Orthodontics can no longer just be concerned with occlusion. Aesthetics are top of mind for patients, and they should be for orthodontists as well. Clear aligner treatment can marry the two. 

By Trevor Nichols, DMD, MS, and Stuart Frost, DDS

The profession of orthodontics is changing at a faster rate than ever before. As a result, patients’ needs are changing. Patients know what they want, and they are expecting us to deliver. Patients have been embracing new technologies and are asking for a clear non-bracket solution, ie, clear aligners, and hoping for better results than ever. Thus, we must grow, adapt, evolve, and reinvent to thrive in today’s world. 

Part of this reinvention includes an expansion of our practice. We must work to obtain excellent clinical results, predictably and consistently, and we must inform our communities of where to go to get these exceptional results. What better way to increase branding than to utilize demanding and innovative technology to obtain superior clinical results? To achieve these goals, we too must demand greatness in the products we use. 

We must hold the belief that we are more than scientists, doctors, and practitioners. We must consider ourselves as artists. We must view the patient as our canvas as we work to create a masterpiece with our skills. Just as an artist creates a vision of his work in his mind, we too should have a vision for the finish before we begin any and every case. We might then ask ourselves, “What is a beautiful finish? What are the characteristics of a stunning smile?”

This article will introduce what we refer to as “The 5 keys to creating beautiful Frost smiles” using the latest in aligner technology, Spark Clear Aligner System from Ormco Corp. Spark Aligners TruGEN material has been proven to provide advanced sustained force retention1 and has 19% better contact surface area with the tooth, which may result in more efficient tooth movement compared to other brands.1 Spark’s TruGEN is more transparent for increased esthetics and scalloped uniquely for enhanced comfort. Truly the best, to create the best. 

Key #1: Midface Support

The traditional approach to orthodontics, with emphasis placed on occlusion, has been challenged. The new approach must include more. It must increase emphasis on aesthetics and facial support and consider aging. The mid-face is the area lying between the bicanthal and oral commissures and is one of the first areas of the face to show signs of aging. The culprit of poor aging is a lack of volume of supporting structures, as the tissues and muscles of the face lose tonicity and as infraorbital fat undergoes herniation. 

As we consider orthopedics for growing individuals, we must also consider what else can be done to increase facial aesthetics. This can include preservation or modification of the mid-face. Preservation would be the choice for patients with optimal mid-face esthetics, such as avoiding extractions and retraction in these cases. It can also involve enhancement for patients lacking support and can even include modification to reduce protrusions. 

Key #2: Treating the Upper Incisor

Traditional orthodontics lead with a focus on the lower incisor position. As we increase our scope, we must now treatment plan focusing on the upper incisor, instead of the lower incisor, to increase smile aesthetics. Goals include 100% incisor display with 1 to 2 mm of gingival show upon a genuine smile. 

Key #3: Arch Width

For us, this is the most important of all keys to creating beautiful smiles. This includes filling buccal corridors and uprighting posterior teeth for a wider, more incredible smile. Here, we work to provide consistent torque transitions from anterior to posterior. The proper flow is created as the central incisors introduce the cuspid, the cuspid introduces the bicuspid, and finally, the bicuspid introduces the molar. These transitions lead to a “flow” of the smile that is recognized across the room with no distractions. 

Key #4: Smile Arc

Smile arc is a hot current topic. Smile arc refers to the positions of the teeth as they arc to the curvature of the lower lip. The ideal smile arc has the maxillary incisal edge curvatures parallel to the curvature of the lower lip, with the central incisor being the longest with a gradual decrease from the lateral incisor all the way back to the molars. The smile arc is anterior and posterior and enhances the flow of the smile. 

Key #5:  Hard and Soft Tissue Contours for a Beautiful Smile

Clearly, a significant component of a beautiful smile includes not only the shape of the teeth but the appearance of the teeth themselves. Therefore, we are constantly picking up the handpiece in our office to correct the shape and contours of the dentition. We use a series of burs and disks to obtain a natural-looking veneer-like appearance for each patient. This is done during and after treatment to reduce black triangles, perfect incisal edges and embrasures, and control line-angles and reflection.

The finishing touch on many of these cases is to perfect the shape and contours of the gums. For this, we recommend the use of a soft-tissue laser. The laser is used to ensure the proper height of teeth, the shape of tissues, the placement of zenith, and the overall aesthetic appearance of the teeth and smile. Topical anesthesia is used for patient comfort, and the laser procedure is performed during the lunch hour. This is a worthwhile procedure to enhance the patient’s smile and your brand.

Many of the unique tools of Spark Aligner’s Approver software allows for enhanced abilityto obtain these results consistently. Examples include requesting a “Damon Arch Form” and smile arc. Furthermore, CBCT integration ensures the most accurate diagnosis. As we utilize the best in technology to provide the best clinical results, we enhance our brand and give the patients a life-changing outcome. 

As we view ourselves as artists and utilize “The 5 Keys,” we can become more as clinicians. We can expand our ability, reach, and influence for good. We can provide more consistent results that become recognizable to the public.

We encourage you to find the artist within! We encourage you to find your keys to beautiful smiles, adopt ours, and strive to improve each day. We thrive as practitioners as we learn, grow, and provide more excellent value, and the same is true for our profession. So let us help one another to help our profession as we provide greatness to the world. OP

Trevor Nichols, DMD, MS, practices at Frost-Nichols Orthodontics in Mesa, Ariz. Nichols attended Arizona State University where he completed a bachelor’s degree and Arizona’s School of Dentistry and Oral health for his doctoral training, certificate in dental public health, specialty training in orthodontics and dentofacial orthopedics and gained a master’s degree while completing research on temporomandibular joint dysfunction.

Stuart Frost, DDS, is a recognized orthodontist, lecturer, educator, and author of The Artist Orthodontist. He is the owner of Frost Orthodontics in Mesa, Ariz, and received his dentistry degree from the University of Pacific and his orthodontics specialty certificate from the University of Rochester.


1. Ormco Corporation. Data on file

Disclosure: Nichols and Frost are paid consultants for Ormco. The opinions expressed are those of Nichols and Frost. Ormco is a medical device manufacturer and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients. (Patient results may vary.)