12 September 2007Irish Dentist

View from the bench

I’ve never seen Jesus ChristSuperstar, so I can’t be sure,but I suspect when the chorussings ‘What’s the buzz? Tellwhat’s a-happening’, theyaren’t referring to cosmeticdentistry.

However, if they were theanswer would definitely be‘smile design’. Pick up anydental magazine or look atany one of the 17,000,000websites a Google search willkick up and you’ll see therecertainly is a buzz about smiledesign.

So, what is smile design?Until recently, with theadvent of televisionmakeover shows, it was justwhat we know as bestpractice cosmetic treatmentplanning. Your laboratoryshould be able to help makethis process successful andstress-free for you and yourpatients.

There are umpteensolutions to the misaligned,discoloured and missingteeth that your patients maypresent before you at yoursurgery, and it’s yourresponsibility to talk themthrough the options so they

understand what is and isn’tpossible.

Your lab should be able toprovide you with literaturefrom their suppliers withglossy before and after shotsof successful cases using theirproducts, although you mayprefer to go to an impartialwebsite such as The BritishAcademy of CosmeticDentistry (www.bacd.com),which has plenty of caseexamples.

Many of my clients find aMasterpiece Study Model agreat communication aid.With examples of all thedifferent types of crowns,bridges and veneers we offer,if the patient can actually seethe product, the surgeon canquickly and easily explain thedifference between an all-ceramic and a bonded crown,or demonstrate a veneer or aMaryland bridge.

Once the patient is awareof what is available and howmuch it will cost, it’s time toget the lab involved in all butthe simplest cases.

Impressions for studymodels and, ideally,photographs are dispatched to

the lab, while you begin anypreparatory treatment such asperio work, gingivaladjustment and especiallyteeth whitening; pleaseremember finished ceramiccrowns can be darkened withstain but not lightened.

Once the models have beencast and duplicated your labshould contact you to discusswhat you are hoping toachieve before going on tomake a diagnostic wax-up.

This can be trimmed oradded to by you to get exactlythe effect that you and thepatient are looking for. Withmodern light-cured waxes,veneer wax-ups with minimalpreparation can even be tried-in. A soft, clear suck-downsplint can be made over thewax-up, giving you a stentguide for the space you arecreating during preparationand a mould for temporary/provisional crowns andbridges. These have the added

advantage of giving thepatient the chance to get usedto the approximate shape andsize of the finishedrestoration.

There is one final stepbefore you start prepping theteeth – check that the patienthasn’t got a major holiday,wedding or movie screen testplanned for the next fortnight.This might sound bleedin’obvious, but the number oftime I have ended updelivering cases to dentists’homes at midnight because apatient has forgotten tomention their daughter’swedding the next week aren’tthat rare and normally involvean express fee!

So, that’s what I think of assmile design: dentist andtechnician working togetherto give the patient theinformation to choose atreatment and smile theycan be happy with for thenext 20 years.

In the first of a series of six, dental technician Peter Wagon explores the meaning of smile design,and how dentists can work with technicians to provide their patients with the best possible aestheticand functional results

Peter can be contacted at Associated Laboratories Ltd, DayLewis House, 324 Bensham Lane, Croydon, Surrey CR7 7EQ,England; tel: +44 (0) 20 8689 2905; email: allden@aol.com;web: www.theteethpeople.co.uk.

View from the bench

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