Smile Design in All-On-4 : A Sneak Preview (Part 1)
November 15, 2012
Reconstruction of missing or failing dentitions with implants is an area that has been well-documented over many decades. There are now literally a plethora of implant systems and tech- niques for replacing single or multiple teeth from which to choose.
The overall goal of natural-looking implant restorations, however, continues to be a challenge confronting dentists and dental technicians alike. Patients, univer- sally, present seeking a beautiful smile but in full arch implant reconstructions in particular, outcomes can vary consid- erably. If the ultimate goal of a beautiful smile is not achieved, disappointment ensues for both the dental team and the patient, with the patient often leaving disgruntled and in some cases litigious.
This article discusses a method of controlling the vision of the dentist, the desires of the patient and the artistic dis- position of the ceramist/technician. Due to the subjective nature of a “beautiful smile”, it’s possible that in many casesthese three parties to the final result have completely different visions in mind. As with most endeavours in life, careful planning typically leads to successful outcomes and dentistry is no different.
If we’re able to give our patients a sneak preview of the final smile, they are likely to be accepting of treatment and relaxed in the knowledge you have listened to their wishes and are skilled enough to produce the vision that they have for themselves. This is the beginning of treatment and the genesis of a plan.
In contemporary cosmetic dentistry, there are many methods for pre-planning smile design. Traditionally, the dentist will provide the laboratory with a study model, photos and guidelines for aesthetic design. The technician, in turn, will wax-up the desired result and provide the dentist with a matrix/template. The dentist will use this mould to transfer the new smile design to the patient’s mouth using a temporary dual-cure crown and bridge material (e.g. Integrity, Pro Temp, etc). Although this can be very helpful to the dentist, it may not be ideal due to the transfer of distortions or it may integrate poorly with the patients face due to artistic interpretation by the dental technician during the wax-up stage.
At best, it can be a time saver, but at worst, it can leave the dentist with a time- consuming adjustment process and a wasted appointment.
An alternative method is to use con- ventional paste composite (e.g. Charisma, Heraeus Kulzer) to freehand design “The Smile”, one tooth at a time in the patient’s mouth. This can be done rapidly and the designer is able to control length, pitch and form following the dynamic movement of the patient’s mouth. The additional use of a black text marker or felt pen enables the designer to adjust the illusion of the final tooth position without the need to cut the existing teeth.
This is truly a “Smile Design – Sneak Preview”. It’ s an immediate and pow- erful motivator for the patient who sees in their mouth a realistic preview of the final outcome – not on a computer screen or in some vague wax up on a model but directly in their own mouth in the familiar view of a mirror. This can be supported with before and after photos that the patient can take home to show loved ones if desired and to personally evaluate in a relaxed manner. No “selling” of the case is required. The patient decides if this is what they want or not. If the answer is “yes I want to go ahead with the case” we have an accurate starting point or plan. This information is then used to communicate with the dental technician.