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JADA Specialty Scan - Cosmetic/Esthetic
Cosmetic/Esthetic - A Quarterly Newsletter on Dental SpecialtiesJADA

Dental education and esthetic perception

A study in the Autumn 2015 issue of the International Journal of Esthetic Dentistry found that dentists, dental students and patients evaluating the same dental appearance made different assessments about its esthetic acceptability.

Previous studies have shown that dentists typically observe a greater need for esthetic treatment than patients do. An analysis of shape, symmetry and proportion of maxillary central incisors found that patients, dental students and dentists all had different thoughts about the ideal characteristics.

Understanding that communication between dentists and patients can be challenging, especially in esthetic dentistry, this study evaluated the influence of dental education on students’ judgment as well as the judgment of dentists and patients about patients’ dental appearance.  

“In order to avoid common misunderstandings in the clinic regarding esthetics, and to further advance dental teaching, it would be of interest to know the extent of the difference in judgment of esthetics between patients, students and professionals,” authors said.

They compared patients’ satisfaction with their dental appearance with evaluations by dental students and dentists of esthetics in those patients before and after oral rehabilitation. A total of 29 patients (21 female and 8 male); 95 dental students (49 female and 46 male); and 30 dentists (16 female and 14 male) rated the dental appearance of patients on a visual analog scale. Patients measured dental appearance by reporting absolute dissatisfaction to absolute satisfaction within the range of zero to 100, with 100 indicating absolute satisfaction. Dentists and dental students evaluated within the same range with 100 indicating absolutely esthetic. Dental students in the first, fifth and 10th semesters of study comprised the dental student groups.

Results showed that while all groups of participants judged a significant improvement after oral rehabilitation, there were significant differences between them. Ratings by dentists were closest to that of the patients. It is interesting to note that the students’ ratings converged with the dentists’ judgment the longer they had studied. In the current study, researchers found that the younger the students, the harsher their judgment.

“It is likely that as students become older and acquire more dental education, a larger variety of dental problems becomes known to them, which leads to a more balanced judgment of what is ‘normal’ and what can be achieved with dental treatment,” authors noted in discussion.

“Dental education seems to narrow the gap between patients and professional judgment, but in order to avoid patient dissatisfaction, communication with the patients and incorporating their feedback seem to be of utmost importance,” the authors noted. Among conclusions, they said that teaching esthetic rules should include insight about incorporating patient input as a means of better insuring patient satisfaction.

Read the original article.


Using CAD-CAM mock-ups

Scientists in Switzerland highlighted case studies showing that digital technology may go a long way toward obtaining mutually satisfying treatment goals when final restorations are planned. They published an article describing the opportunities digital technologies offer to the diagnostic processes during a comprehensive restorative treatment and presented clinical cases to illustrate the procedures in the Autumn 2015 issue of the International Journal of Esthetic Dentistry.

Conventional wax-ups and mock-ups are sometimes insufficient to convey potential outcomes prior to treatment, authors reported. For example, the process is time-consuming and only yields a single version, which may end with the patient or the restorative team dissatisfied with the result. Although small changes can be attempted to modify the initial draft, the range of modifications is limited and often a new diagnostic version is necessary. However, with the computer-assisted diagnostic treatment sequence, multiple try-ins can be produced simultaneously using a 3-D printer and tried in on the patient. The restorative team and the patient can then evaluate and compare the different options and make a decision based on the patient’s dental and facial appearance.

“Computer assisted design/computer assisted manufacturing (CAD-CAM) processes are transforming what were previously manual tasks into easier, faster, cheaper and more predictable mechanized methods,” authors reported. They explained the benefits a CAD-CAM workflow provides to the diagnostic processes during comprehensive restorative treatment. They described computer assisted diagnostic treatment sequences and offered clinical examples to illustrate possible outcomes.

Read the original article.


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Treating fluorosis

“It is important for the practicing dentist to be knowledgeable in the diagnosis and treatment of dental fluorosis,” said authors publishing in the July 2015 issue of Dental Clinics of North America. They use the case report of a 35-year old man to chronicle the process of conservatively achieving a successful esthetic result in a patient with severe dental fluorosis. A multistep approach to developing the treatment plan and its sequencing with an emphasis on the need to evaluate the plan at each step along the way is presented.

When over ingestion of fluoride disturbs enamel mineralization, intrinsic discolorations in the teeth lead to poor esthetic appearance. Whereas mild fluorosis is often categorized as small opaque areas or streaks covering less than 25 percent of the tooth surface, moderate fluorosis presents with brown staining and wear on occlusal surfaces. Severe fluorosis affects all of the teeth and causes mottling in addition to brown staining.

Embarrassment when smiling, difficulties in pursuing relationships and poor self-esteem are among the challenges patients with dental fluorosis report experiencing. 

The patient, with atypical staining as a result of high ingestion of fluoride in drinking water as a child, was originally from Senegal, Africa. (Authors noted recent studies indicating overexposure to naturally occurring fluoride in regions of Africa, China and India.)

The treatment plan described included in-office bleaching to reduce discoloration and porcelain veneers for maximum function and esthetics. “Patient teeth have been treated with bleaching and/or microabrasion with some degree of success. However, predictable long-term results for stained discolored teeth can be achieved with resin bonded porcelain veneers,” authors said within the summary.

In addition to the treatment plan, the report included the patients’ dental history, a discussion of treatment options, restorative considerations and prognosis.

Read the original article.

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“Dental Veneers” also lists the benefits of porcelain versus composite veneers, as well as placement steps and factors to consider before opting for veneers. The six-panel brochure is sold in packs of 50. Brochure contents can be viewed on this page. To order, call 1-800-947-4746 or go to A personalized version is also available. Readers who use the code 15410E before Aug. 28 can save 15 percent on all ADA Catalog products.


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Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

All matters pertaining to advertising should be addressed to the advertising sales manager, Sales and Marketing Department, American Dental Association, Publishing Division, 211 E. Chicago Ave., Chicago, IL 60611, 1-312-440-2740, fax 1-312-440-2550. All advertising appearing in ADA publications must comply with official published standards of the American Dental Association, a copy of which is available on request.