How can we treatment plan
for aesthetic success?
The use of simple digital photos will aid this process. The basic smile design principles can be explained to patients manually or using photo-editing software on either a screen or a printed image. This dialogue with visual aids can help us identify exactly how we can help patients achieve their goals for their smiles.
After detailed discussions with my patients, identifying their main cosmetic concerns and educating them on the importance of a healthy foundation, the treatment planning process will commence either at that visit, or after further considerations have been made. Often, opinions will be required from our specialist endodontic and periodontal colleagues before presenting realistic treatment options to patients.
Often I’ll hear, “I would like my smile to be whiter, and more even.”
This can be a difficult concern to correct. The colour is often the least challenging aspect now, with predictable whitening options available to us, but in some cases we will have achieved an overall result that to us is beautiful but to our patient is not quite right. This can be stressful and uncomfortable, and often leaves us feeling inadequate.
In Case A (Fig. 1), an direct composite mock-up (Fig. 2) and a digital mock-up (Fig. 4) can aid in our creation of a trial smile (Figs. 5 and 6). This is one technique we have at our disposal to help us, and our patient, confirm the final aesthetics before committing to final restorations.
Therefore, we are able to tailor each smile to exacting standards and simultaneously guide our lab technicians to produce a stunning result, which addresses our client’s concerns.
This can be planned in a number of ways: Digitally (Fig. 3) or manually, using facially driven treatment planning, or without a wax-up at all and building a trial smile freehand. All options are valid, depending on the specific case, and we’re lucky to have such a wealth of options available. This trial smile will allow us to perfect the aesthetic result, down to colour, texture, length, width, incisal embrasures and, most importantly, our line angles. Line angles can disguise a wide tooth, a long tooth or a square tooth, and can transform a smile from a false to a natural appearance. Subtle corrections to line angles on a trial smile can change the effect of the entire smile design and can be the difference between an aesthetic failure or a success.
As a cosmetic dentist I am able to facilitate a dream, a desire, a goal for my patients, which is more than just a set of nicely proportioned teeth. The skills we have equipped ourselves with can allow us as dentists and technicians to design, create and deliver a life-changing event in the life of a patient—and the importance of this, and what it means to each patient, can never be underestimated.
Figure 1. Case A. ‘I hate the dark areas around my old crowns—they’re uneven, and my smile is narrow’.
Figure 2. Direct composite mock-up to widen the upper premolars and fill the narrow buccal corridors.
Figure 3. 3-D printed wax-up for upper central incisors.
Figure 4. Digital mock-up to guide us through the smile design process
of Case A. Tooth shapes, angulation, and parallelism can be previewed before treatment.
Figure 5. Trial smile for Case A from upper 5-5 constructed
from resin temporary material and direct composite.
Note line angles and textures have been considered.
Figure 6. Trial smile for upper lateral incisors in Case C,
indicating the position of mesial line angles to re-create
nature and blend the restored teeth into the smile.
Figure 7. Final outcome of Case A.
Coming in Part 2: Occlusal considerations for long-term functional success.
Dr Sam Jethwa qualified in 2012 and since has trained in aesthetic and rehabilitative dentistry with thanks to The British Academy of Cosmetic Dentistry (BACD). Jethwa practices in Hertfordshire at The Perfect Smile Studios and has been a Best Young Dentist finalist at The Dentistry and Private Dentistry Awards. He is chairman of The Young Membership Committee at the BACD and is a qualified clinical teacher and mentor for younger dentists.