cosmetic dentistry - beauty & science

I 33 opinion _ un-cosmetic dentistry I cosmeticdentistry 3_2012 contours of the teeth, so scrap the idea of using a wax-up as an instant makeover if orthodontics would be helpful. The Clearfil shade XL appears to have a cha- meleon effect that works for most shades of teeth. If a lighter shade is desired, then a cut-back tech- nique can be employed to modify the final appea- rancewithanothershade/materiallike3MSupreme (3M ESPE). From my review of the CRA/Clinicians Report literature, this brand of composite is particularly strong in clinical use, and I have heavily restored casesthatarestillholdingupafterfiveyearsofserv- ice.Thecompositedoesnotpolishverywell,soIhave started using G-Coat as a final glaze, especially for smokers. I simply tell the patient that if he breaks the fillings, there is a 50 per cent warranty for the first12months,regardlessofhowtheywerebroken. With orthodontic treatment, you should, as mentioned earlier, try to rebuild any worn teeth beforestartingbraces.Sinceyouwillbeabletomove teeth in three dimensions, you simply build up the teeth to full size and then you move directly into orthodontic records to get started. The occlusion should be left “high” and finalised with the braces. The change in vertical dimension (VDO) appears to be another handicap that paralyses some den- tists.Ifthepatientdoesnothavemuscularproblems and headaches, there may be no need to move into splint therapy to test a bite change. Simply by look- ingattheeffectenamelreplacementwouldhaveon the bite and considering how orthodontics could manage the result may be sufficient without an articulator. A less deep overbite and a less trapped mandibleappeartobedesirablewithinmostschools of training. The cosmetic training really will begin to come into play with incisal displays, tooth proportions and fuller arches. The arch form after orthodontics usually is very pleasing and mimics the technique of overlaying ceramic on the facial surfaces of the upperbicuspids.Thetermforthishasfadedfrommy memory because I tend to avoid courses that push the use of porcelain. WhenIattendedtheUCLAAestheticContinuum, Dr Jimmy Eubank took a few moments to talk about a case in which a young teen had had her teeth dis- figuredwithbulkyveneers.Hewasforcedtoretreat her teeth but she had been compromised for life. As dentists, we are subject to many sales presenta- tions disguised as courses and we rarely get the truth. The truth is dentistry is not easy and taking one weekend course will not be nearly enough. No guru is going to tell you all that you need to know. At a recent course on anterior aesthetics taught by Dr Gerald Chiche at the Seattle Study Club, I was forced to prepare a number of veneers on plastic teeth. The burning smell reminded me of dental school, which brought back mixed emotions. I took away the idea of additive cosmetic strategies and the use of minimal reduction if choosing to use ceramic. Bonding to enamel instead of dentine still seems to be the better plan. (I also gave Dr Chiche a few photographs of John Lennon’s decayed molar andhesharedthefactthathehadanoriginalphoto oftheBeatlethatwaslostinKatrina—Ihopehefinds the copy sometime soon!) As one of the first dentists to combine STO con- ceptswithadvancedtreatmentplanningoftheworn dentition, I can honestly say that if you can set aside the use of porcelain veneers and substitute some of the treatment modalities mentioned in this article, youwilleventuallyfindawaybacktoceramicusage with a better empathy for patient care. The public is becoming wiser and the market is shifting towards dentists who are ready to mix up their training. As my UK dentist colleague Dr Martin Kelleher, who lectures on “veneerial” disease, would say, use the daughter test before you do anything irre- versible. I would add that you owe it to your patients to learn from the best in the profession, and cross- training in continuing education may be the best investment you can make in dental practice._ Dr Michael Zuk is the author of the book Confessions of a Former Cosmetic Dentist. As a consultant to several marketing programmes, includingHighSpeedBraces.org and KillerToothache.com,the dentist has cultivated unique niches as alternatives to the veneer-based practice model.Hecanbecontactedatdrz@bowerdental.com. cosmeticdentistry _about the author “...the market is shifting towards dentists who are ready to mix up their training.”