Help your patients to smile with confidence. This non-formulaic focus on Smile Design offers a “how-to” approach to patient communication surrounding the art of smile analysis, the treatment planning process, and case presentation. Read it again and again as you master each step of smile creation at your own pace. This tried and tested method will transition your dental practice from a single tooth method toward full-mouth care. Honed over 30 years in her award-winning dental practice, Dr. Halley brings you her system for Smile Analysis, complemented by an array of case studies that allow you to test your skills before trying them in the clinic. Packed with “how-to” checklists, red flags, and decision points, this book will guide you through a step-by-step process, including how to incorporate technology, in the most understandable guide to better smiles available today.
Author: Elaine Halley, BDS
Dr. Halley graduated from the University of Edinburgh in 1992 and achieved membership of the Royal College of General Dental Practitioners in 1995. She is a member of the American Academy of Cosmetic Dentistry and is a director of the UK’s first Seattle Study Club, Pathfinder in Scotland. She is a member and past president of the British Academy of Cosmetic Dentistry and was the first accredited member in Scotland. She is also a member of the International College of Dentists. She is clinical director for the Pain Free Dental Group. In 2018 Dr. Halley was awarded Outstanding Contribution to Dentistry at the Dentistry Scotland Awards.
Table of Contents
WHY I WROTE THIS BOOK AND WHAT IS IT ABOUT........................................................................V
CHAPTER 1
Why Do We Smile?..............................................................................1
CHAPTER 2
Who Is the Person Behind the smile?.........................................................................................11
FIRST... LISTEN.......................................................................................................................................11
WHO IS THE PERSON BEHIND THE SMILE..............................................................................................11
CHAPTER 3
The Dental Experience...................................................17
VULNERABILITY AND TRUST................................................................................................................17
PATIENT PERCEPTION IS REALITY.....................................................................................................18
TIMELINES FOR THE PATIENT JOURNEY.............................................................................................. 20
CHANGE AND THE STAGE OF LEARNING.............................................................................................. 22
VALUES AND LEADERSHIP................................................................................................................. 23
HABITS................................................................................................................................................ 24
PERSONALITY STYLES........................................................................................................................ 26
LEARNING STYLES...................................................................................................................... 28
CHAPTER 4
Decision Point: Single Tooth or Comprehensive Approach...................................................................31
DENTIST: DR. SMITH............................................................................................................................. 32
DENTIST: DR. JONES.............................................................................................................................. 32
EMOTIONAL INTELLIGENCE .................................................................................................................. 34
SINGLE-TOOTH PROBLEMS................................................................................................................... 35
WHEN TO IMPLEMENT A DIFFERENT STRATEGY............................................................................ 36
APPOINTMENT STRATEGIES FOR TRANSITION TO GUIDED TREATMENT PLANNING.......................... 37
DIGITAL CAPTURE................................................................................................................................. 40
SCREENING VERSUS DIAGNOSIS.............................................................................................................41
RED FLAGS ............................................................................................................................................. 44
CHAPTER 5
Capture the Data.....................................................................47
PRECLINICAL............................................................................................................................................ 48
PHOTOGRAPHY AND VIDEO................................................................................................................... 49
Technical versus emotional photography................................................................................................ 50
Full-face smile photograph...................................................................................................................52
Full-face retracted photograph............................................................................................................ 52
Profile at rest......................................................................................................................................... 53
Full-smile profile.................................................................................................................................... 54
Full face at rest (M-Position)................................................................................................................ 55
Tooth display at rest............................................................................................................................... 56
FURTHER IMAGES................................................................................................................................. 58
INTRA-ORAL IMAGES................................................................................................................................ 59
The Value of a video capture protocol....................................................................................................... 60
FREEDOM—THE IMPORTANCE OF VIDEO.......................................................................................... 60
DIGITAL INTRA-ORAL SCAN......................................................................................................................64
CLINICAL EXAMINATION.............................................................................................................................65
RADIOGRAPHS/CBCT................................................................................................................................ 66
EMERGING TECHNOLOGIES .................................................................................................................... 66
COMMUNICATION SKILLS TO ENHANCE CASE ACCEPTANCE ............................................... 67
HOW TO ORGANIZE THE CAPTURED DATA......................................................................................... 68
CHAPTER 6 Guided Observation..............................................................71
TIME MANAGEMENT.....................................................................................................74
SCREENSHOT OF MULTIPLE SCREENS OPEN IN GOOGLE CHROME ................................. 76
Keynote storyboard open for the patient................................................................................................ 78
STEPS FOR ANALYSIS THROUGH GUIDED OBSERVATION........................................................ 79
CHAPTER 7
Macro Observations.............................................................81
STEP 1: GLOBAL DIAGNOSIS......................................................................................................................81
STEP 2: GENERAL RISK FACTORS............................................................................................................. 89
STEP 3: MACROESTHETIC CONSIDERATIONS.................................................................................. 92
CHAPTER 8
Mid Observations....................................................................121
STEP 4: GLOBAL FUNCTION ..................................................................................................................121
STEP 5: ORTHODONTIC OVERVIEW........................................................................................................122
STEP 6: MISSING TEETH........................................................................................................................122
CHAPTER 9
Micro Observations..........................................................123
STEP 7: TOOTH-BY-TOOTH ANALYSIS...................................................................................................123
Example of annotated screenshot from MyiTero inserted into storyboard........................126
Predicting the prognosis....................................................................................................................127
STEP 8: MICROESTHETIC EVALUATION...............................................................................................128
Other microesthetic observations.......................................................................................................128
STEP 9: SUMMARY RISK ASSESSMENT..............................................................................................134
Example case with storyboard and diagnosis and observations from filled out...............134
Diagnosis and Observations..........................................................................................................136
CHAPTER 10 Smile Design....................................................................................141
SEEING BALANCE AND HARMONY.........................................................................................................142
SYSTEMATIC SMILE DESIGN......................................................................................................................149
NON-RESTORATIVE SMILE DESIGN ........................................................................................................161
CHAPTER 11
Dental Imaging — the Power of a Visual Image.....................................................................................165
SO HOW DOES DENTAL IMAGING HELP US?.....................................................................................167
ARTIFICIAL INTELLIGENCE OPTIONS....................................................................................................170
CHAPTER 12 Trial Smile.............................................................................................173
TRIAL SMILE..................................................................................................................................179
CHAPTER 13 Outcome Simulation....................................................183
CHAPTER 14 Risk Assessment..................................................................187
1. PATIENT’S ESTHETIC EXPECTATIONS AS A RISK ........................................................................190
2. MEDICAL CONDITIONS AS A RISK......................................................................................................193
Listen to your intuition............................................................................................................................195
3. PERIODONTAL STATUS AS A RISK......................................................................................................196
4. SMILE LINE AS A RISK..........................................................................................................................196
High Smile line—No Hiding Place............................................................................................................. 200
5. LIP MOBILITY AS A RISK......................................................................................................................201
6. GINGIVAL LEVELS AND BIOTYPE AS A RISK.................................................................................201
7. SKELETAL PATTERN, BUCCAL CORRIDORS AND ARCH WIDTH AS A RISK............... 202
Anteroposterior dimension................................................................................................................. 204
8. OCCLUSAL PLANES AS A RISK........................................................................................................... 207
Curves of Spee, Wilson, and Monson...................................................................................................... 207
9. TMJ/MUSCLES AS A RISK...................................................................................................................... 208
10. OCCLUSION AS A RISK...................................................................................................................... 208
11. GUIDANCE IN LATERAL EXCURSIONS AS A RISK.................................................................... 209
12. BITE FORCE AS A RISK................................................................................................................... 209
13. CHEWING PATTERN AS A RISK............................................................................................................210
14. TOOTH ALIGNMENT AS A RISK............................................................................................................210
Bolton analysis ......................................................................................................................................210
15. MISSING TEETH AS A RISK................................................................................................................211
16. BIOMECHANICAL RISKS....................................................................................................................212
17. CARIES RISK......................................................................................................................................212
18. TOOTH SURFACE LOSS AS A RISK.....................................................................................................213
19. TOOTH COLOR RISK ASSESSMENT..................................................................................................215
CHAPTER 15
The Pause Before the Patient Presentation..............................................................................................219
STEP 1: THE CHALLENGE SUMMARY................................................................................................... 220
Considering integrated treatment planning ....................................................................................... 223
STEP 2: ASK FOR OPINIONS.......................................................................................................................224
STEP 3: TREATMENT PLAN OPTIONS .................................................................................................. 226
STEP 4: PATIENT PRESENTATION TOOLS.......................................................................................... 229
CHAPTER 16
Case Presentation............................................................231
CODIAGNOSIS...........................................................................................................................................231
WHO OWNS THE PROBLEM? ................................................................................................................ 232
STEPS FOR CASE PRESENTATION......................................................................................................... 234
STEP 1: THIS IS WHAT I SEE..................................................................................................................... 236
STEP 2: THIS IS WHERE WE COULD GO............................................................................................... 239
STEP 3: HERE ARE THE WAYS WE COULD GET THERE............................................................... 240
STEP 4: HERE ARE MY CONCERNS/OUR LIMITING FACTORS................................................241
STEP 5: HERE ARE THE RISKS, INCLUDING DOING NOTHING................................................ 242
BUILDING TRUST.................................................................................................................................. 243
STEP 6: HERE ARE THE NEXT STEPS, THE FIRST THINGS........................................................ 243
STEP 7: HERE ARE THE COSTS INVOLVED........................................................................................ 243
Discussing finance............................................................................................................................. 244
COACHING OUR PATIENTS THROUGH THE DECISION-MAKING PROCESS................... 244
CHAPTER 17
Case Studies..............................................................................247
STUDY 1: PATIENT A........................................................................................................................... 247
Preclinical information.......................................................................................................................... 247
CLINICAL EXAMINATION......................................................................................................................... 248
STORYBOARD CREATION....................................................................................................................... 249
EDITING A VIDEO IN KEYNOTE ................................................................................................................ 250
GUIDED OBSERVATION..................................................................................................................250
FILLING OUT THE DIAGNOSIS AND OBSERVATIONS FORM.....................................................251
SMILE DESIGN........................................................................................................................................ 255
RISK ASSESSMENT FORM......................................................................................................................... 257
PRE-TREATMENT AND POST-TREATMENT PHOTOGRAPHS................................................. 259
Reflection.............................................................................................................................................. 259
CASE STUDY 2: PATIENT B..................................................................................................................260
Preclinical information.......................................................................................................................... 260
CLINICAL EXAMINATION..........................................................................................................................261
DIGITAL TOUR OF THE MOUTH................................................................................................................ 262
GUIDED OBSERVATION......................................................................................................................... 265
SMILE DESIGN...................................................................................................................................... 268
RISK ASSESSMENT............................................................................................................................. 270
REFLECTION........................................................................................................................................... 274
CASE STUDY 3: PATIENT C................................................................................................................ 276
Preclinical information........................................................................................................................ 276
CLINICAL EXAMINATION................................................................................................................. 277
GUIDED OBSERVATION......................................................................................................................... 280
SMILE DESIGN......................................................................................................................................... 283
RISK ASSESSMENT.................................................................................................................................. 285
CASE PRESENTATION................................................................................................ 287
ETHICS ................................................................................................................. 287
REFLECTION............................................................................................................291
APPENDIX Diagnosis and Observations............................. 293
References............................................................................................................. 297
To the Reader........................................................................................... 299
Acknowledgments................................................................................................301
