It’s not all just about a cosmetically pleasing results. Rahul Doshi has explained what other things you need to consider when embarking upon an aesthetic procedure
Achieving success when dealing with restorative cases in a premium practice can tip the boat in different ways depending on a patient’s requirements or expectations. It can be only too easy to focus entirely on the aesthetic changes driven by patient demand. This can mean that the planning concentrates solely on a cosmetically pleasing result. This way of planning can be plagued with repeated failures and loss of future patient confidence in the treatment itself. In my opinion, to achieve success when treating cosmetic cases there are three essential aspects that integrate with each other and should be considered thoroughly when treatment planning. This ought to be done before any treatment is carried out to prepare against any unforeseen eventualities.
The goals to achieve during treatment planning of comprehensive cosmetic cases are:
1.OPTIMAL ORAL HEALTH
This forms the foundation of treatment planning. Long-term planning should be centered around those teeth that can support other teeth or have a good long-term prognosis. Hence, firstly you need to decide which teeth are going to form the basis of the foundation on which to build the aesthetics. Also, planning must be done to restore carious or deteriorating teeth back to health. It goes without saying prevention also forms a large part of this aspect of treatment planning and assessment.
Rahul Doshi BDS LDSRCS was the senior clinical director of The Perfect Smile Advanced Training Institute in Hertford and offered hands-on training courses in aesthetic dentistry. He lectured both in the UK and abroad and was PPD’s clinical editor. www.theperfectsmile.co.uk
Here the occlusion needs to be studied in detail to determine occlusal interferences or any abnormal excursions that exit prior to cosmetic treatment. In particular when looking at cosmetic cases, the anterior guidance becomes very important. This is because the final form of the anterior teeth should take the pre-treatment occlusion versus creating a centric relation occlusion into account. I decide whether I want to keep the original bite or change it before any treatment is carried out. This allows me to have more control over the end result.
Looking at the final expected anterior guidance before cosmetic treatment of any kind can help considerably in achieving great final cosmetic results. This is because more often than not the correct anterior positions (following smile design principles) lead to better aesthetics.
3. NATURAL AESTHETICS
Natural aesthetics is using techniques to create what is ultimately perceived as beautiful in that person when creating a new smile. This is because it complements the facial aspects of the patient as well as their personality. In my experience a great majority of patients are looking for a pleasing and natural appearance as oppose to the gleaming Hollywood Smile.
Also, I believe the creation of a natural looking smile is technically more challenging than a set of Hollywood dazzlers. This is because more consideration is needed in respect of the different characteristics, colours, contours and surface texture that you will need to use. Creating teeth to suit the personality, face, lips and mouth requires a lot of thought and more detailed smile designing. This creates teeth that are completely unique to the individual.
A good smile design is one that takes account of aesthetics and alteration of tooth form to achieve the correct functioning. In fact I like to think of designing smiles as a dynamic process looking at the occlusion, tooth wear, TMJ, muscles and finally combining it all with a great natural looking smile that ‘suits’ the individual. This is because if the teeth created are not in harmony with the muscula-skeletal complex surrounding the TMJ, then the teeth will either be moved into harmony (the neutral zone) or be worn into harmony.
Lack of harmony creates ‘occlusal disease’. As well as the muscle problems, occlusal disease also creates tooth symptoms such as sensitivity, tender to touch, tooth mobility, tooth wear and fractures.
Often aesthetics drives a case initially but it is clear to see that the correct occlusion and function completes it.