Dr. Irwin Smigel is a legend in the area of aesthetic dentistry, and he wrote many articles on the subject of aesthetics for Dentistry Today when the magazine was founded 25 years ago. In this 25th Anniversary year it is a fitting tribute to Dr. Smigel that we publish an interview conducted exclusively for us by Dr. Dean Mersky, Director of Clinical Communications for Captek. In this interview Dr. Smigel shares some of his favorite memories about the early days of cosmetic dentistry and his role in its continuing evolution.
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| Irwin Smigel, DDS |
Dr. Mersky: Dr. Smigel, you go back a long way with the whole idea of cosmetic dentistry. When did it really start for you?
Dr. Smigel: It started when my father was a dentist. When I was graduating dental school, they had an alumni day, and my father came. The dean of the school went over to my father and said, “Irwin is a good boy, he works hard, but he has some crazy ideas about cosmetics in dentistry. I think you ought to straighten him out.” That was way, way back. From the origin, I always wanted to think as best I could in terms of aesthetic dentistry. When I first graduated, we did have porcelain crowns, but there was no such thing as porcelain-fused-to-metal. The best option we had for bridges was what we used to call acrylic veneers, which was acrylic baked onto a metal substructure. And it was very, very difficult to achieve an ideal aesthetic result.
From the beginning everything I did was based on making people look better. But the only materials we had for anterior fillings were a form of silicate. And the silicate didn’t sustain; the colors weren’t really accurate. It was very, very frustrating. Then along came a couple of people who really helped me and were instrumental in developing new aesthetic modalities. One was Dr. Michael Buonocore, who developed a concept of acid-etching. Acid-etching revolutionized many things. Instead of having to undercut teeth to retain fillings, we could etch an area and bond to it. At the time it wasn’t used in the manner it is today. Actually, they would still drill the tooth to create class III and IV preparations, then they would etch them. Dr. Buonocore was a good friend of mine, and a giant in our profession.
Then along came the great Dr. Raphael Bowen…Ray Bowen. And he really changed the world as well; he developed composite. That was such an advance from the old plastic fillings. These were stable and much more color consistent. Instead of using the old plastic fillings, we would use the composites instead. And they looked much better and they lasted much, much longer. The original material was Adaptec; it was just for fillings, but it was a great leap forward. And then came along the L.D. Caulk company, which I worked with intimately. They developed the first concept of light-curing; they developed an ultraviolet light. At the onset the tube was all ultraviolet, and eventually they covered the light to protect the dentist and the patient. But it enabled us to control the setting of the material. Unlike Adaptec, which would set and force you to work quickly, with light-cured materials we could do whatever we wanted, and the material would not set. The composite material had a catalyst inside that the light activated, causing it to set. The process was still called acid-etching, but once light-curing came along, I immediately started playing with it. And I saw the great potential.
L.D. Caulk developed a material at that time called Nuvafill. It was far less accurate than today’s materials in terms of color-matching, but it was much better than anything we’d ever had before. With Nuvafill I saw that we could close diastemas as well as cover teeth that were stained. At that time we saw teeth that were stained from tetracycline use, but nobody knew why these teeth were stained until later, when we realized it was from tetracycline. After the antibiotic revolution a great many young people grew up with their teeth stained dark from tetracycline. Nuvafill enabled us to cover the teeth without destroying them. It was a tremendous revelation.
One of my patients was a young opera singer who had orthodontic treatment for congenitally missing lateral incisors; the canines had moved into the lateral position, and they looked awful. I bonded her 6 anterior teeth. I reshaped the centrals, made the canines into laterals, and the premolars into canines. And I gave one of the first lectures on bonding and invited all the principals from the L.D. Caulk Corporation. The patient was nice enough to come to the lecture. I first showed them what the patient looked like before treatment and then what she looked like after treatment. They said to me, “We’re not interested in what crowns can do; we want to see what bonding can do.” And I said to them, “This IS bonding.” They came closer to look at her, and it was amazing to them. They invited me to Milford, Delaware, to bond her second premolars, and they watched me and observed the way I bonded them, improving her smile even more than before. They couldn’t believe that could be done.
Dr. Mersky: That was around 1971, correct?
Dr. Smigel: I would say ’70, ’71, that’s when I started this.
Dr. Mersky: That is amazing because so many dentists today, especially more recent graduates, think that the light-cure is a more contemporary invention. But it really goes back well over 30 years.
Dr. Smigel: Absolutely. It was unbelievable. You have to understand that when it first came out, people didn’t embrace it. I saw the potential and I started lecturing. And of course you would get certain followers. You know human nature…a lot of the established dentists made their living on crowns. They realized light-cure materials might alter the way the public viewed our profession, and they made bonding acceptance difficult. What changed that completely was the show That’s Incredible! But before I get to that, I want to tell you the origin of the term tooth bonding.
It used to be called acid-etching. This is what dentists did…they used the acid to etch and then place fillings. Now, our dental society—the First District (New York) Dental Society—had a little bit of a problem. There was a very popular show that was on the radio all night called the Long John Nebel Show. It was very popular here and had a big following. Long John used to love to attract celebrities and then put them on the spot. Because of its popularity, physicians, specialists, and an occasional dentist would appear on the show. One dentist was an oral surgeon. He was president of one of our district dental societies. John tricked him. What John would do is isolate one topic and learn it completely. He was a very street-smart guy. He studied the potential dangers of radiation—and this dentist came on the show ready to talk about surgery—and he immediately lured him into the area of radiation and wouldn’t let him off. He was so relentless the dentist got up and left the show. John loved that, and he kept saying, “What’s wrong with dentistry? Are they afraid to come here? Are they hiding something?”
I used to enjoy questions and answers at my lectures. So the society came to me and suggested that I go on John’s show. With trepidation, I went there. That night I really studied everything I could. I didn’t want to be tricked the same way the previous gentleman had been. But John wasn’t nearly that bad, and we got along quite well. The show was interesting, and we had a good rapport. By the second or third show, John asked, “What’s new in dentistry?” And I told him about this great thing that we called acid-etching. And again, he was a very street- smart guy. We were off the air, and he was talking to me before the show, so he said, “You can’t say that. I’ll be inundated with callers if people hear that you’re putting acid in their mouths.” I tried to say, “Listen, even orange juice has some acidity.” He said, “Just tell me…what does it do?” I explained that we bond a tooth-colored material directly onto the tooth without necessarily having to drill it or touch it at all before we do the bonding. He said, “That’s great. Just call it tooth bonding.” And so help me, that was the origin of the term tooth bonding.
Dr. Mersky: So, a nondentist came up with this…?
Dr. Smigel: Not a dentist, it was Long John Nebel. I started writing about tooth bonding in the early 1980s and was soon writing for Dentistry Today. Cosmetic dentistry was just burgeoning. Dentistry Today asked me to write an article for them in every issue, and as the response from the articles on bonding was very positive, I wrote regularly for several years.
Dr. Mersky: Aside from the use of plastic in your bonding techniques, you also were involved early in veneers. Is that correct?
Dr. Smigel: Yes, but that came later on. I just want to discuss one other area related to bonding before we get into veneers. Bonding was growing, but very, very slowly. A lot of people who came to my lectures started doing it. And it was making some inroads. I was asked to appear on a show called the Mike Douglas Show in California. Mike Douglas had a very popular show, but it was shown at different times in different areas of the country. It was popular, but it wasn’t earthshaking. Mr. Douglas brought on someone who had a large diastema between his centrals. I closed the space between his teeth and bonded the surrounding teeth as well. I bonded 4 teeth in a relatively short time. Mike Douglas later told me that they got more inquiries on that show than all the times he had been on the air. And he was one of the originators of talk shows.
Shortly after that, because of the excitement created by the Mike Douglas Show, the No. 2-rated show in the country, That’s Incredible! (second only to 60 Minutes), invited me to appear on their show. Again, I had to go out to California. But on this show we did some interesting things. I again did a bonding procedure, but I also showed slides of cases that I had done previously, and was asked to explain the bonding procedure. Altogether it was a 12-minute segment, but those 12 minutes changed dentistry. The show was extremely popular. They didn’t have cable television at the time, so almost everybody seemed to watch the 3 major stations, CBS, ABC, and NBC. Immediately, I was inundated with responses from across the country. My office was in a building with 19 floors that would receive about 10 bags of mail every day. Even weeks after that show I would receive 3 to 4 bags of mail regularly. Mostly people asking questions, asking about dentists, about how they could find someone who could do bonding. Our office was inundated with people seeking appointments, and I was in great demand for lecturing. It was an exciting but overwhelming time. We were ex-hausted. Thank heavens for the ASDA. At least I was able to recommend dentists who I was certain had the ability to do the bonding properly. Recommending was a tremendous responsibility.
Dr. Mersky: You mentioned the ASDA. That is the American Society for Dental Aesthetics, correct? What’s the story behind that? How did that come into being?
Dr. Smigel: Well, actually, it started 35 years ago. When I was starting with bonding, I formed a study club. And after 5 years there were so many people trying to get into the club, we formed the American Society for Dental Aesthetics. This was 30 years ago (1976). Slowly, more dentists got involved. We decided at the onset to make it an honor society. To become a member one had to demonstrate aesthetic integrity, as well as be recommended by 2 people who were members of the society. We also insisted that they be in practice at least 5 years. We didn’t feel that a dentist could really understand the basics of aesthetics until he or she had some experience in the real world. We also wanted to be apolitical, so we decided from the onset that we wouldn’t have any infighting. We’ve had one president in our 30 years, and fortunately that was me. We have meetings once a year, and they’re always filled. We try to get the best lecturers, and our hands-on courses are renowned. The essence of this society is to improve the quality of dentistry worldwide. We have members from all over the world, and it’s just been a great experience for us.
Dr. Mersky: I’ve attended some of those meetings myself, as you know, and it’s like a giant family, although the word “giant” is relative and is a subjective description because we’re not talking two or three thousand people. It’s a very warm environment you’ve created.
Dr. Smigel: We didn’t want the large numbers. There were other societies; some of them like to get a giant attendance. We never wanted that. We wanted a family style attuned to learning. We get the best lecturers possible every year, and we want everyone there to participate. We want them to be part of the learning environment. We do have hands-on courses that people can attend and improve any area they desire. The lectures, however, where everyone is together, are the crux of the society. Also, we carefully screen companies who exhibit. The ASDA is not an organization built to make money and become rich. Our sole purpose is to advance the concept of aesthetic dentistry.
Dr. Mersky: If anyone might want to find out more about the ASDA, you would suggest they go to the Web site?
Dr. Smigel: Absolutely. The Web site is ASDAtoday.org. I would like to go back and answer the question you asked me about veneers. Why have veneers been so successful and how did it originate? Some people felt, and rightly so, that as good as the composite material was, porcelain would be better. The concept of porcelain veneers was essentially started at New York University. Drs. Harold Horn and John Calamia are pioneers in this area, and Dr. Robert Weller (a Fellow of the ASDA) developed the original concept for tooth preparation. Adrian Jurim was the first technician to make it a feasible discipline. He developed the technique to opaque veneers that enabled them to hide deep tetracycline stains. Early on I worked with Adrian and embraced the veneer concept. I lectured on it and helped propel veneers into the modern world by writing in Dentistry Today.
Dr. Mersky: Adrian Jurim, in Great Neck, New York, is a fabulous ceramist. With all the history that you bring, and all the experience, what is your take on today’s cosmetic dentistry, and the fact that you coined the phrase “nonsurgical face-lift”?
Dr. Smigel: After a while, when you are involved in the type of work I do, you visualize different potentials. I was always in awe of the possibilities we have for bringing faces back to their original shape. I started this with dentures. When patients were edentulous, their faces collapsed. I found that if I could use my understanding of how facial muscles support the face, I could build dentures that would bring the face back to what it was originally. Afterward I realized I could make people look even better than they ever had before. Once I established this with dentures, I saw the possibility of doing something similar with bonding, crowns, and veneers. That was my next challenge. It took time, but by understanding the essential muscle structure of the face, I found I could use similar techniques to support the muscles properly, stimulate the tissues, and often make people look better than they ever did. It’s like a face-lift, only it’s nonsurgical.
Concerning the future of aesthetic dentistry, there are a couple of things that worry me, and I’m not the only one. Dr. Gordon Christensen talks about this all the time. Dentistry is a beautiful profession. It offers a great deal for patients, and aesthetics is a vital part of it. Because of the influence of aesthetics, people look at dentists differently than they ever did before. They realize that dentists can be artists, not—as awhile back—just repairmen. However, every revolution comes with disadvantages. Some dentists will focus on the patient’s appearance when other types of treatment are needed. Also, certain aesthetic procedures may not be right or necessary for that particular patient. That disturbs me, because as much as I love cosmetic/aesthetic dentistry, I want it to be one part of the profession, not something that dominates every aspect of it. Also, if a dentist doesn’t have the ability to perform excellent aesthetic dentistry, he or she should do whatever possible to improve. Today so many courses are available where one can learn the basic fundamentals and techniques. I humbly suggest all young dentists take it upon themselves to learn first, and not to jump in and use the concepts that we’ve worked so hard to establish, to simply get patients to ac-cept procedures that may not be best for their particular needs.
Dr. Mersky: With teachers like you available to us, it’s not all that tough to learn. And from you we have learned a lot of things that will help us reach greater satisfaction in our own practices. I know that you’ve helped me reach that level in the past, to the benefit of my patients. Dr. Smigel, Dentistry Today and I want to thank you for the time that you have given us today.
Dr. Smigel: Nothing is more important to me than having dentists tell me the impact I had on their lives. Thank you very much.
Dr. Mersky is a 1976 graduate of the University of Detroit dental school, and practiced in Manhattan Beach, Calif, for 26 years. Currently, he serves as the director of clinical communications for the Captek Company. Dr. Mersky has authored many articles on the use of Captek in the restorative practice, and has lectured nationally on the material to dental groups for the past several years. He and his family currently reside in Doylestown, Pa. He can be reached at (215) 348-2079 or drmersky@captek.com.
