No matter how skilled and well trained esthetic dentists or technicians may be, they cannot deliver results without a proper partnership. Close ceramist-clinician communication is a critical component of successful esthetic dentistry. In order to design an esthetic vision, convey this vision to the patient, and then execute the vision successfully, there must be effective communication between the ceramist, the clinician, and (most importantly) the patient. This article highlights some of the authors’ philosophies, as well as an overview of the key communication protocols that have proved effective for this team.
Key points
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Close dentist/ceramist communication is critical for successful esthetic dentistry, and it is the dentist’s responsibility to accurately convey the patient’s desires to the ceramist.
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Digital photography is an indispensable tool for the esthetic dental team.
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Each patient should be analyzed from the facial (full face), dental-facial (lips and teeth), and dental (teeth only) perspectives.
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The most important element and starting point of any smile design is the three-dimensional position of the maxillary central incisor’s incisal edge within the face.
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Whenever possible, an intraoral esthetic evaluation is performed at the outset. This evaluation serves to motivate the patient, identifies any potential limitations, and allows the team to assess the plan before performing any irreversible treatment.
Teamwork: the combined action of a group of people, especially when effective and efficient.
Introduction
No matter how skilled and well trained esthetic dentists or technicians may be, they cannot deliver results without a proper partnership. Close ceramist-clinician communication is a critical component of successful esthetic dentistry. In order to design an esthetic vision, convey this vision to the patient, and then execute the vision successfully, there must be effective communication between the ceramist, the clinician, and (most importantly) the patient.
To execute high-level esthetics, both members of the dentist/technician team must have a deep understanding of tooth position, preparation design, form, color, and of the indications/limitations of the many materials available.
Although it is easy to connect with people via social media these days, if hoping to partner with a like-minded, serious counterpart, a beginning dentist or ceramist would be wise to attend symposiums and courses geared toward both groups. Aside from the quality of the lectures and educational value of these events, the networking element is equally important. Those who spend the time and money to travel to these sort of conferences and courses are serious about their profession. It is also inspiring and educational for anyone just starting out to rub shoulders with those who have already achieved greatness in the profession. As the saying goes, if you are the smartest person in the room, you are in the wrong room.
The authors of this article, both New Yorkers and both on New York University faculty, only met for the first time in California, during a conference’s networking session 6 years ago. This article highlights some of the philosophies they share, as well as an overview of the key communication protocols that have proved effective for this team.
Philosophy
As restorative options evolve, our understanding of each material’s optical and functional properties must evolve. Each patient presents unique challenges and the solution is never 1 size fits all. It is crucial for ceramists to be comfortable with a wide range of materials, and that clinicians understand the differences in preparation design and cementation that each material necessitates.
In terms of practicing conservative dentistry, the authors aim to be minimally invasive whenever possible, but with the understanding that some patients call for a less conservative approach. For example, a 0.3-mm porcelain veneer in a patient where the tooth substrate is extremely dark might not make as much sense as a full-coverage crown. The authors share the view that, in the words of Dr Marcelo Calamita, clinicians should be less concerned with minimal preparation and more concerned with appropriate preparation.
Another viewpoint the authors share is that the ceramist must be involved from the beginning of each case, during the initial planning phase. Material considerations often have implications on not only the tooth preparations but also the surgical aspects of a case. A common example of this is situations where there is a soft tissue deficiency. The decision must be made at the outset whether the pink deficiency will be solved surgically (grafting) or prosthetically (pink porcelain), because this affects the extent of preprosthetic surgery needed. The early involvement of the ceramist in every procedure also relates to managing patient expectations, because a thorough discussion between dentist and ceramist allows the dentist to explain any limitations of a procedure to the patient at the beginning.
Initial records
Photography
The dentist-ceramist team relies heavily on the use of photography, a topic covered in depth elsewhere in this issue. Essentially, the clinician moves through a series of facial (face and teeth), dental-facial (lips and teeth), and dental photographs (teeth only) ( Fig. 1 ). These photographs, beginning with the full face and zooming in to analyze just the teeth, help the team move through a mental checklist of diagnostic criteria, from macroesthetic to microesthetic elements. The macroesthetic elements are those such as midline canting, incisal plane, and buccal corridor, whereas the microesthetic elements include aspects such as zenith levels, axial inclinations, and shade. These facial, dental-facial, and dental photographs will be repeated after the provisionals are cemented, and again on cementation of the final restorations. Table 1 shows the complete list of macroesthetic and microesthetic elements that are analyzed as these photographs are taken.
| Facial (Macroesthetic) | Dental-Facial (Macroesthetic) | Dental (Microesthetic) |
|---|---|---|
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In our offices, we have recently also incorporated video, allowing us to more fully grasp our patients’ wants and needs by seeing who they are and what they want to gain from this experience. From a diagnostic perspective, video allows us to capture each patient’s lip dynamics during speaking, and phonetic analysis, both of which are hard to capture via still photography alone. Technically, the simple setup consists of a tripod-mounted 4K high-definition (HD) video camera with a light-emitting diode (LED) ring light ( Fig. 2 ). The patients are seated in front of a black backdrop and asked to discuss their expectations, then asked to smile both naturally and with an exaggerated smile. A video of no longer than 30 seconds should be sufficient, and, from this video, HD still images can be extracted for analysis.
