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The shape of teeth to come

April 1, 1998
The desire to "look good" is deeply embedded in the human character. People derive pleasure, self-confidence and a sense of well-being from the cosmetic services we offer them. With modern technologies and materials, it`s possible to offer more predictable and longer lasting "smile solutions" than ever before. The number of people who want to look their best is enormous and growing. This is a great opportunity for dentists!

Cosmetic computer-imaging illustrates in visual terms the benefits of our services.

Lorin F. Berland, DDS

The desire to "look good" is deeply embedded in the human character. People derive pleasure, self-confidence and a sense of well-being from the cosmetic services we offer them. With modern technologies and materials, it`s possible to offer more predictable and longer lasting "smile solutions" than ever before. The number of people who want to look their best is enormous and growing. This is a great opportunity for dentists!

The challenge we face is getting the public to understand the benefits of cosmetic dentistry. Most people want an attractive smile, but erroneously believe that improvement is either technically impossible, beyond their financial means or time-consuming and painful.

Most of us experience a significant amount of rejection when presenting cosmetic dentistry. People simply don`t understand the real benefits that are being offered. Instead of visualizing how they could benefit from a more attractive smile or understanding the treatment options available, they might focus on the difficulty of dental appointments, fear of dentistry or the cost. They say "no" without knowing what they are missing. A case presentation, to be effective, should inspire people to want cosmetic dentistry. Then, cost and other factors become secondary to the benefits.

Cosmetic dentistry is elective. That means that a persuasive case presentation must involve the patient in the decision-making process. People want to see how they will look before committing to permanent, visible changes. We always must remember that it is an irreversible procedure. So, of course, they would like to see their esthetic options and might want to discuss the proposed changes with family and friends before making the crucial decision.

Cosmetic computer-imaging is a proven case-presentation technique that works when words alone are not enough. To be effective, full-face pictures must show how a person could appear with more attractive teeth (see Figure A). Teeth in the pictures are altered to reflect clinically accurate changes. It is important to use full-face pictures to illustrate the proposed changes to the facial features.

My experience with more than 1,500 restored cases proves that the pictured results can be consistently reproduced in real life. That`s because the teeth are hard structures that are visible to the camera. The same changes made in the pictures usually can be made in the mouth with predictable results.

Measurement pictures, which accompany each work-up, are useful for dentists and the laboratory when planning cases, preparing teeth and fabricating restorations (see Figure B).

Most current imaging machines require a large initial in-vestment in both money and the time necessary to become proficient using this technology.

For the last year, I`ve incorporated a handsome light, camera and computer combination on a conveniently located cart. A chair and a modem line make the system complete. We have an on-line service that makes it possible to send pictures to a laboratory for quick and easy processing. This on-line service increases picture quality and reduces turnaround time.

I make a folder of the mounted prints and send it to the patient. The folder, "before-and-after" pictures and a short note inviting the patient for a complimentary consultation, make for a convincing visual argument. This is done with a minimum investment of time and money to train a staff member to take the pictures and to install the camera computer cart. It`s simple.

Cosmetic computer-imaging has opened up our lines of communication. People see how cosmetic dentistry can improve their lives. It`s relatively fast, painless and inexpensive. The following three cases, as well as the one described in the related article on this page, illustrate the power of this life-changing tool.

The psychiatrist: She was referred to me by her periodontist, Dr. Craig Goodman, to restore her posterior teeth. She never considered improving her smile. With computer-imaging, we planted the seeds for a better smile and gave her two options.

Not only was she shown what she would look like with an even smile line, we created a smile that reflected the naturally longer length of her right central. This personal touch convinced her to proceed with treatment. This consisted of whitening her lower front teeth, replacing various bridgework and crowns in the posterior, doing crowns for teeth 5 and 7 and veneers on teeth 6, 8, 9, 10, 11 and 12.

The newscaster: This case illustrates the detailed work-up available with computer-imaging. This young newscaster never was happy with the color or shape of her front teeth. She remembered getting a crown on the right central 10 years earlier as an unpleasant experience and was hesitant to undertake any more dental treatment.

We did a computer work-up. She was impressed by the technology and referred many of her friends for cosmetic dental treatment. She continued to see me for her preventive and posterior dental needs.

Four years later, with her high-school reunion approaching, she made a second consultation appointment, image folder in hand, and did the treatment. The details provided by cosmetic computer-imaging were invaluable in guiding treatment-planning, preparation and laboratory construction of five veneers and one crown. This was accomplished with no surgery, just the excellent tissue response to the temporary and, finally, the all-porcelain crown. The final result was beyond her expectations.

The lawyer: The young lawyer had been a patient since an emergency root canal nine years earlier. In all those years, we discussed veneers, ortho and whitening. He just wasn`t interested. However, he was very concerned about his health and the potential hazards of dental mercury. At his demand, I replaced all of his amalgams, one quadrant per year. Still, he didn`t see himself as a candidate for cosmetic dentistry. I took diagnostic models, met with an orthodontist and did extensive wax-ups. Nothing could convince him to do anything about his front teeth.

The first week we had computer-imaging, he came in for a check-up, and my hygienist took his picture. As soon as he got the picture folder, he made the appointment. In such cases, I usually whiten at least the lower teeth before starting the upper preparations. He couldn`t wait. So while I prepared his eight maxillary teeth for porcelain veneers, my assistant prepared a whitening splint for his lower teeth. We made another splint from his pre-op maxillary model. So, while he whitened his lower teeth, he wore his upper splint so he could tell people that he was "just whitening" his teeth.

Ten days later, we seated his eight veneers to be slightly lighter than his whitened lower teeth. Cosmetic computer-imaging gave me the opportunity to appeal to his visual sense. It created the need for cosmetic dentistry that would change his life. In his eyes, I am no longer just a dentist, but an artist.

Unexpected cases

I picked these cases because they all were unexpected. No extensive consultations were necessary. A lot of the people who received the folders went ahead and scheduled treatment. It`s that simple.

In summary, cosmetic computer-imaging is an excellent tool that allows us to illustrate in visual terms how our patients will benefit from our services. It also is invaluable in treatment-planning, preparation and, when appropriate, laboratory fabrication.

Cosmetic dentistry is a big part of my practice. It is not all I do, but it`s what I do best and enjoy the most. This simple visual approach has provided me with a better way to communicate to patients, both old and new, just how much I can do for them. With no advertising, computer-imaging is making my practice grow with happy patients and more referrals.

The lady from San Antonio

She was visiting her son and family in Dallas when she came in for emergency treatment. After performing endo on an upper bicuspid, we brought her to the computer terminal and camera. When she got her folder, she made an appointment to come back to Dallas to discuss treatment. She was not satisfied with her crown on the central incisor (see Figure C), but all of the dentists she had seen had never convinced her to do anything different. After seeing her pictures (see Figure D), she was anxious to begin treatment. We immediately did five veneers, one crown for the central and two posterior crowns. She was thrilled!

Click here to enlarge image

Figure C

Click here to enlarge image

Figure D

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