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Simple, Predictable, and Stress-free Elective Anterior Dentistry Build a Successful Outcome Into Every Case

Anterior cosmetic procedures differ from posterior dentistry because of the psychological factors that accompany them. Unless planned and executed with great care, changing the way a person appears (and changing a smile certainly does that) creates apprehension in patients that is transmitted to the entire dental team. Communication is the key to countering apprehension. This article discusses a simple step-by-step procedure that builds confidence and predictability into every case.


Communication between individuals may be defined as an exchange of ideas or dialogue. It’s not telling, explaining, or coaxing. Understanding between the provider and recipient of cosmetic procedures is essential to make sure patients get the smile they love when it’s all over. With good communication, any capable dentist can deliver a predictably successful outcome. For the sake of simplicity, let’s divide good communication into four checkpoints. Get a patient’s permission at each one, and success is ensured.

Step 1: Permission to Discuss Cosmetic Procedures

Beginning the dialogue is often the most difficult and delicate part of the procedure. Many adult patients have an unflattering smile, but only some of them are ready to change now or might be ready in the future. In most general practices, the only way to differentiate is to ask. For example, the doctor or a team member might ask all new adult patients and re-care patients: “Modern dentistry makes straight white teeth a possibility for everyone. It that something you might want?” There are three possible answers: “yes,” “no,” or “maybe.” If the answer is “no,” let it go for now. Nobody will be offended. When the answer is “yes” or “maybe,” go to step No. 2.

Step 2: Permission to Create a Plan

Figure 1. Patient “before.” Figure 2. Virtual “after.”

Once a patient has expressed some interest in cosmetics, it’s time to present a preliminary plan. Because all cosmetics are meant to be seen, the plan should be visual for maximum impact—to bring out the “want.” The three choices are:

(1) Diagnostic wax-up on model,

(2) Mockup in the mouth, and

(3) Computer-enhanced portraits (cosmetic imaging) (Figures 1 and 2).

For many dentists, cosmetic imaging is the logical next step because it relates a proposed treatment to the patient’s facial appearance in a cost-effective and noninvasive manner. It gives patients the opportunity to “think it over” away from the dental office environment and discuss the potential changes with family and friends. Sending “before” and virtual “after” pictures to a patient’s home is a powerful yet nonconfrontational way to continue the dialogue.

Step 3: Permission to Implement the Plan

Over time, some people who expressed an interest at step 1 will express a desire to investigate the matter further. At that stage they already want the new smile but have questions relating to fees, time commitments, and durability. Once they have that information, and if they are interested in proceeding, it’s important to verify that there is a definite plan in place that will produce the cosmetic result they want. This step is perhaps the most crucial of all. Realistic, clinically accurate cosmetic imaging is an excellent way to connect with patients’ likes and dislikes. In some cases several sets of pictures may be necessary until the patient loves the result shown or, if no pictures will satisfy the patient, it might be best not to proceed with the case. One thing is sure—leaving this step to chance is inviting disaster.

Step 4: Permission to Create the Final Case

Figure 3. Bring the plan to life with wax replicas, prep guide, and temporary template.

Once a case actually gets under way it’s important to include a reliable method of turning the plan into reality. A common method employs a preparation guide and template for temporary restorations created from stone models of teeth as they will appear in the desired result (Figure 3). Such models can be made from impressions of an intraoral mock-up, or directly from cosmetic imaging pictures. Get permission from the patient to create the final case a couple of days after the provisional restorations are inserted. If the provisional restorations don’t meet the patient’s expectations, it’s important to make the needed corrections before proceeding. From that point a competent lab that is willing to “follow the plan” from a model of the temporary restorations will make insertion a routine procedure. Success is guaranteed, in advance.

Dr. Brooks is the president/CEO of Smile-Vision and a pioneer in the field of cosmetic imaging. He has a cosmetic practice in Newton, Mass. Dr. Brooks is also a national speaker and has authored numerous articles. For more information or to schedule a speaking engagement, call (800) 634-3480 ext.13 or visit www.smile-vision.net.

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