Not always relying on yourself

June 1, 2006
I like to think that experience hones my esthetic skills, but part of the skill that comes with experience has little to do with me.

I like to think that experience hones my esthetic skills, but part of the skill that comes with experience has little to do with me. I am a better dentist because I have learned to recognize when and how to depend on others - whether they be specialists, lab technicians, or patients. This insight is reinforced whenever someone comes to me to have restorations redone. For example, I recently treated a woman who was very frustrated with veneers that had been placed by another dentist. She requested that he retain the basic shape of her original teeth, and complained about different gum heights. Unfortunately, the dentist chose not to maintain the basic shape of her original teeth, and could not properly treat her gum lines because he did not ask a periodontist to correct underlying gum problems. Cosmetic dentists succeed when they take the time to listen to patients and, when necessary, make use of other professionals.


Patient-doctor communication can be as tricky as it is important, though sometimes our egos get in the way. We spend years learning our craft, so sometimes we tend to downplay a patient’s opinion. However, cosmetic dental patients are more educated than ever, and often have a fairly good sense of what they want. You should listen carefully because success can depend on a patient’s esthetic sensibilities, which fall outside the scope of dental education. While many patients are vague and simply request “beautiful teeth,” you must spend the time to find out exactly what this means to them. In these cases, it is important to use exploratory techniques to understand what they are looking for before seating the final restorations.

One way to facilitate communication is by asking patients to bring pictures of smiles they admire, and discuss whether similar results are possible and desirable for them. Since people want to see what treatment results will look like, I sometimes use imaging companies to add new smiles to patient photos and gauge patients’ reactions. After listening as best I can, I design and order waxups of the predicted final results, and make sure that patients approve them as templates for provisionals. After seating the provisionals, patients go home to evaluate them. When they return, I work with them to get the look just right. Only then do I instruct the lab to create final restorations. The provisional stage is really a crucial tryout period. If a patient repeatedly requests something that I know won’t work for them, I sometimes will provide them with provisionals of that look so they can see the predicted results for themselves. More often than not, they will choose something I originally recommended. But it’s important that they know you are willing to listen and work with them to achieve the best results.

Working with specialists

Specialists make me look better, and I use them more than ever, even though it may lead to longer completion times. For example, I sent the woman mentioned previously to a periodontist, who corrected underlying gum and bone problems. This allowed me to make her gum heights more appealing. The process took a bit longer than her original treatment but produced far better results. Recently, I placed veneers on a man’s front teeth two and one-half years after referring him to an orthodontist. I could have solved his esthetic problems initially with a full-mouth reconstruction, but orthodontics gave him a better bite. This saved him more than $40,000. Sometimes esthetic success is not possible without prior orthodontics. Patients often do not require full-blown, multi-year treatment (i.e., if braces correct some of the problems, then cosmetics can do the rest).

Unfortunately, some cosmetic dentists resist using specialists. Perhaps they are just impatient, don’t fully understand what specialists can do, or lack confidence in the specialists they know. Since a good specialist can turn a problematic cosmetic case into a spectacular success, I strongly urge colleagues to educate themselves about the capabilities of specialists and seek out the best professionals they can find. The same is true with artistic lab technicians. Frequently, I speak with the technicians at MicroDental since they translate my instructions into the final product. Their advice, talent, and intuition can make or break a cosmetic case. A little time and effort will pay off in patient satisfaction.

Dr. Christopher Pescatore lectures worldwide on topics such as state-of-the-art esthetic procedures, techniques, and materials. He holds a U.S. patent for a nonmetallic post system to restore endodontically treated teeth. He is the former clinical co-director and current featured speaker at the Las Vegas Institute for Advanced Dental Studies. He has a full-time practice in Danville, Calif., dedicated exclusively to esthetic dentistry, and also serves as Clinical Director of MicroDental Laboratories. Contact him at (925) 362-9330, or at [email protected].

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