond Instagram posts?

My name is Dr Ali Direnç Ulaşan, Oral & Maxillofacial Surgeon and owner of Milim Dental – a boutique, specialist-led clinic and Turkey’s first Health Tourism Authorized dental center, located about a 1-hour drive from Sabiha Gökçen Airport.

Every week, my team and I design and deliver complex smile rehabilitations, from implants and bone grafts to ceramic veneers and full mouth reconstructions.

Let’s take you inside that design process.

1. Design Is Not a Filter – It’s a Medical Plan

In social media, “design” often looks like:

1. A quick before/after
2. A hyper-white, identical smile
3. A filter that makes everything look perfect

In real dentistry, design is something very different:

Design is a bridge between your medical needs and your aesthetic wishes.

It is a plan that we build before we touch a single tooth.

A proper smile design answers questions like:

1. How long should your front teeth be to support your lips and smile line?
2. How wide should each tooth be so your smile doesn’t look too “wide” or too “narrow”?
3. How much tooth should show at rest (when you are not speaking)?
4. How do your teeth need to move when you speak and chew – and how will shapes affect that?
5. How can we protect your jaw joints, your implants and your bone in the long term?

So when we say:

“We will design your smile using digital systems.”

what we mean is:

1. We will measure your face, lips, smile and teeth
2. We will simulate changes on a computer
3. We will show you before we do anything permanent
4. We will test the design in your mouth with a temporary phase
5. And only then will we commit to the final ceramic or implant-supported restoration

2. Step One: Understanding You Before Touching Any Tooth

Tooth size is not decided in isolation.

It’s based on you as a whole person, not just a close-up of your mouth.

2.1. Face & Lip Analysis

We begin with:

1. Full-face photographs (front, profile, smile, rest position)
2. Short videos of you talking and smiling naturally
3. Clinical examination of your lips, smile line and how much gum you show

We assess:

1. The midline: does it match the center of your face?
2. The smile arc: does the curve of the upper teeth follow your lower lip line?
3. The tooth display at rest: how much of your upper incisors are visible when you are relaxed?
4. Vertical dimension: does your lower face look collapsed or over-opened?

These details guide tooth length and position.

For example:

1. In a younger smile, a small amount of upper front teeth usually shows at rest.
2. If none of the upper teeth are visible when you speak, the smile can look “aged”.
3. If too much gum shows, we may need to adjust the gingival levels, not just tooth length.

2.2. Bite & Function Analysis

We also look at:

1. How your jaws come together (occlusion)
2. Whether you have crossbite, overbite, or open bite
3. Signs of bruxism (clenching/grinding)
4. Jaw joint sounds or pain

Why does this matter for tooth size?

Because tooth dimensions influence:

1. How much force passes through each tooth and each implant
2. How the lower jaw moves in sideways and forward motions
3. Whether your new teeth will survive years of chewing or break/chip constantly

If we design teeth that only look good from the front but ignore these movements,

we risk creating problems in your muscles, joints, restorations – and even in your implants and bone.

3. Step Two: Digital Records – Scanner, Photos, X-rays and 3D

Once we understand your face and function, we collect digital data.

3.1. Intraoral Scanner – Your Teeth as a 3D Model

Instead of messy impressions, we usually use a digital intraoral scanner:

1. It captures your teeth and gums as a 3D model
2. We can rotate, zoom and measure every angle on the computer
3. This model becomes the base for digital smile design, mock-ups and implant planning

If you have no teeth or only some teeth, we still scan the gums, existing prostheses, and any provisional teeth you may have.

3.2. X-Rays and CBCT – Seeing the Bone and Roots

To design a safe, realistic smile, we must also see:

1. Root positions
2. Nerve canals
3. Sinus cavities
4. Bone height and width

So we take:

1. A panoramic x-ray
2. Often a CBCT (Cone Beam Computed Tomography) – a 3D x-ray of your jaws

This is crucial for implant and bone graft planning:

1. How big should the implant crowns be?
2. Where can we place implants to support them?
3. Do we need sinus lifting or other bone augmentation?

Tooth size is therefore not just about aesthetics – it is tied to implant positions and bone realities.

4. Step Three: Digital Smile Design – Turning Data into a Plan

Now comes the part most patients are curious about: digital design software.

4.1. What Is Digital Smile Design (DSD)?

Digital Smile Design (DSD) and similar systems are software tools that allow us to:

1. Overlay your photos and 3D scans
2. Draw reference lines (midline, smile line, facial proportions)
3. Choose tooth shapes and sizes from digital libraries
4. Adjust length, width and angulation live on the screen
5. Simulate how the new teeth will look in your face

Think of it as architectural software for your smile.

Just as an architect uses 3D software to plan a building before construction,

we use digital smile design to plan your teeth before we prepare or restore them.

4.2. How Do We Decide Tooth Size in Software?

We use a combination of:

1. Proportion rules
2. Central incisors often set the “scale” for the smile
3. Width-to-height ratios (not too square, not too rectangular)
4. “Golden proportion” concepts as a starting point – but always customized
5. Facially driven design
6. The midline aligned with your facial midline
7. Tooth length adjusted to your lip line, speech and age
8. Lateral incisor and canine shapes tailored to gender, personality and preferences
9. Functional constraints
10. Space available between jaws
11. Implant angulation and position
12. Avoiding over-length that would create overload on bone and implant fixtures

We literally drag and adjust digital teeth until they match:

1. Your face
2. Your function
3. And our clinical principles for long-term stability

Then we show you these simulations and discuss:

1. Colour options
2. Shape preferences (more rounded, more square, softer, more characteristic)
3. Levels of “brightness” vs natural translucency

This is where “design” becomes a dialogue between you and our team – not a one-way decision.

5. Step Four: From Digital Design to a Real-Life Test (Mock-Up)

A major advantage of using digital systems is that we can test-drive your new tooth size before committing.

5.1. Printed or Milled Models

Once we are happy with the digital design:

1. We convert it into a physical model – either 3D-printed or milled
2. We create a mock-up (temporary version) that can be placed over your existing teeth or gums

5.2. The Mock-Up in Your Mouth

We then:

1. Place the mock-up onto your teeth or implants with a temporary material
2. Ask you to smile, talk and move your lips
3. Take new photos and videos

You can tell us:

1. “I like this length.”
2. “These two teeth feel too long when I speak.”
3. “I want the edges a little softer.”

We prefer to make these adjustments in the mock-up phase, when changes are easy, rather than after final ceramic or zirconia is made.

This test phase is especially important if:

1. We are rebuilding your bite on implants after bone grafts
2. We are changing your vertical dimension (how open your bite is)
3. You have TMJ issues or a history of clenching

6. Step Five: Finalizing Tooth Dimensions for Different Treatments

Tooth size and design principles are applied differently depending on the treatment type.

6.1. For Veneers and Ceramic Crowns on Natural Teeth

With veneers and crowns, we must respect:

1. Remaining enamel and dentin thickness
2. Pulp (nerve) position
3. Existing tooth axis

We design tooth size so that:

1. We remove the minimum amount of tissue needed
2. The margin placement is healthy for the gums
3. The bite remains balanced

The digital plan is sent to our ceramic technicians, who craft each veneer/crown with:

1. Correct length, width and contour
2. Subtle surface texture (so it does not look like plastic)
3. Colour layering that mimics natural teeth, not opaque blocks

6.2. For Full-Arch Implant Bridges (All-on-4 / All-on-X)

In implant-supported bridges, tooth dimensions must be coordinated with:

1. Implant positions and angulations
2. Underlying bone grafts
3. Prosthetic materials (zirconia, titanium framework, hybrid acrylic, etc.)

Here, tooth size affects:

1. Load distribution on each implant and bone graft
2. Cleanability (how you will brush and use special floss/brushes)
3. Speech (especially “S” and “F” sounds)
4. Lip support and facial aesthetics

Digital design allows us to:

1. Adjust incisor length to support the lip
2. Ensure there is enough space for cleaning underneath the bridge
3. Avoid excessively long teeth that would put implants and bone at risk

6.3. For Orthodontics and Clear Aligners

Even in non-prosthetic cases (braces or clear aligners like aligner systems), tooth size matters.

1. Some patients have small teeth with gaps
2. Others have large teeth in a small arch

Digital systems allow us to:

1. Measure each tooth
2. Predict the final tooth arrangement
3. Combine orthodontics with additive bonding or veneers in a controlled way

Again, design = planning how tooth dimensions will interact with jaw size and facial features.

7. Why a Surgeon-Led, Multidisciplinary, Boutique Clinic Matters for Design

You might wonder:

“Can’t any clinic just buy software and say they do digital smile design?”

Technically, yes.

But the value of digital tools depends completely on who is using them and how decisions are made.

At Milim Dental:

1. I lead the planning as an Oral & Maxillofacial Surgeon with deep understanding of bone, implants, grafts and jaw function
2. We sit together as a multidisciplinary team:
3. prosthodontists (restorative and aesthetic dentistry),
4. orthodontists,
5. periodontists (gum specialists),
6. endodontists (root canal specialists)
7. We are a boutique clinic, intentionally seeing fewer patients per day so that:
8. Each design gets the time it deserves
9. Each patient can ask many questions and understand their plan

Being a Health Tourism Authorized center also means:

1. We are set up to treat complex international cases safely
2. We are used to combining digital design with implant and bone graft procedures in structured phases
3. Our location (about 1-hour drive from Sabiha Gökçen Airport) makes it practical to integrate treatment with travel

Digital systems are powerful –

but only when combined with clinical judgement, experience and honest communication.

8. Design as a Conversation – Not a One-Click Filter

The most important thing for you to know is this:

Design is not something we “do to you”.

It is something we create with you.

Throughout the process, you are invited to:

1. See your photos and 3D models
2. Understand why we suggest certain tooth lengths and shapes
3. Share your preferences, fears and expectations
4. Approve the mock-up before we move to the final restorations

We do not believe in:

1. Copy-paste “Hollywood smiles”
2. Extreme whitening that looks artificial
3. Over-drilling healthy teeth to fit a uniform template

We believe in:

1. Facially driven design – your face tells us what your smile should be, not a marketing trend
2. Functionally protected design – your jaw joints, implants and bone must be safe
3. Biologically respectful design – preserving as much natural structure as possible

9. In Summary: How We Set the Size of Your Teeth

When you ask:

“How do you decide the dimensions of my teeth?”

our answer is:

1. We start with you – your face, lips, smile, bite and personality.
2. We collect digital data – scans, photos, x-rays, CBCT.
3. We use digital smile design software to plan tooth size and shape in harmony with your facial proportions and functional needs.
4. We test the design with a mock-up in your mouth before anything final is made.
5. We coordinate tooth dimensions with the type of treatment you receive – veneers, crowns, implant bridges, aligners – always considering bone, implants and grafts where relevant.
6. We implement the design through a multidisciplinary, surgeon-led, boutique team, not through a rushed, high-volume process.

Digital systems do not replace the dentist.

They enhance our eyes and minds, allowing us to plan more precisely, communicate more clearly, and give you more control over the outcome.

If you are thinking about veneers, crowns, full-arch implant bridges, or a complete oral rehabilitation and you worry:

1. “Will they just make my teeth too big?”
2. “Will I look fake?”
3. “Will it feel uncomfortable?”

then the next step is not to trust a filtered before/after.

The next step is to sit down with a team that can show you, in digital detail, what design really means in your case.

At Milim Dental, that is exactly what we do –

every design, every day.