By David S. Hornbrook, DDS, FAACD
The practice of clinical dentistry is at its finest moment — in terms of profitability and economics — since the early 1960s. The public's increased awareness of the benefits of modern dentistry has never been higher. The desire for "wants-based" dentistry frequently replaces "needs-based" dentistry as the reason a patient seeks dental treatment. This increased awareness, coupled with the overall desire of the public to look and feel better and younger, has created an entirely new arena in dentistry that was much less explored prior to the new millennium.
The media's attention on dentistry's entry into providing positive changes in people's appearance has resulted in a prolific number of articles in leading national beauty and glamour magazines. These articles cover topics such as bleaching, bonding, veneers, and orthodontics. This increased awareness by the media has had a profound effect on one group of patients — the ones who seldom visited the dental office because of its association with unpleasantness and pain. Dentistry now has established itself near the forefront of delivering self-image-enhancing services, along with providing and maintaining excellent oral health.
When combined with the proliferation of new materials and techniques that simplify the clinician's ability to provide patients with aesthetic procedures, the number of dentists providing and, in many cases, focusing their practices on aesthetics is incredibly high. However, success in the delivery and execution of aesthetic dental procedures is based on predictability. With higher patient expectations and demands, providing beautiful, functional dentistry — without sensitivity or premature failure — is determined by effective communication skills, understanding the applications and limitations of the new materials, clinical confidence in the new techniques, and an excellent relationship with your ceramic laboratory.
Predictability with communication
Excellent communication skills are equally as important as clinical skills in delivering predictable aesthetic dentistry. The ability of the doctor and team to create value for aesthetic dentistry can only be achieved by creating an environment where the patient knows what is available and what can be done. Creating and establishing value frequently begins with the simple statement, "Is there anything you would like to change about your smile?" or "If you could wave a magic wand, what would you like to change about your smile?" Unfortunately, few clinicians and their teams actually take this easy, first step and, as a result, they miss out on countless opportunities to provide their patients with beautiful smiles. Although the patient may have heard about new techniques in dentistry, few truly understand exactly what is available and the miraculous results that can be achieved in a very short time. Listening to the patient's goals and desires about their smile then becomes the next step. Frequently, just handing patients a large, hand-held mirror and asking them to describe what they do and don't like about their smiles will elicit responses that will result in treatment acceptance.
Increased treatment acceptance is usually a result of the enthusiasm of the doctor and the team in describing the treatment and the results that can be obtained. Since most patients are going to accept treatment based on an emotional response or need, rather than on the clinical merits of a specific material or technique, this enthusiasm establishes credibility that the patient's desires will be met ... and possibly even exceeded! Those clinicians and teams that are most successful in obtaining case acceptance are the ones that are able to effectively infuse excitement and enthusiasm into the treatment plan and the final outcome.
Creating value through visual communications is as important as verbal communications. The physical environment of the office should elicit patient's questions and desires about how they can improve their appearance with an enhanced smile. This can be accomplished with before and after photo books, beautiful smiles and faces as artwork on the office walls, or even screen- savers that morph from before to after pictures. Since the aesthetic-based dentist is in the business of enhancing smiles, anything that can be placed within the patient's view that promotes awareness of beautiful smiles will help in establishing the correct environment for increased treatment acceptance.
One of the greatest ways to create value is the concept of "practicing what you preach." When the doctor and the team members have had their own smiles enhanced with aesthetic dentistry, this escalates the value, durability, and safety of the specific procedure. Most of the successful cosmetic-dental practices have a doctor and several of the team members who personally have had a smile enhancement with porcelain veneers or orthodontics. It is difficult for the patient to see the value when the doctor and team aren't walking advertisements for what can be achieved with aesthetic dentistry
Predictability with the new materials
The materials and techniques used in aesthetic dentistry are changing at an alarming rate. It is difficult — if not impossible — for the average clinician to try to keep up with all of the changes. The importance of understanding what is available, as well as the applications and limitations of the new materials is paramount in providing patients with state-of-the-art, predictable dental care.
Since most of the new techniques are not discussed in dental school, post-graduate continuing education becomes even more important for the aesthetic dentist. Success in eliminating post-operative sensitivity, premature failure, and obtaining the optimal results is determined by the use of the most ideal materials and an understanding of the techniques utilized to place them. Many clinicians have stopped using excellent materials because of a lack of understanding of the proper techniques. The successful aesthetic-based clinician is one who attends numerous hours of continuing education and stays abreast of the latest literature. Another important asset is to seek out and follow a mentor who has the ability and time to investigate the various materials as they are introduced to the dental community by the manufacturers. The pinnacle in post-graduate education is to attend a live patient, hands-on program where leading clinicians actually treat patients using the latest techniques in aesthetic, restorative dentistry. There is no substitute for this infusion of hands-on experience, and many clinicians have stated that these types of programs are responsible for propelling their clinical self-confidence to a new level.
This acquired clinical self-confidence is another key ingredient in increased case acceptance. When the doctor and the team express confidence when describing the options — and ultimately the results — the patient can sense this confidence and case acceptance is enhanced. It is the doctor's lack of confidence, usually based upon lack of clinical experience, that results in the patient's concerns about the final results and the overall treatment experience.
Your ceramist and predictability
Once the value for treatment acceptance is established and the clinical skills are acquired, the desired results can only be obtained with the use of an artistic ceramist. Artistic skills alone, however, are not enough to yield the most ideal result. The artistic ceramist must be allowed to follow a set of blueprints based upon a design process established by the clinician. The concept of "designing the smile" is one in which the variables of the smile are addressed with the patient by the clinician and then transferred to the ceramist through the laboratory prescription. The smile design addresses such things as tooth length and shape, surface anatomy, incisal edge translucency, shade, and functional concerns. Frequently, these criteria are developed using photographs, models, or, ideally, an intraoral resin mock-up. Placing a flowable resin of the patient's pre-existing teeth to determine ideal length, profile, central and lateral relationships, smile line, and contour allows him or her to express their own preferences on the final design. This mock-up can then be impressed and used to fabricate the provisional restorations. The provisionals, in turn, can be used as a working diagnostic model. The ceramist then duplicates and uses the model to fabricate the definitive restorations.
Usually the relationship between the clinician and the ceramist begins and ends with the prescription. It is a one-way dialogue that inhibits the preferred interaction between the two. Successful clinicians are those who have established a consultatory relationship with their ceramists. The ceramist becomes a peer in the design process, whether it be the discussion of the materials used, or even the design of the smile itself. Optimal aesthetics and patient satisfaction can only be achieved when this kind of relationship exists.
Predictability and perception
Dentistry can be an incredibly rewarding and satisfying profession. For many clinicians, it has become a hobby at which they have been able to make an excellent living. The ability to have a positive role in helping other people improve their self-image and self-worth is an honor that is limited to very few professionals. Aesthetic dentistry has taken away the stigma of just relieving and/or causing pain and created, in its place, a profession that is associated with beauty and enhancement. It is a profession that individuals can turn to when they want to improve the quality of their lives.
Successfully implementing the benefits of modern dentistry into your practice requires the confidence that you can deliver the results predictably. It is this confidence, above all else, that will change the perception of your patients, your team, and, ultimately, your own.