Communicating Proposed Smile Changes to Patients

  • Initial Patient Communication:
    • Begin by discussing the patient's concerns and desired changes.
    • Use a questionnaire to gather information about what the patient dislikes about their smile.
  • Visual Presentation:
    • Use photography to show before-and-after scenarios.
    • Utilize software (e.g., DSD) to digitally alter images and demonstrate potential outcomes.
    • Diagnostic wax-ups on study casts to visualize proposed changes.
    • Mock-ups (direct or indirect) to show the patient how the changes will look in their mouth.
  • Diagnostic Wax-Up:
    • Take impressions to create study casts.
    • Perform a diagnostic wax-up to modify the teeth on the casts.
    • Consider mounting the casts on an articulator to assess functionality.
  • Mock-Ups:
    • Direct mock-ups involve applying composite directly to the teeth without bonding to provide a real-time visualization of the proposed changes.
    • Indirect mock-ups use a putty index made from a diagnostic wax-up to transfer a temporary material onto the patient's teeth.
  • Key Considerations:
    • Functionality: Assess potential impacts on speech, bite, and overall function.
    • Visuals: Confirm satisfaction with the aesthetic appearance.
    • Occlusion: Ensure any changes do not negatively affect the patient's bite.
    • Patient adaptability: Determine if the patient can adjust to the changes.
    • Realistic expectations: Confirm the patient's desires can be achieved.
    • Informed consent: Maintain thorough documentation and patient approval at each stage.
  • Reversible Intraoral Prototype:
    • A method to visualize the endpoint predictably and reversibly.
    • Adjustable prototype placed inside the mouth.
  • Digital Smile Design (DSD):
    • Using facial center lines, gum levels, and smile lines to modify a static 2D image to project a 3D outcome.
  • Video Documentation:
    • Record videos of the patient speaking and smiling to evaluate lip movement and tooth display especially at 90 degrees to the face along the occlusal plane
  • Informed Consent:
    • Show proposed changes and get patient feedback to ensure alignment with their expectations.
    • Document records with photographs, videos, DSD designs, and diagnostic wax-ups.
  • Collaboration with Specialists:
    • Orthodontists: Need to understand the desired final tooth position.
    • Implant surgeons: Need to visualize the planned location and dimensions for implants.
  • Treatment Planning Steps:
    • Address any acute problems and ensure periodontal stability.
    • Diagnose and correct any existing issues (e.g., caries, lesions).
  • Dynamic Process:
    • Acknowledge adaptability varies among patients.
    • Some may not adapt regardless of fit or occlusion.
  • Treatment Approach:
    • Aim for minimal intervention by showing the patient the potential outcome without irreversible changes.
  • Kesseling Setup:
    • Technique to address complex cases where teeth are moved on a cast by a technician with subsequent impressions taken and put in patient mouth.
  • Important factors:
    • Color, shape, gap and crookedness.
  • Overall Goals:
    • Visualize the endpoint as early as possible in a reversible way.
    • Ensure good communication and realistic expectations with the patient.
    • Maintain detailed records for informed consent and potential legal protection.