Increasing the Predictability of Anterior Restorations

by Leonard A. Hess, DDS • Associate Faculty Member • The Dawson Academy

Every clinician is on a constant journey.  We all must continuously learn and hone our craft. Every year thousands of dentists trust the Dawson Academy to help them on their path.  One topic that interests many restorative dentists is anterior indirect restorations, and how to do them better. 

Improving a smile is one of the fastest ways to make a person happy, as their life is often changed for the better.  But a pretty smile must also function properly. Changing the anterior teeth with disregard to function can lead to broken restorations, uncomfortable speech, and muscular disharmony.  Here are a few commonly overlooked ingredients to “cooking up” a beautiful and functional smile.

Incisal Edge Position: The incisal edges must be placed in the proper position vertically and horizontally.  The teeth must be long enough esthetically, but must also work with the patients anterior guidance and envelope of function.

Photographs: The Dawson Academy consistently teaches the necessity of a complete set of diagnostic photographs. Photos are needed for treatment planning, patient education, lab communication, and documentation. Their importance cannot be overstated. 

Preparation Design:  One often neglected step in case planning is the creation of reduction stents.  The lab must have adequate reduction for esthetics and material requirements. Remember, if the lab needs 0.6mm of reduction and you only gave them 0.4mm that is a 33% error!

Laboratory Communication:  Predictability comes from giving the proper information to the lab. It isn’t their job to decide all the variables involved in anterior reconstruction. And the lab certainly shouldn’t be put into the position of guessing length and incisal edge position.   

Predictable results come from a consistent approach. As a practicing clinician I always find myself reviewing the Dawson Academy fundamentals that help me succeed.  

Comments

[Hadley Thurmon DDS]

Hi Dr. Hess,
I completely agree with your post. I have a question for you, what camera do you use and recommend? I understand the importance of photos but out camera is poor and not user friendly so photos tend to go by the way side unless we know upfront that it is an esthetic case. Also once the photos are taken, what is your process to get the photos off the flash card and into the patient's chart?

Hadley Thurmon DDS

[Dr. Lenny Hess]

Hey Hadley,

Thanks for your question and honesty. I can relate to your situation. The way to really make photography pay off is to consistently take pictures, not just some, but the whole series that we teach at the Academy. We take them on every patient that gets a diagnostic records visit. Photos help us in documentation, treatment planning, marketing, education, and lab communication. I could not practice without my camera!

I use a Canon D20 with a 105mm macro lense and ring flash. It is an older camera (only 10 megapixel) but does the job. I organize my photos on my Apple iMac. It is certainly important to invest in a good camera and put the effort into using it properly. Practice, practice, and more practice is needed. But the effort will quickly pay off in better communication, improvement in treatment planning, and the quality of case results.

You can also buy the photo aid checklist off the Dawson Web site.

Good Luck,

Dr. Leonard A. Hess