Principles

The principles for treatment planning where aesthetic dental procedures are being considered follow the same basic tenets as for any other form of restorative care provision. Effective planning should aim to help restore oral health and function, with a concomitantly acceptable aesthetic outcome.

Predictability is a key determinant for long-term success in restorative dentistry. That success is based on the implementation of a sound, sequenced and logical plan derived from the information gathered from the patient’s history and examination, taking into account the wishes of the patient and the skills of the dental operator. The need for the clinician periodically to assess the efficacy of each stage of the treatment plan (prior to progressing to the next stage), as well as the importance of maintenance and monitoring, are readily overlooked during treatment planning, highlighting the flexible nature of the process (especially with more complex casework).

The importance of effective dentist–patient communication, good record keeping and obtaining informed consent to treatment cannot be overstated.

Procedures

Start by compiling a ‘problem list’ from the information you have gathered. This diagnostic information should be ordered as described in this chapter. Your primary consideration should be the management of any presenting emergency, hence this is termed the acute stage. An effective, empathetic approach can prove to be an excellent practice builder. Treatment may range from the simple application of a proprietary varnish to seal patent dentinal tubules, the placement of a splint to treat an incomplete fracture, prescription of chemical-therapeutic agents, the placement of a composite bandage to treat a fractured tooth, extirpation of an inflamed dental pulp or drainage of a swelling to the extraction of a symptomatic tooth.

Many clinicians would contest the notion of the existence of an ‘aesthetic dental emergency’, although a missing anterior crown or an anterior dental restoration may prove to be socially debilitating! Successful treatment planning does involve a level of pragmatic flexibility. It may be desirable to deal with this emergency in a reversible manner, an example of which is shown in Figures 2.7.1 and 2.7.2.