Dental Asia Jul/Aug 2017 - page 68

lthough it has
been six years
since I published
my first articles
on Progressive
Smile Design, I actually discovered
this concept in 2006.
However, it
is quite clear from attending many
conferences, and witnessing the fierce
debates on Facebook, that its potential
significance has not quite yet sunk in
amongst those practicing aesthetic and
cosmetic dentistry. It is also true that that
subject of smile design usually polarises
readers. Some will think they already know
it all, while others will think it is irrelevant
to their practice. I’m hoping to prove both
groups wrong by joining the debate with
three suggestions that I truly believe in.
forms of aesthetic dentistry that can have
dramatic effect withminimal risk.
Smile Design planning, as it has been
known, is taught from back to front
(tobeexplained) andonly serves aniche
market which is disconnected from
most dentists.
3. The tools for any dentist to create
beautiful smiles without even picking
up a drill are available.
I would argue that cosmetic dentistry
traditionally focusses on big high-end cases
and I find that this is a very shortsighted
approach. It has effectively become a very
well publicised niche market that very few
patients could afford. It is also a treatment
that can be carried out by very few dentists
as many patients simply do not have the
budget or are unwilling to take the risk.
With Progressive Smile Design, a much
wider range of patients can potentially be
treated by amuch larger number of dentists
at a much lower risk.
Traditional smile design focusses on an
endpoint – now processed in a digital
manner via computer software. This is
translated to a
wax-up and the
patient is shown
what could be
achieved. This can
even be tried in
the mouth with a
stent made from
the wax up. Often,
ideal smile design
parameters are
built into this set
up so a patient will
commonly view
8-10 units changed
in their mouth via
simulation or the
trial smile. These parameters will include
golden proportion, connector harmony,
wider buccal corridors, perfect incisal
outlines, correct gingival zeniths.
However, by showing a patient this at
the start point, they are naturally going
to assume that this is what they want.
Irreversible treatment is then carried out
to achieve this using porcelain /composite
veneers/ even no prep veneers. Currently,
many patients are having the concept of no
prep, minimal prep or composite veneers
promoted to them as a way of achieving a
perfect smile.
The big question is: Do these people really
need these techniques at all?
Digital smile design, as clever as it is does
not allow patients to see small, in situ
changes and more often than not, means
a patient will opt for a far more dramatic
treatment plan than may be required to
make them happy. I have personally
witnessed countless occasions where
patients who initially thought they
wanted ideal smile design, changed
their minds after seeing their teeth
align/whiten and after receiving
edge additions.
The cynical will commonly say,
“Improving smiles in anyway at
all is completely unnecessary,”
but that would be highly
The Concept of
Progressive Smile Design
Dr. Tif Qureshi, Past President of the BACD
and Director of IAS Academy, shows how
a step by step approach to smile design
can make things simpler, far safer and
something many dentists can do.
Dr. Tif Qureshi
Fig. 1: Before left side retracted view.
Fig. 5: Before Upper Occlusal View.
Fig. 6: After upper Occlusal View and Bleaching
(10 weeks).
Fig. 3: Before upper model.
Fig. 4: After 3D Print.
Fig. 2: Right side retracted view
after alignment and whitening
(10 weeks).
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