cosmetic dentistry - beauty & science

patient communication _ diagnostic mock-up I help patients understand and visualise the ex- pected aesthetic outcome, with each having its limitations. These include diagnostic wax-ups, before and after pictures of other patients, com- puter imaging and direct mock-ups with com- posite resin. The diagnostic wax-up is created by modifying the shape of teeth on a patient’s diagnostic cast with the application of wax and by reducing the stone as needed. It is well known that this diag- nostic tool is indispensable in complex aesthetic cases.Itmaybeveryhelpfuleveninsimplercases. The diagnostic wax-up often reveals additional necessary treatment that was not evident during the clinical exam and is a dynamic visual and functional aid in achieving predictable results. It is highly recommended that the practitioner keep one duplicated cast unaltered for future reference and for comparison when explaining the treatment plan to the patient. However, it might be difficult for the patient to envision the final result only by looking at a cast. Direct mock-up with composite resin may assist with visualisation, by the process in which com- posite resin is applied to the desired shape on dry and unetched teeth without application of adhesive and is therefore fully reversible. A pilot study conducted by Dr Dov Almog et al.2 compared these different communication tech- niques in cases of diastema closure, including before and after pictures of other patients, diag- nostic wax-ups, direct mock-ups using composite resin on unetched teeth and computer-imaging simulation. Twenty-four patients, nineteen women and five men, were included in the study. Their re- sults showed that computer-imaging simulation wasthepreferredmethodofvisualisation(54.2per cent) followed by direct composite resin mock-up (33.3 per cent), and before and after pictures of otherpatients(12.5percent).Nopatientindicated diagnostic wax-up as his or her preferred method of visualisation. While computer-imaging simula- tion allows for modification of pretreatment pic- tures to the desired outcome, it does not take into consideration factors such as occlusion and may not be reproducible clinically. Therefore, it should be used with caution. Direct mock-up with composite resin was also preferredbypatientsforvisualisationofexpected aesthetic outcome. Direct mock-up can help in determining the correct shade for direct compos- ite resin restorations and can serve as a practical chairside alternative to the diagnostic wax-up. It can also be used to create a lingual matrix for multilayered composite resin restorations. How- ever, achieving the desired results with the direct mock-upcanbequitetime-consumingandcostly with the use of composite materials as the mock- up medium. An easy way to overcome these drawbacks while still using the same principle of applying material to teeth in a reversible manner has been described in the literature3–6 and is called a diag- Fig. 6_Diagnostic mock-up (Case I). Fig. 7_Intra-oral view of diagnostic mock-up (Case I). Fig. 8_Post-op photograph of patient’s smile (Case I). Fig. 9_Post-op intra-oral view (Case I). I 21cosmeticdentistry 3_2012 Fig. 6 Fig. 7 Fig. 8 Fig. 9