April 1, 2013
by Dr. Elliot Mechanic, DDS
I am the quarterback. I call the plays and lead my team. I have learned from several great coaches and always appreciate my teammate’s input. However, I am the one that makes the final decision on how to play the game. After all, I am the one who is responsible for the final outcome. Over the years I have improved my skills. I have carefully studied the playbooks and have created new inventive plays that have consistently led the team to victory. We have made significant changes over the years adding new equipment, players with better skills and have systematically upgraded our office personnel. Time has taught us many valuable lessons. First and foremost is that the success of our team is dependent on having talented, loyal players with unique, specialized skills.
Dentistry has certainly evolved rapidly in recent years. Advances in materials and new procedures allow us to produce results that can very closely replicate nature. The bar has been raised for the standards of care in every dental discipline. Orthodontists are today creatively moving teeth on adults with debilitated dentition to enhance periodontal health and tooth position to accept ultraconservative restorations. Dental implants are no longer just placed randomly but can be precisely positioned to have the same emergence profile, contour and function as real teeth. Periodontal surgery no longer routinely aggressively reduces pockets resulting in the loss of papilla.
Wow! The dental team has learned to work together and the patient is the one benefiting. How did all this happen? What brought on these changes and paved the way to what many believe is the golden age of dentistry?
For the first 70 years of the 20th century, dentists, for the most part, practiced ABC dentistry (Amalgam, Blood, Chrome) and were looked upon by their patients and the public with fear. The pioneers of esthetic dentistry, in the 1970’s, were regarded as mavericks and charlatans. Some practitioners thought that these quacks should lose their right to practice. However, inventive esthetically driven treatment and subsequent patient demands led to creative new ways of thinking which spread throughout the entire dental profession. Today adult orthodontics has become common and orthodontists have learned to use their skills not only to straighten teeth but also to align tissue levels, treat periodontal defects and to place teeth in exacting positions to accommodate a proposed restoration. Elective periodontal plastic surgery, treating the defect not the disease, is routinely used to reposition gingival levels to where they esthetically belong.
Clearly it has been esthetic dentistry that has opened the door to the dental revolution. Knowledge of dental esthetics requires dentists to have knowledge of occlusion, periodontics, materials, etc. As a result, continuing dental education has flourished. Worldwide, a number of live, and online courses are easily accessible. The changes that esthetic dentistry has brought to the development of new procedures, technology and materials cannot be overstated. Today we speak of facially generated treatment planning with coordinated treatment between all specialties. We have begun to rethink the old conventional rules and standards of the dental profession. We are no longer living in G. V. Black’s and E.H. Angle’s world. I wish to highlight some of the milestone dates in the development of modern dentistry.
1900 –1970 – ABC dentistry. “Hollywood smile” (Dr. C. Pincus)
1955 – Buonocore – acid etch adhesive dentistry
1960 – Bowen – composite resins
1972 – Rochette – porcelain bonding
1976 – American Society for Dental Aesthetics
1979 – Smigel – bonding on ABC television’s “That’s Incredible”
1983 – Porcelain feldspathic veneers
1983 – Cerastore Crown-no metal
1983 – Dental titanium implants introduced in North America
1984 – Kokich – Orthodontic intrusion for esthetics
1985 – Dicor – 1st transluscent crown Willi-Glass – 1st porcelain veneered crown
1986 – Guided bone regeneration
1986 – Miller – periodontal plastic surgery.
1990 – In Ceram and Empress
1991 – Kanca – dentin bonding
1990’s – Esthetic (cosmetic) dentistry Adult orthodontics
1994 – Smigel – Plastic Surgery without a scalpel
2000’s – “Pink esthetics”
2010’s – Facially generated treatment planning
For approximately the first 70 years of the 20th century, the “Hollywood smile” was believed to be reserved for movie stars. How they got it was a mystery to the average patient who routinely was serviced by ABC dentistry. The introduction of resins and porcelain bonding led, in 1976, to the establishment of the first academy devoted to dental esthetics, the American Society for Dental Aesthetics. It’s founder, Dr. Irwin Smigel, in 1979, went on national television and cosmetically bonded a patient’s 6 anterior teeth. Now that was incredible! In the subsequent years, new esthetic restorative options were introduced, inspiring a new way of thinking for the entire profession. Dental implants, guided bone regeneration and elective periodontal plastic surgery were introduced in the 1980’s and by the nineties patient’s desired and demanded elective cosmetic dental changes. Why shouldn’t they be able to look their best? Dr. Smigel further described that well planned artistic dentistry was like plastic surgery without a scalpel. Esthetic dentistry suddenly was constantly in the media and public awareness and demand created the impetus for a new golden age. Consequently, orthodontists began to recognize a need, that although always there, was not widely addressed. It became common to see adults of all ages with braces! By the turn of the century the periodontists began to jump on the bandwagon. They started to use the terms “pink esthetics” and “the tissue is the issue” to convey that they were esthetic periodontists. They would have been called traitors by the periodontists of the 1970’s whose vision focused on aggressive pocket elimination, resulting in long, sensitive teeth with large embrasures so that the patient could have better access for oral hygiene.
Wouldn’t you agree that esthetic dentistry has raised the bar and set new standards for all the other dental specialties? And yet esthetic dentistry, like implantology, is not a recognized dental specialty.
Malcolm Gladwell, in his book, Outliers states that to be a master of an art one must have talent, determination and 10,000 hours of practice and experience. I sincerely believe that there is a huge difference between a dentist performing instant “smoke and mirrors” cosmetic dentistry and that of a highly trained and experienced practitioner quarterbacking a coordinated team to achieve spectacular, healthy and functional dentistry. To master es
thetic dentistry requires advanced education, knowledge of occlusion, periodontics, implantology, orthodontics, facial esthetics, prosthodontics and above all artistic skill and experience. To satisfy the credentials offered by the American Society of Dental Esthetics and the American Academy of Cosmetic Dentistry takes dedication, perseverance, hours of continuing education and artistic skill. Does every dentist possess the skills to claim that they are expert esthetic dentists? Dental advertisements certainly seems to lead the public to believe so.
The world we live in has changed drastically over the past 20 years. I believe we must rethink the dental specialties. A specialty degree may not be relevant if technique, knowledge and artistic skills are lacking. Does a degree in music composition from an accredited university program make someone a better composer than Mozart, Tchaikovsky, Gershwin or Lennon and McCartney who never had any formal university training? No longer are many general dentists simply thought of as just tooth fillers and pullers. They often spend hundreds of hours learning and perfecting their skills and complete education programs with rigid credentials. The student has often times become more skilled than the teacher. Advances in esthetic dentistry have continually led the way and pioneered the incredible changes to the entire dental profession. I am a general dentist and I am proud to be the quarterback of my team.OH