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    It’s a very interesting read

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    2 views44 pages

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    Hashim B. Fraij
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    of 44
    CHAPTER 1 Esthetic Diagnosis: A Three-Step Analysis PCa ean eT a ee 2 Senn eta) 3 freee 27 The diagnostic wax-up. Ey The esthetic mock-up Ea ed ry INTRODUCTION TO THE THREE-STEP ANALYSIS ‘Beauty is in the eye of the beholder’, itis said, and we have been hearing this, old comment for many years. One person can love Renaissance art, for instan while another favours post-modernism, and neither would be wrong. However, while the perception of ‘beauty’ is a subjective experience (flavoured by ethni- city, culture and an endless list of other factors), there are certain universal guidelines that transcend this subjectivity and provide us with factual, objective criteria as to what pleases the human eye. These fundamental esthetic standards can help us as clinicians to design and create ‘beauty’ in a quantitative, scientific and predictable manner. ‘Today — duc in part to a convergence of trends in tooth-whitening, ‘Extreme Makeover’ style television shows and oral care companies spending millions on advertising - the smile has been solidified in our culture as a centrepiece of overall beauty. There is greater demand than ever before for elective, esthetically driven dentistry, which is a major shift from the atmosphere of just a few genera tions ago, when a trip to the dentist meant either a cleaning or the resolution of pain. Patients today. in addition to wanting clean, pain-free mouths, commonly seek rejuvenated, improved or completely transformed smiles. We as dentists must retool, redefine and reinvent ourselves to be not only competent clinicians, but ‘smile experts’. Simply stated, we need to reimagine who we are today. INTRODUCTION TO THE THREE-STEP ANALYSIS As smile experts, we need to use objective, fact-based thinking to understand the esthetic demands of our patients. We must use a systemized and structured methodology to make sure no stone is left unturned and, through the data we have collected, propose a plan that will not only resolve the esthetic problems ut will respect the critically important functional requirements of our patients teeth as well. The approach can be broken down into three steps: identify the problems, visualize the customized solution (in three dimensions) and choose the appropriate technique to get there. Historically the diagnostic approach has been to lead with structure—function— biology and only then to consider esthetics, which could easily result in @ com- promised esthetic outcome and an unhappy patient. What we are suggesting in this chapter is reversing the approach: considering the esthetics first (which is usually the patient's chief concern) and then studying the structure function-biology' in the context of an ideal esthetic vision, By diagnosing cases in this new sequence we sct ourselves up for success, optimizing communication from day one and ensuring that we meet the desires of our patients (Figs 1.1 and 1.2) esmerics Fig. 11. Tradonal thinking Fig. 12. New way f thinking, Step tivo of the analysis is to perform a diagnostic wax-up on the mounted casts that is guided by the information from the Esthetic Evaluation Form. This allows us to visualize tooth shape, tooth position and soft tissue harmony as it relates to the three views of facial, dentofacial and dental esthetics. Once the diagnostic wax-up is done, we then transfer a ‘mock-up’ of it into the patient's mouth. This offers our patient a preview of the visualized solution and is an opportunity for us to gather crucial feedback, By listening to the patient's opinion about the proposed tooth colour, shape and position. it is possible to avoid future communication mistakes. CLINICAL TIP ‘Many allure are tnibtable to a breakdown of communication among the exsenliny of patent, dest and technica, rather than a probe fe echnical nature vang the Festorations themselves ‘The notes we take during this stage will be conveyed directly to the lab techni- clan and, together with the dentist and patient, the three parties then become an empowered team (Fig. 1.3). We can now co-create our esthetic vision together, THE ESTHETIC EVALUATION FORM. Dr Peter Dawson once said, ‘If you know where you are and you know where you want to go, getting there is easy.’ That statement aloncis the key to tackling any case. In this section we will describe a systemized method for determining exactly ‘where you are’ at the outset of any esthetic case. THE ESTHETIC EVALUATION FORM Restorative dentist Patient, << Technician pow As we know from other industries (i. technology, manufacturing and hospital- ity), a factual checklist approach to any process avoids errors, miscalculations and miscommunication. In our field, a checklist used at the esthetic consulta- tion appointment will allow a clinician to move seamlessly through the diagnos- tie process, assessing both esthetics and function at the same time. Figure 1.4 is an Esthetic Evaluation Form that was originally created by the author (Dr J. Levine) in 1995 and has now gone through multiple revisions, CLINICAL TIP The key objective of the Esthetic Evaluation Ferm ito establish the incisal edge position and the singval margin ef the maxifary central incisor, two crucial landmarks around which the entire case willbe designed, As we move through the form, we study the smile in increasing detail and ask effective, open-ended questions to pinpoint the patient's true esthetic needs. Like acamerazooming in, we analyse facial esthetic elements first (‘macro-esthetics’) follow this with a dentofacial assessment and, finally, study the dental view (‘micro-esthetic’ elements) SECTION ONE: EFFECTIVE QUESTIONS ‘We begin by asking our patient the open-ended question, ‘If there was anything you could change about your smile, what would it be?” This question is designed to clicit as much information as possible, as opposed to a closed-ended question such as, ‘Do you like your smile?” which only gives the clinician a yes or no answer. We want the patient involved in the process and, by creating effective communication right from the beginning, the team (comprised of the patient dentist and technician) can then begin to build a strong relationship that is focused on effective communication and, by default, success. We are guided by the 80:20 rule of listening, where we ask our effective questions and we listen 80% of the time, Esthetic Evaluation Form” Patent Examine Det 1.Effective Questions 18: Do you tke he visu! image of Strain, White, Perec "Clan,Hoany Nata” White ang Nata looking tat? 10: Previous Records Do you have any photos of your sil, os srile you Kha, os in ove Ne hate vesment parsing? 2. Facial Analysis :A: Fall Smile 1: Lips at Rest 4. terpuplary Line to Oeelusl Plane 4. Upper Lip © Ganted ight 8 Average 8 Canta lot 3 Thin (iastlay) to Face (Pniron) oro 6 Right ot cener thin 3 let of canter 3. Lge 5, Relationship of Lips to Face Prominent CpSymmetn) SRenuded 1 symmaticl 8 Let sigemgher 4 Tooth Exposure 2 Right sie higher Met Masilay mm Manat ar — "me 4. Nasolabil An 2 hormal(appron, 0") 3 Promnant Raia (¢ 90°) 1 Rruog Maw (> 90") 2. Rickatts' Elan (Orawn fom tis of nose t chin) ‘Uppe tip eplane mm (cea rm) oie Lip to Eplane — rm (eal 2 om) OWN S cenvex 0 encave mus prominent. nasolbi angle i < 90% orl ene, ‘oneier smal less dominant maslaryanttioresteralons imal ia ered, nals angle» 90, poe concave, ‘onsiser more sominant maxi seri restoration, Fig. 14 Esthetic Evaluation For. THE ESTHETIC EVALUATION FORM 3. Dentofacial Analysis - Vertical and Horizontal Components ‘A: Upper Smile Line Incisal ages to Lower Lp ‘avenge eFigh Convex Curve ‘oSvaght™ —oReverse £6: Tooth —Lower Lip Postion Fu Sul —Number of Text Olga STouching 9 NetTavehing_ Sight Covered oe oe Wo Mee Ry ee fe toaen-Camca param ee Semen Sete saree 0a At eg tar NegveSace, pment Serena se "TERRE ate tment on ty teat = =a 2. ssn ost pce snt she 4. Dena Anaya ‘A: Stating shade 8: Central Incisor WidthiMeight Ratio :C: Proportion of CentrallatraliCanine Manabu ro o> t0% 0

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