Realistic and clinically accurate full-face digital cosmetic simulation is gaining momentum as an important aid for presentation, planning, and delivery of more predictable anterior dentistry. It is an incredibly powerful and welcome tool for more intimate dentist/patient communication and better collaboration between dentists and laboratories. When used properly, it helps replace guesswork with certainty. Whether performed in-office or by professional artists at a remote location via the Internet, projected digital representations of what final treatment results could be help dentists, patients, and laboratories communicate with one another like never before.
Since 1988, Smile-Vision has been involved in delivering thousands of remotely created cosmetic simulations to dental offices worldwide using a variety of technologies (today using the Internet) to obtain patient images and deliver simulations. This laboratory routinely turns the simulations into provisionals and then into final restorations using Empress, Captek, and inVizion materials. This process has made life easier and better for dentists, patients, and the lab in every way.
The following are some frequently encountered benefits cosmetic simulation offers for presenting, planning, and delivering more predictable anterior dentistry.
For patients:
• Lets patients make an informed decision about proceeding with cosmetic procedures.
• Facilitates collaboration with family and friends regarding the “new look” before consenting to treatment.
• Enhances communication with the doctor regarding the appearance of the final outcome.
• Improves satisfaction with the new smile and eliminates buyers remorse.
For dentists:
• Offers a cost-effective, powerful, and nonconfrontational case presentation medium.
• Opens the door to more complete communication with patients, thereby reducing stress and uncertainty.
• Creates a definite aesthetic plan that can be communicated clearly to the lab and implemented in a stepwise fashion.
• Puts the dentist more firmly in control of the outcome.
• Increases earnings.
• Reduces stress.
• Enhances predictability.
For the lab:
• Creates a plan that the lab can follow for predictable results.
• Saves the lab time and money on remakes.
• Reduces wasted time and effort due to miscommunication.
• Improves client satisfaction.
The following clinical cases are examples of some of the ways cosmetic simulation solves problems for dentists, patients, and dental laboratories.
CASE NO. 1: CREATING AWARENESS
 |
|
Figure 1. Before, imaged, and after of Case No. 1 (from left to right). |
You would think that the person shown in Figure 1 would be aware of his unflattering appearance. However, in his postoperative interview, he said, When I saw the before photo I was simply appalled! When I saw the potential in the after photo I thought it looked awesome. Never take it for granted that people have a realistic self-image. (Case by Dr. Richard DeForno; Thorndale, Pa.)
CASE NO. 2: BUILDING VALUE
 |
|
Figure 2. Before, imaged, and after of Case No. 2 (from left to right). |
Jim was reluctant to get that new smile because of the cost (Figure 2). But once he posted the imaged smile on an Internet dating service and came up with a serious number of hits, he saw the value of a nice smile, and suddenly money wasn’t the obstacle it was before. (Case by Dr. Adrian Fenderson; Napa, Calif.)
CASE NO. 3: CASE PRESENTATION
 |
|
Figure 3. Before, imaged, and after of Case No. 3 (from left to right). |
Putting case presentation on an emotional level stimulates the I-want-it-now factor. Jeff had always been self-conscious about his teeth, but was putting off doing anything about it (Figure 3). But once his imaged photograph was mailed to him, he called the next morning and asked when we could begin. When he was asked when he wanted to begin, he said, “How about this afternoon?” (Case by Dr. Shaun Dowd; Bangor, Me.)
CASE NO. 4: DEVELOPING PATIENT CONFIDENCE
 |
| Figure 4. Before, imaged, and after of Case No. 4 (from left to right). |
When Helen came in, she had been to several dentists over the years for consultations about her smile, but none of the visits ever felt right to her or compelled her to pursue treatment (Figure 4). However, after showing her how she would appear with the new smile, she was incredibly pleased with the dentists effort to show her the projected results. No other dentist had ever made this much effort on her behalf! The imaging photos gave her the confidence she needed to proceed. (Case by Dr. Cathleen Carson, West-lake Village, Calif.)
CASE NO. 5: KEEPING THE PASSION ALIVE
 |
| Figure 5. Before, imaged, and after of Case No. 5 (from left to right). |
This patient lived for many years with worn teeth that caused asymmetry to her smile, with shorter teeth on her left side (Figure 5). Cosmetic imaging was done for her in 2004, and she was very thrilled with what her teeth could look like. Similar to many patients, however, she needed time to come up with the financing. She was ready to start a year later. (Case by Dr. Steven West, St. Louis, Mo.)
CASE NO. 6: ENHANCING DOCTOR/PATIENT COMMUNICATION
 |
| Figure 6. Before, imaged, and after of Case No. 6 (from left to right). |
The dentist found Bob in the chair one late afternoon, scheduled by hygiene to begin a crown on tooth No. 10 (Figure 6). As the patient was put back in the chair, it occurred to the dentist that restoring tooth No. 10 alone would leave many unsolved aesthetic and functional issues. So, before the chair had gone all the way back, the dentist reversed the cycle and sat Bob up. Bob, before I do anything, he said, I’d like you to be able to see what it would look like if we restored all of your front teeth at the same time. Let me take a photo for a cosmetic simulation and meet you back here in a week to discuss the matter further.
Needless to say, the dentist continued, when Bob laid eyes on his simulation, it took about 15 minutes to decide to redo his entire smile. The best part was that the decision was his not mine. (Case by Dr. Martin Goldstein; Wolcott, Conn.)
 |
| Figure 7. Before, imaged, and temps of Case No. 7 (from left to right). |
This complex case was a collaborative effort by the periodontist, oral surgeon, and general dentistry office (Figure 7). The aesthetics of the case were planned and verified with the patient using cosmetic simulation. Then, in one day, the oral surgeon removed the patients upper and lower incisors before returning him to the general dentists office for provisional restorations. The office was ready for him with temporary templates (from Smile-Vision), made in advance so they went in with-out a hitch. The patients thoughts the next day and a few days later were that everything went exactly as planned for him. There were no surprises. (Case by Dr. Dennis Ayre; Lexana, Kan.)
CASE NO. 8: HELPING THE LAB DO A BETTER JOB
 |
| Figure 8. Before, imaged, and after of Case No. 8 (from left to right). |
By utilizing computer imaging in conjunction with a diagnostic wax-up, the dentist was able to present the appropriate result to the patient and later translate it into reality in the provisionals and final case (Figure 8). The cosmetic simulation served as a realistic plan for the entire case. (Case by Dr. David Poiman; New York, NY.)
CONCLUSION
Cosmetic imaging is a powerful presentation, planning, and delivery tool for multiple-tooth anterior dentistry. It allows dentists, patients, and laboratories to proceed with confidence by establishing and sharing a common, predetermined goal. Although dentists often express the fear that cosmetic imaging can lead to unfulfilled promises and patient disappointment, my own experience has proven that fear not to be realistic. In more than 18 years of providing thousands of imaging cases to dentists worldwide, I cannot recall even one instance of dentist, patient, or laboratory difficulties related to the cosmetic imaging process.
Dr. Brooks is a practicing dentist and lab technician as well as an experienced speaker, teacher, and author. He is developer of the Template Technique, making cosmetic simulation an integral part of planning and delivering more predictable aesthetics. He has spoken to dental audiences, both large and small, in all parts of the United States. His articles have appeared in many popular publications including Dentistry Today, Dental Products Report, Contemporary Esthetics, and Dental Economics. Dr. Brooks can be reached at (617) 923-9616, ext. 13 or larrybrooks@smilevision.net.
Disclosure: Dr. Brooks is CEO of Smile-Vision.
