How to Evaluate Cosmetic Dental Work You Already Have — The ACE Smile Index Self-Test
Stage 3 of three: a retrospective self-test for cosmetic dentistry you ALREADY have. Ten patient-translatable criteria from the ACE Smile Index — what to look for in your finished work, what counts as a passing grade, what is fixable. (Stage 1: clinic selection. Stage 2: consultation questions.)
Most patients evaluate their cosmetic dental work by looking in the mirror and asking one question: do I like it? That's a good starting point. It's not a good finishing point. Cosmetic dentistry is partly aesthetics and partly biology, and some of the most consequential things about a restoration — how the material ages, whether the bite still works, how much tooth the work cost you — are invisible in a selfie.
I published the ACE Smile Index in 2023 under Creative Commons — a 10-criterion clinical framework, open for anyone to use, adapt, or argue with. It's written for professionals. But nine of its ten criteria translate cleanly into questions a patient can ask themselves, or their dentist, about any piece of cosmetic dentistry they're considering or already carrying.
This article walks through those ten questions. It won't make you a clinician. It will, in about eight minutes, make you a substantially more informed patient.
CRITERION 1 — CANDIDACY. Was this the right treatment for your case? A full-mouth porcelain makeover is a powerful aesthetic tool. It's also the wrong tool when the case would have responded to orthodontics, bonding, or simple whitening. A clinician who proposes veneers for every cosmetic consultation is failing the first and most important criterion. Ask: 'If I hadn't asked for veneers, what would you have recommended for this case? And why did you change that recommendation to veneers?' A good answer references your specific situation. A weak answer references what you asked for.
CRITERION 2 — TRANSLUCENCY. Do the teeth look like teeth in daylight? Natural enamel is semi-translucent. Light passes through the incisal third, catches the edge, and does something a photograph can't quite capture. Veneers made with fully opaque ceramics block that light. In studio lighting they look fine; in daylight they look like dentures. Step outside into bright shade. Look at your incisal edges in a mirror. Is there any translucency there, or is the edge a solid colour? A well-made veneer has a soft translucent halo at the incisal edge. A high-volume one doesn't.
CRITERION 3 — PROPORTION. Width to length, tooth to tooth, midline to face. The widest part of a natural central incisor is about 75–80% of its length. The two central incisors match each other closely but not perfectly. The midline between them usually sits slightly off the facial midline — noses are rarely centred. Take a macro photo of your central incisors and measure the width-to-length ratio. If every tooth is the same length and perfectly symmetrical, the work is failing criterion 3.
CRITERION 4 — CHARACTERISATION. The imperfections that real teeth have. Real teeth have horizontal enamel lines, subtle stains, slight surface texture, minor asymmetries. A uniformly bright, glass-smooth, perfectly matched set of teeth is the signature of volume veneer work. Ask the ceramist — not the dentist, the ceramist — if they characterise the work. If you can't speak to the ceramist, ask why.
CRITERION 5 — MARGINAL INTEGRITY. Where the ceramic meets the tooth. The margin is the interface between your natural tooth and the ceramic. A margin under 20 micrometres is invisible to the eye. A margin over 50 micrometres collects plaque and becomes a long-term problem. Ask: 'What was the marginal fit on my restorations? Can I see it under microscopy?' A lab that measures margin fit will show you. A lab that doesn't measure will change the subject.
CRITERION 6 — COLOUR STABILITY. At one year, five years, ten. Different ceramic materials age differently. Hand-layered feldspathic porcelain holds its colour well for 15+ years under normal conditions. Lithium disilicate (IPS e.max) is very stable. Some zirconia layering systems are not. Ask: 'What material was used on my case, and what's the documented colour stability over time?' A serious clinician answers with specifics. If the answer is 'don't worry about it', worry.
CRITERION 7 — MATERIAL INTEGRITY. Chip resistance, fracture toughness. Every ceramic has a failure threshold under bruxism, acidic diet, or impact. Feldspathic porcelain fractures under certain loads that lithium disilicate will survive. Zirconia is extremely strong but loses aesthetic translucency. Ask: 'Given how I use my teeth — do I grind, do I play contact sport, what's my diet — what material balance is right for my case?' A generic answer ('we use the best ceramic') is not engaging with your case.
CRITERION 8 — OCCLUSAL HARMONY. Does the aesthetic outcome still let you bite? This is the most commonly skipped criterion in high-volume veneer work. Beautiful veneers that change your bite to something uncomfortable are a clinical failure regardless of how they look. Ask: 'Were my veneers checked on an articulator? How?' If the answer doesn't include the words 'articulator' or 'occlusal check', the work isn't passing criterion 8 by design.
CRITERION 9 — CONSERVATION. How much enamel did the work cost? Enamel is finite. Remove it, it doesn't grow back. Minimally prepared veneers cost you 0.3–0.5 mm of enamel. Heavily prepared ones cost you 1 mm or more — after which the tooth is committed to a lifetime of crowns. Ask: 'How much enamel was removed for my case, in millimetres?' If the dentist doesn't know the answer or waves it off, criterion 9 was failing before the first drill touched the tooth. This criterion is why minimal-prep is the ACE DNTL default where biology permits.
CRITERION 10 — PATIENT ALIGNMENT. Did you get what you understood you were getting? Criterion 10 is a consent criterion. Did the pre-treatment preview (Digital Smile Design, wax-up, try-in) match the final result? Was there anything about the delivered outcome that surprised you? Looking at your pre-treatment photos and your post-treatment photos, does the post version feel like the natural endpoint of the preview you were shown, or does it feel different in some way you didn't agree to? If the latter, criterion 10 is failing. Patient alignment is often where communication between clinician, ceramist, and patient breaks down.
How to use this list: take it to a consultation before you commit to treatment. Ask the ten questions. Watch which ones get specific, confident answers and which ones get hand-waves. A clinician who engages with all ten — particularly 5, 6, 7, 8, 9 — is operating against a written standard. A clinician who waves most of them away is operating against a private one, and you don't know what it is. If you already have cosmetic work, run the list retrospectively. The failures (if any) are not usually catastrophic — most issues are correctable with revision or refinement. But you deserve to know which criteria your work is passing and which it isn't.
Why publish this openly: the ACE Smile Index is released under Creative Commons BY 4.0 — anyone can use it, adapt it, cite it, or critique it. DOI: 10.5281/zenodo.19634136. The full framework, with scoring scales and clinical rationale for each criterion, is open access. The decision to publish wasn't commercial. Private clinical heuristics exist in every serious cosmetic practice — writing them down so they can be argued with is how standards actually improve. If a better framework exists, I'd like to read it.
Direct Answers
- Can I use the ACE Smile Index myself without clinical training?
- The full framework is published for professionals, but the ten questions in this article are written for patients. You can run them during consultations or retrospectively. You won't be able to score every criterion like a clinician would — some (marginal integrity, occlusal harmony) require examination tools — but you will be informed enough to have a substantive conversation.
- What if my current dentist dismisses these questions?
- That's a data point. A clinician operating against a written clinical standard welcomes questions about how their work maps to that standard. A clinician operating against a private heuristic often finds the questions annoying. You're paying for both the aesthetics and the clinical thinking — you're entitled to see the thinking.
- Is the ACE Smile Index used outside ACE DNTL?
- It's released under Creative Commons — anyone can use or adapt it. It was published in 2023 and sits on Zenodo (the open-access repository operated by CERN). Adoption by other practices isn't tracked centrally, but the framework is free to use.
- Where can I read the full framework?
- DOI: 10.5281/zenodo.19634136 — open access, Creative Commons BY 4.0, no account needed. The framework is also explained page-by-page at acedntl.com/ace-smile-index.