Visagism: An Essential Concept in Esthetic Dentistry

Introduction

Every person has a unique personality, and the same is true of their smile. As it is rightly said by David Hume, “Beauty exists in the mind that contemplates them”. Every mind views beauty differently, just as every culture and ethnic group does. A smile improves a person’s social acceptability and innate characteristics of human social interaction is enhanced by smile.¹

Smile serves as the most prevalent way for people to express a range of emotions. Dental professionals have been attempting to harmonise tooth shapes based on characteristics like gender, age, and personality, for many years. The most accurate predictor of someone’s uniqueness is their personality. A more realistic appearance can be achieved by tailoring the smile to the individual’s personality and behaviour as opposed to basing it solely on mechanical considerations like face size and shape.²

Before beginning any aesthetic procedure, a thorough, systematic dentofacial examination is required. Numerous factors, such as socioeconomic, regional, and cultural differences can have a significant impact on facial aesthetic perception.³

There are various aesthetic dentistry guidelines available around the world. These rules or concepts determine whether a smile is attractive, ordinary, or unappealing.³

In today’s competitive society, having a good appearance can frequently mean the difference between success and failure in both our personal and professional lives. Globalization and modernization are taking place inevitably as a result of the expanding world population. Men and women both feel self-conscious about how they look. In order to develop their personalities, today’s generation places a high value on aesthetics in every aspect of their lives. As technology develops, more people are curious about how dentistry can help them enhance their smiles. The goal of aesthetic or cosmetic dentistry is to balance form and function with the preferences and needs of each patient. Corrections to the jaw and changes to the facial profile are also included in the field of aesthetics. In general, aesthetics is crucial for increasing one’s self-confidence. Cosmetic dentistry is a blessing to mankind, transforming smiles in a beautiful way. Everyone wishes to be recognised by others, and dental aesthetics makes this possible.⁴

The “art and science of dentistry” are combined in aesthetic dentistry. A clinician can produce outstanding aesthetic and functional results by combining their technical and artistic abilities. The dental team must comprehend the pertinent principles, particularly those of smile design, and be aware of the various interdisciplinary treatment modalities available in order to practise successful aesthetic dentistry. Additionally, they ought to be knowledgeable about the various aesthetic materials available, as well as their clinical applications, restrictions, and limitations.⁵

Furthermore, achieving the objectives of aesthetic dentistry, such as patient satisfaction and avoiding unaddressed, potentially unrealistic expectations, requires effective communication between members of the dental team, the dental technologist, and, most importantly, the patient. These components all work together to support and lay the groundwork for successful aesthetic dentistry.⁵

The term “smile design” describes the numerous scientific and artistic ideas that, when put together, can produce a stunning smile. These guidelines are supported by patient information, diagnostic models, dental research, scientific measurements, and fundamental aesthetic principles.⁶

Smile

In the literature, smile is classified into two types: social smile and spontaneous smile (Figure 1A, 1B).⁷

The social smile is also known as the conscious smile, the posed smile, or the forced smile, while the spontaneous smile, has also been referred to as the Duchenne smile (Figure 2) or the smile of joy.⁷

A spontaneous smile happens only under certain emotions, unlike a social smile, which is strongly influenced by the emotional state of the individual.⁷

Duchenne smile (Figure 2B) marks a sincere sign of joy and reminds us of crow’s feet that appears at the corners of the eye. Its consistency is fairly high, whereas the reproducibility of the social smile is higher.⁷

Personality

The term ‘Personality’ was derived from the word ‘persona’ nearly 2000 years ago. Persona literally means “outer covering” or “mask,” referring to the costume worn by stage actors at the time.⁸

A person’s personality is defined by how meticulously he/she behaves under various life circumstances. It demonstrates a person’s potential to act or react in a range of perspectives, considerations, moral principles, and behaviours. It addresses patterns of behaviour, perceptions, and feelings. It affects social ties, the workplace, one’s career, and one’s self-esteem.⁹

Combining factors like shape, texture, colour, and how the teeth are arranged, the four dimensions of smile such as biology, structure, function, aesthetics, and the fifth dimension, which is personality, come together to amalgamate, thus creating the ‘unity of the entire concept’.¹⁰

It incorporates the person’s personality and emotional state to create a distinct new smile design. It can be done digitally or using analogue techniques.¹⁰

The fifth element is fundamental because the other four elements act as a keystone to balance it.¹⁰

Hippocrates proposed a number of temperaments, which will be discussed more in detail in a later section of the article as factors to consider when assessing personality.^11,12

“Big 5’’ Personality Traits

Many modern personality psychologists believe that there are five basic dimensions of personality, which are commonly referred to as the “Big 5” personality traits. Extraversion, agreeableness, openness, conscientiousness, and neuroticism are considered as the five primary personality traits.^11,12,

Personality trait theories have long attempted to quantify the number of traits that exist. Earlier theories proposed various numbers. Gordon Allport’s list, for example, included 4,000 personality traits, Raymond Cattell had 16 personality factors, and Hans Eysenck proposed a three-factor theory.¹¹

Many researchers thought Cattell’s theory was overly complicated, while Eysenck’s was too narrow in scope. As a result, the broad characteristics that act as the foundation for personality development are referred to as the “Big 5 personality traits.”¹²

It is worth noting that each of the five primary personality traits represent a golden mean between two extremes. Extraversion, for example, represents a continuum between extreme extraversion and extreme introversion. In reality, most people are somewhere between the two extremes.¹²

While there is a substantial body of research supporting these primary personality traits, researchers do not always agree on the precise labels for each dimension.

These five characteristics are typically described as follows:¹²

Openness

This personality trait includes traits like imagination and insight. Individuals with high levels of openness are associated with a variety of interests, are more adventurous and creative.¹²

Conscientiousness

This personality trait is distinguished by high levels of thoughtfulness, good impulse control, and goal-directed behaviours.¹²

They deliberately plan ahead, take other people’s feelings into account, and keep track of deadlines.¹²

Extraversion

Extraversion is a personality trait that is characterised by excitability, sociability, talkativeness, assertiveness, and a high level of emotional expressiveness.¹²

People who are introverted or have a low level of this personality trait are more reserved. Social gatherings can be exhausting for introverts who frequently require solitude and quiet in order to “recharge.”¹²

Agreeableness

Trust, selflessness, kindness, affection, and other prosocial behaviours are examples of this personality trait.¹²

High agreeableness tends to render individuals more cooperative, while low agreeableness makes people more competitive and occasionally even manipulative.¹²

Neuroticism

Neuroticism is characterised by sadness, irritability, and instability of emotion. The more stable and emotionally strong a person is, the lower their level of this personality trait.¹²

Relationship between temperament and tooth morphology

A person’s personality, according to Hippocrates, is formed by a unique combination of four temperaments.^13,14

1. Choleric/strong

2. Sanguine/dynamic

3. Melancholic/sensitive

4. Phlegmatic/calm

Paolucci et al. proposed the idea of combining aesthetic smile designs with the four temperaments.¹³

The temperament of each individual is associated with the morphology of face.^13,14

Cholerics: Individuals with strong/choleric characteristics exhibit deep set eyes and a rectangular facial structure, have attributes of leadership and bravery. These people are known for their fearlessness.¹⁵ The maxillary anterior teeth in these individuals are positioned with their long axes perpendicular to the horizontal plane, with visually dominant rectangular central incisors, and vertical canine position. Radial symmetry is evident in the choleric/strong design. The maxillary arch is mostly rectangular (Figure 3).¹⁴  

Dynamic/Sanguine: Individuals of this personality are outgoing, communicative, enthusiastic, and dynamic and they have an angular facial shape with slanting lines highlighted around the forehead and eyes, a prominent nose, and a wide mouth, and is an extrovert and communicator in general.15 The maxillary anterior teeth are positioned with their long axes slightly inclined distally, with discrete radial symmetry. The central incisors are usually triangular or trapezoidal, and the canine labial aspect is straight and palatally inclined. The maxillary arch is primarily triangular (Figure 4) or polygonal in shape.¹⁴

Sensitive/ Melancholic: Melancholics are organised, perfectionists, timid, and reserved. These individuals have an oval face and close-set eyes with softened line angles, and are distinguished by tenderness and delicateness. Gentleness and abstract thinking characterise this personality.¹⁵ The maxillary anterior teeth have rectilinear or distally inclined long axes and discrete radial symmetry. The central incisors are typically oval in shape, whereas the labial aspect of the canines is curved and inclined medially. The maxillary arch is mostly oval (Figure 5).¹⁴

Phlegmatic/peaceful: Persons with this personality have a round or square face, protruding lower lips, and heavy eyelids, and are polite, diplomatic, calm, mystic, spiritualized, and discreet.¹⁵ This design consists of maxillary anterior teeth with long axes perpendicular to the horizontal plane, with the exception of the canine, which may be slightly rotated sideways. There are no dominant group of teeth. Horizontal symmetry is present, typically with diastema in a wide arch. The central incisors are typically square and small, whereas the labial aspect of the canines is curved and vertically positioned. The maxillary arch is typically round (Figure 6).¹⁴

In Prosthodontics, Dentogenics concept offers a method of aesthetics that enables the dentist to design a restoration that complements the patient’s personality. This idea takes into account the patient’s gender, age, and personality to restore the dignity and distinctive individuality that have been sorely lacking in far too many prostheses.¹⁶ The dynesthetic and dentogenic concept produces a prosthesis that is more aesthetically pleasing and natural-looking, which is something that patients not only want but also deserve.¹⁶

Discussion

Visagism: An often-overlooked concept in dentistry People from all walks of life are becoming increasingly interested in aesthetic treatment. In order to provide the patient with the most harmonious smile possible, we present Visagism, the most underappreciated idea that is actually very important to aesthetics.¹⁴

Visagism is a cutting-edge idea that enables dentists to create smiles that are more natural, acceptable to patients, and provide patients the chance to have a beautiful smile. It recognises that, like a person’s fingerprint, every individual is absolutely unique. This concept emphasises the individual’s unbiased personality in order to craft the million-dollar smile that everyone aspires to have.^14,15

The concept is noteworthy since it emphasises each person’s unique characteristics. It has been more than 60 years since French hairstylist and cosmetic artist, Fernand Aubry invented this idea.¹⁴

It is derived from the French word, visage meaning the ‘face’ and the concept of Visagism was eloquently articulated by the artist Philip Hallawell.¹³

Visagism aims to improve the patient’s flaws while highlighting the positive aspects of their unique personalities. Dr. Braulio Paolucci has incorporated the concepts of dental visagism and has combined the traditional ideals of psychology, anthropology, and visual arts into the patient’s smile design.^13,14

The concept of Visagism is the product of personality, tooth morphology, patient desires, and physical appearance. A harmonious synchronization and blending between these elements is a challenge to the clinician; nevertheless, once achieved will leave the patient pleased with the smile. The patient has the chance to take part in the design of his or her smile, facilitating a predictable outcome.^13-15,17,18

Dental Visagism renders the opportunity to customize the smile for every individual based on the personality traits of the individual.^13-15,17,18

Why Visagism?

Although there are many techniques to assess personality, psychologists tend to concentrate on personality traits.¹⁹

Using this idea, the dentist may construct an aesthetically pleasing smile that matches the patient’s disposition by fusing artistic creativity and scientific discernment with the dentofacial complex.¹⁴

Due to mismatch between the patient’s smile design and personality, the patient may feel as though the restored teeth do not belong to him or her, therefore the final aesthetic outcomes should never undermine the patient’s expectations.¹⁴

In order to get outcomes that are trustworthy and predictable in all respects, physicians have been working for decades to align the forms of the teeth with the entire face depending on prospective characteristics such as gender, age, and personality.¹⁴

The clinician is not only confronted with the challenging task of interpreting the patient’s personality traits, emotions, and desires, but also with the ongoing challenge of incorporating these factors into the parameters of smile design.⁶

Pathway to achieve Visagism

Questionnaires with in depth interviews, photographic analysis and high-tech sophisticated software are the approaches used to achieve the concept of Visagism.¹⁷

Questionnaires

In order to evaluate the temperament of the individual, it is important to formulate a questionnaire that will cover all the aspects that will lead to the assessment of the persons temperament.¹⁷

The questions are framed based on the following aspects (to name a few): confidence, provocation to a situation, enthusiasm, agitation, weakness, etc.¹⁷

The options for response are ‘yes’, ‘no’, or ‘uncertain’. The affirmative responses are assessed, and the temperament with the highest score from the list of options provided at the end of the questionnaire is identified. It is then interpreted that the subject was best suited to that particular temperament with the highest score.¹⁷

Photographic analysis

To determine the shape and long axis of the maxillary central incisors as well as the connection line of the embrasures between the central and lateral incisors, the photographs are evaluated on a computer using software. The outcomes thus obtained for each subject are compared with that subject’s temperament type.¹⁷

Based on this idea, it was intended for a photographic study to discover:¹⁷

1. The relationship between temperament and tooth morphology

2. The orientation of each temperament’s maxillary anterior teeth’s long axis with respect to the horizontal plane

3. The lines that connect the lateral and central incisors of the maxilla in each temperament.

Utilizing computer software, the photographs were analysed to determine the shape, long axis of the maxillary central incisors. The outcomes thus obtained for each subject were compared with that subject’s temperament type.¹⁷

Software

There are currently two software’s available to incorprate the concept of Visagism, namely Visagismile and Rebel software ^10,18

a) VisagiSmile

It is a software for cosmetic dentistry that automates the dental Visagism theory and is based on the facial analysis, face map selection, and automatic classification of the face into strong, dynamic, delicate, and calm, thereby enabling the calibration of the image.¹⁸

A sophisticated programme called Visagismile takes into account a variety of factors, including considerations for personality tests, facial type analysis and calculation of the tooth configurations.¹⁸

The solution is to create a software programme that does all the calculations automatically, eliminates subjective judgement, and displays the ideal tooth configuration in a matter of minutes.¹⁸

The patient’s personality is ascertained from the questionnaire/interview, and the software then suggests the design of teeth that is customised for each patient based on their preferences and is matched to the patient’s photo.¹⁸

The requirements for the software are constantly changing as a result of ongoing research on the Visagism concept.

b) Rebel software

Rebel software is an artificial intelligence-based programme that enables simultaneous generation of stereolithography (STL) files of digital wax models.¹⁰

Software for creating a customised smile that takes into account the patient’s personality, biologic, structural, functional, and aesthetic parameters to create a three-dimensional smile^.10

The Dellinger and Eysenck personality tests give insights about the patient’s personality and enables the dentist to directly feed the data into the software and patients preferences, personality and the facial analysis is formulated into a mathematical formula wherein the 2D image is designed and transformed into a 3D smile design.¹⁰

Including the patient’s personality in the design of the smile will enable clinicians to offer patients new smiles that reflect them holistically.¹⁰

It is considered to be an online facility that produces three-dimensional, custom smile designs.

Conclusion

Smile is an essential tool that seems to be ingrained in the DNA of every individual In order to accentuate the essence of smile, it is absolutely essential to correlate and incorporate personality traits while crafting a smile that eventually blends with the nature of the person, thereby boosting patient satisfaction. The best way to convey the magic in your smile is to emphasise the significance of the concept Visagism. Visagism enables to construct an integrative framework for advancing smile science. The Duchenne smileis reflected once the smile is designed and blended with the personality of the individual and that’s exactly what the dentist strives to achieve via Visagism.

Smile is the beauty of soul, and personality is the blueprint of the soul, and amalgamation of both the virtues (smile and personality) is achieved through the concept of Visagism.

Conflict of Interest

None