32 I I opinion _ un-cosmetic dentistry thatareactuallymuchmorecomplexthanyourealise (you will be defeated!). You MUST take a full ortho- donticcoursesuchastheonetaughtbyDrRichardLitt, andyouareinsanenottotakeaseriesoforalrehabil- itation courses from Dr Frank Spear or Dr John Kois. Adultorthodonticsisfull-mouthreconstruction, and the treatment of worn dentition is too impor- tant to overlook. In fact, orthodontists have a very difficulttimetryingtotreatadultswithworndenti- tion, so I consider this a very good niche for doctors ready to invest in cross-training. I have seen an orthodontist try to treat an ad- vanced wear situation with full orthodontics, and the result was all wrong. Instead of allowing for the restorative material, the practitioner moved the short teeth into place as if they were full size, so when we wanted to lengthen the worn incisors the result was a posterior open bite. The easier way to treatthecasewouldhavebeentobuilduptheteeth with composite prior to starting the orthodontics. Cosmetic dentists have a tendency to veneer everything.Theyveneerteethstraightbecausethey claim braces take three to four years. They veneer teeth to get rid of wrinkles and headaches. They veneer teeth to whiten and straighten them. They veneer teeth because the old veneers break. Exag- geratedtimesinbracesareoftenliesthatneedtobe corrected as soon as possible to stop the abuse that isgoingon.Cosmeticdentistsneedtoreprogramme tobackoffandgetsomeair.Andorthodontistsneed togivealittleelbowroomtotheirreferringdentists who want to offer some orthodontics. The smart ones maintain a positive relationship and often see referrals from the primary care dentist increase. I know, NOT ALL cosmetic dentists are Veneer Nazis, and NOT ALL orthodontists tell patients that GP or- thodontics causes root resorption. My suggestion for breaking an aesthetic obses- sionis“cosmeticdetox”,whichisverydifficultifyou have focused your training on aesthetic dentistry. The easiest way to do this is to take porcelain ve- neers off the table in the treatment planning stage. Composite resin can be used conservatively with orthodontics to provide a near-complete medium to long-term solution. Any time you stick to a single series of training programmes, you start to pick up biases that warp your thinking. You will find that the ideas within thedentalprofessionareasextremeasthereligions and political beliefs around the world. The pro- ponents of the various philosophies can be very convincing, but I think each doctor needs to take a stepbackandmakeupanindividualphilosophythat puts the patient first. If you take the average patient, this means that you will offer fast, affordable, reversible and con- servative treatment. Millions has been spent to makepeoplethinkveneersarebetterthanrealteeth; I challenge that idea. Porcelain is not as good as healthy enamel, not now and not ever. Of course, it isamaterialthatservesapurposebutoftenitisused simply to line the dentist’s pockets. So to recap this approach to care, I suggest you take an STO course from one of the two 6-month braces programmes, add a full orthodontic pro- gramme (ideally taught by an orthodontist who has taught orthodontics grad students), take a full- mouth reconstruction programme (or at least a worn dentition component), then if you want you can take a composite technique course. I personally do not get fancy with composite, since my patients do not have loupes or want to pay double for advanced microscopic cosmetics. Whatpatientsdohateiscompositesthatchip/stain. This brings me to use Clearfil AP-X PLT (Kuraray— no endorsement money yet!). Free-hand compos- ite bonding is the best way to be able follow the Dr Zuk is also known as the crazy dentist who bought a tooth from John Lennon. (DTI/Photo courtesy of Sandra Olson, Canada) cosmeticdentistry 3_2012