April 1, 2000
by Steven J. Hill, BSc., DMD
For the past few years, I’ve been actively studying how to make composite filling materials look like teeth. Five or six decades of preventative dentistry has lead to a significant increase in the number of older people with complete dentitions and this has lead to the maturing (aging) of their smiles. I have found an increasing demand from my patients to make restorations of the front teeth ‘invisible’ and to reverse some of that ‘maturing’ as they have become more and more aware of the possibilities available from cosmetic dentistry. To this end, I have found that a useful exercise is to complete a few cases on stone models before going to a patient, but be careful. You don’t know what you don’t know.
Dentists have been trained traditionally with emphasis in scientific methodology and as such have been aligned with physicians as healers. In order that dental schools produce capable dentists, duplicable skills are taught and practiced producing acceptable craftsmen.
With the development and refinement of composite restorative materials, the next level in our evolution can be attained through ‘artistry.’ Nowhere in our profession is this better practiced than with composite resin restoration of teeth. Advances in adhesive technology have changed dentistry forever. The ability to predictably bond first to enamel and then to dentin has resulted in entirely new principles for preparing and restoring teeth. One of the many benefits of bonding technology is the ability to adhere restorative materials to tooth structure with a force greater than the cohesive structure of dentin. In order to produce exceptionally natural-looking results, we have to be well educated about the properties of the products on the market and we must train ourselves to really see what we’ve taken for granted before.
For example, to an art expert, a statue by Rodin and one done by another artist in Rodin’s style are readily distinguishable. What the art expert has (that I don’t) is a studied appreciation for the subtleties between them. If you complete ten cases of direct veneers on ten stone models, doubtless you will improve the speed with which you can perform the task, but will you repeat your first effort nine more times?
If I can today provide my patient an exceptional direct veneer, it’s because, “I stand on the shoulders of giants.” I try to keep current on what new materials the market has to offer by reading the journals but it’s impractical to try all the newest materials. And I’ve never been able to achieve much change from sitting through a lecture. Hands-on courses have been the only effective way I have of advancing my craft. The perspective I have gained from each of the many courses I’ve taken has been well worth the cost.
To anyone in search of mastery in a selected field of dentistry, I encourage you to attend any hands-on course you can of interest (whether you work on models, stone or live patients is a matter of individual preference). Identify and study with acknowledged mentors but valuable insights can be gained from your peers as well. Each of us has a different perspective, after all. At the last session of a hands-on course I attended last year, a dentist brought with her a sample of some new incisal shades she had received at a convention some time earlier. By the end of the evening, it was clear to all the participants that her veneers were outstanding and that indeed this new material had merit. Her sharing benefited us all.
Investigation, review and practice are crucial to our continued success but we need fresh perspective, too. I have found that gathering like-minded people together is at least supportive but can lead to surprising insights as well.
Steven J. Hill, BSc., DMD, graduated from the University of British Columbia in 1984 and has completed Creating Restorative Excellence in Seattle with a team of lecturers from the University of Washington, the Continuum on Cosmetic Dentistry in New Orleans at Louisiana State University and Restorative Dentistry III at Baylor College in Dallas, TX. He is co-founder and president-elect of the Western Canada chapter of the American Academy of Cosmetic Dentistry. He is also an accredited member of the American Academy of Cosmetic Dentistry.