by David J. Sultanov, DMD
WHAT is cosmetic imaging? Cosmetic imaging is the process of digitally improving the photograph of a patient's smile to an end result that can be accomplished by using today's most advanced, modern restorative materials and/or orthodontics. The altered image should represent a feasible expectation, taking into consideration the physical parameters of the patient's smile such as midline, root positions, and gingival architecture. It is important that any severe deviations from these constraints required to accomplish the desired smile — such as periodontal surgery — be explained to the patient during the treatment consultation.
WHO should utilize cosmetic imaging?
Any cosmetic or restorative dentist and any orthodontist desiring to increase case acceptance — whether it be for cosmetic, anterior, functional, or full-mouth treatment — can utilize and benefit from the cosmetic-imaging process.
WHY is imaging important?
Looking at examples of the vibrant smiles attained in other cosmetic cases lets a patient know that this type of dentistry is available; it also leaves the patient wondering, "How would I look?" There is emotional impact in seeing yourself with a greatly improved smile.
Patients cannot easily visualize comfortable, functioning dentistry with healthy periodontal tissues, but cosmetic imaging's ability to show them their enhanced appearance after treatment could be the primary reason they choose a dental procedure.
Imaging is a powerful education tool. Patients can see first-hand how cosmetic dentistry can correct various smile defects, such as crown lengthening for a "gummy" smile.
Computer imaging projects your practice as a high-tech operation. Even if patients are not interested in aesthetics, they leave their appointment feeling that you are on the cutting edge of dentistry. While "imaging" patients, you can educate them on how much extra training and continuing education are needed to perform the demanding expert treatment involved in a cosmetic dentistry case. You can inform patients that you are constantly updating your skills to meet the demands of cosmetic dentistry.
If the patient accepts the case, an accurate imaging is helpful in creating a wax-up for smile design and provisionalization. The before-and-after imaging photos are indispensable for laboratory communication to ensure successful completion of the case.
WHAT equipment is required for the process?
A camera is required to capture the patient's image. A digital camera is the quickest way to load the image into the imaging software. An adequate digital camera can cost as little as $300 or as much as $4,000. Conventional 35 mm cameras can be used with print or slide film, but must be developed and then scanned into the computer.
WHERE is the imaging performed?
A computer-savvy dental office can do cosmetic imaging on-site. Numerous software packages are available for this purpose, such as Vipersoft, Digital Dentist, and Image FX. The investment can range from $1,000 to $4,500. Most imaging software packages offer a smile library that costs $400 to $600. Learning the program requires a substantial investment of time as well as money for training-related expenses to expedite integration.
To avoid the expense and time involved in office imaging, the procedure can be outsourced to an expert service that can return the completed images via email or printed photographs. The cost can range from about $28 to $90 per case, depending upon whether the imaging is returned electronically or as prints.
HOW is imaging performed?
Take a direct frontal photograph of the patient. The interpupillary and/or upper arch should be as parallel to the horizon as possible. The camera lens be directly in front of the upper arch so that only a very slight curve is created from the left to the right molar. After the picture is downloaded or scanned into the software, the smile is corrected by morphing the existing teeth, importing new teeth one at a time, or creating an entirely new smile from a library. The new smile is then sized to fit the arch. I use additional graphics programs to precurve some of the library smiles so that they fit more precisely and do not change the curve of Wilson or gingival architecture.
If on-site imaging is not an option, you can email a digital photo or mail a photo/slide to a cosmetic-imaging service.
WHEN is the patient introduced to imaging?
When new patients come into my office, we always take digital photographs of their smile. These photographs serve several purposes. They can be used for cosmetic imaging, as part of the patient's permanent dental records, and for identification purposes in a large multidoctor office. We tell our patients that these photographs are for smile evaluation, which adds to the thoroughness of the initial examination.
We display the imaged photo in an attractive folder and, ideally, present it at the treatment consultation or at the next visit. A staff member, upon greeting the patient, always tries to comment on how good the patient looks in the imaged picture. This reinforces the benefits of cosmetic treatment.
If the patient does not have to reschedule after the initial examination, we always invite him to stop in for a copy of his imaged smile. Again, I instruct my staff to comment on how nice the patient looks in the imaged picture. The staff also notes the patient's reaction to the imaging. The patient's excitement level lets us know how to follow up on the case. Patients who are very excited get a call in a week or two to see if they have any questions, or if they would like to schedule a treatment consultation.
We mail a copy of their imaging to patients who cannot stop in. Providing patients with a copy of the photograph allows them to save it for future reference and to show it to a spouse or significant other. Often, major dental expenditures are a joint decision; both parties benefit from seeing a depiction of the end results.
For existing patients, we take photographs at the periodic exam visit and show them at the next appointment or have them stop back in to pick them up. Our existing patients have turned out to be the most receptive to cosmetic procedures. They already feel comfortable with the care, skill, and judgment of our dental staff and appreciate the higher level of services that we provide.
Case Study
Doris came into my office for an initial examination. She was already aware of existing and potential dental problems.
Visually, she could see many very old, large composite restorations that were stained and fell out more frequently than seemed normal. In the posterior region, numerous large amalgam restorations had reached the end of their lifespan and were ready to be replaced.
The cosmetic imaging of her case using Vipersoft and the Lorin Library of smiles (Figure 1) demonstrated what the final result could look like, with the benefit of creating stronger, more durable teeth that didn't need constant patching. The imaging projected a natural-looking dentition that also eliminated the graying on the posterior teeth caused by the old amalgams.
Doris was excited about the prospect, but also needed to consult with her husband, since this would be a significant investment. She stopped in a few days later and was ecstatic that her husband went along with treatment plan. She exclaimed that the imaging helped to explain the extent of the treatment and how he would really be the one to enjoy it the most.
The case was completed much to Doris' satisfaction, as can be seen by the glow she projects here on the final case photos (Figure 2).
Who are your best patients? The ones referred by other patients, of course. The SmileCash™ Program is designed to reward your existing, loyal patients for referrals. A SmileCash™ card is opened in Microsoft Publisher, and the referring patient's name is easily added. The personalized, business-size referral cards, along with a letter explaining the SmileCash™ Program, can be quickly printed for any patient. Small enough to keep in a wallet or purse, these referral cards have a potential value if the topic of dentistry comes up in conversation. The referred patient gets a discount on services. The referring patient's name is on the card, making referral record-keeping simple. The referring patient is also given a credit for services, with a bonus level to be determined by the individual office. Included with the SmileCash™ Program are the SmileCash card, a generic card that can be customized, an explanation letter, and two different signs that can be printed and framed.
