The Art and Science of Cosmetic Dentistry

by Steven J. Hill, DMD

My wife, Barbara, and I were attending a dental dinner party a while ago when another dentist and his wife engaged us in a conversation. He made the comment that he, too, did a lot of cosmetic dentistry and wondered what kind of camera he should buy, as he didn’t yet own one. If he had said that he had practised a lot of dentistry and had wondered what sort of high-speed he should buy, as he didn’t yet own one, I would not have been more at a loss for words.

As we move from the diagnosis of pathology to the creation of visual impact, we need photographic records to support and complete our existing patient records. I can’t tell you how humbling it was to compare what looked good in the chair to what I saw projected, larger than life, on my own basement wall. Magnification exposed my every failing and provided me with the best feedback I’ve ever received for improving the quality of my dentistry. For the serious dentist intent on moving into cosmetics, I recommend 35mm slide photography, as it provides the best available balance of magnification, resolution, and price.

In the beginning I had a poor appreciation of tooth form and contour, and of course, one has to know what’s wrong with something before one can improve it. We need to become ardent students of the art and science of cosmetic dentistry. After gaining some experience in practice, extra study courses are a must. Weekend continuing education courses are a good way to start but they aren’t a substitute for focused hands-on approaches or mentored hands-on study clubs such as what are now being offered around North America. The last continuing education course I attended was a hands-on technician’s course given by a ceramist accredited by the American Academy of Cosmetic Dentistry. I urge every dentist to take such a course. Seeking accreditation with AACD is an excellent way to motivate dentists to hone their skills in cosmetics.

Cosmetic dentistry is, in essence, good dentistry where all the factors-occlusion, perio, fit, contour, texture, and colour-are addressed; Dr Pascal Magne of the University of Geneva uses the term, “biomimetic”-dentistry that mimics nature. To achieve this result it takes more than special training alone, it takes special attention to a myriad of details. We can’t simply write, “A2” on a lab prescription for an anterior veneer case and expect to get back porcelain restorations that mimic the natural condition.

To dentists unsure of how to enter this arena: start with your own cases in your own practices. Take on the challenge, not only to meet but also to exceed the patients’ expectations, and to make the resulting dentistry invisible. I recently referred a patient to a periodontist for therapy. He called me to compliment the PFM bridge from #13-#15 that I had previously restored. His hygienist had probed the pocket depths around the pontic on both the facial and the lingual and had recorded the 6 readings. It wasn’t until after the x-ray examination had been completed that they realised that it was actually a bridge and not simply a 3-unit splint. Practitioners who can meet a challenge such as this can greatly benefit both their patients and themselves.OH