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Written by Harvey Silverman, DMD Tuesday, 01 November 2011 18:36
Harvey Silverman, DMD
In the last edition of Silverman On Smiles: Cosmetic Dentistry SOS,I described the art and science behind effectively co-diagnosing cosmetic dentistry needs. In this article I want you to sharpen your co-diagnostic ability to solve a cosmetic dilemma – in this case it was one that required immediate attention
This patient came into my office and told me that he wanted to improve the appearance of his teeth (see figures 1 and 2). He was excited because he was getting married. He was a very friendly, outgoing individual who wanted to have a nicer smile for the wedding.
Let's take a closer look at his teeth and decide how you could help him solve his problem.
This is a challenging case. I am sure you agree. First thoughts immediately go to orthodontia. However, he is getting married in a couple of weeks. Finances are an issue - and he really wants you to do something to help him out. In addition to the alignment issue, he also has a congenitally missing left lateral incisor. So, what would you suggest?
Here’s a hint: The patient ruled out orthodontia as well as porcelain veneers due to his upcoming wedding as well as the time / expense. So what would you recommend to this patient?
Lesson Learned: By now you probably know the answer —which is
“I don’t know—until I have a chance to learn more about what my patient wants to have done.” If you did not automatically say this, please go back and read the last 2 articles that I wrote in Dentistry Today about co-diagnosing cosmetic wants with your patient.
Figure 1. Full-face before photo.
Figure 2. Close up before photo.
Figure 3. Performing cosmetic contouring. No local anesthetic needed.
Figure 4. After minimal cosmetic contouring.
Figure 5. “I cannot believe it!” exclaims the patient as he looks into a mirror and sees how 4 LifeLike Veneers dramatically changed his smile.
Figure 6. Looking good and feeling great at the end of the appointment.
Therefore, to know what your patient wants to have changed, review his smile analysis form and supplement that with a chairside smile analysis before making a decision.
Next, perform a Smile Trial directly on the patients’ teeth. This provides you with a sense of what the final outcome will be as well as to determine if the patient is a candidate for in-office veneers. Conventional bonding is also a possibility but bonding is far more technique sensitive and has its own unique set of problems and challenges. In this case I chose to use the in-office LifeLike Veneer System.
Note: while the LifeLike Veneer technique is typically a noninvasive treatment modality, for this case I had to do some cosmetic contouring on #7 to help create room to achieve the final illusion effect with the veneers.
In the introduction to the last 2 articles I said that I would share with you a valuable technique to help determine patient’s cosmetic dental needs through co-diagnosing. From many years of doing on-site coaching with dentists I can reassure you that using this co-diagnostic technique will be seamless in your daily routine after you practice it for 30 days—with the caveat that you never prejudge patient needs.
The take away from this article is to always give your patient an opportunity to share changes they want before deciding if they are a candidate for a specific elective cosmetic dentistry procedure—and then provide your patient with the appropriate cosmetic dentistry service to have a brighter, more self-confident smile. If you are looking for simple “bread and butter” solutions for your cosmetic cases and are interested in taking your elective cosmetic dentistry practice to the next level please feel free to contact me.