Introduction

The Maturation of Esthetic Dentistry

Cherilyn G. Sheets, DDS, and Jacinthe M. Paquette, DDS

Copyright 2002 Journal of the California Dental Association.

Twenty-five years ago, esthetic dentistry focused on bonded composite restorations. Today, esthetic dentistry has become sophisticated in approach, is multidisciplinary in scope, provides numerous potential treatment options, and is an integral part of most treatment plans. It has become popular for dentists to call themselves "cosmetic dentists" or "esthetic dentists," but the reality is that each of us addresses esthetic issues for our patients daily.

As clinicians, once we enter the world of esthetics and beauty, our comfortable world of precision and predictability seems to disappear. The adage "beauty is in the eye of the beholder" takes on a whole new meaning when a dentist has a disappointed or unhappy patient after completing work designed to be "esthetic." The parameters and guidelines that measure beauty may sometimes appear more subjective than objective. Is the patient unappreciative of the dentist’s good work? Does the patient have a better "esthetic eye" than the dentist? Or is the patient crazy and/or impossible to please due to unrealistic expectations? These are all questions that can enter the clinician’s mind when faced with patients who are displeased with their treatment outcome.

Unmet esthetic expectations can be emotionally draining, expensive, and time-consuming for everyone. The more that can be done at the beginning of the treatment planning process to lay the groundwork for a successful final outcome the better. A thorough examination, diagnosis, and treatment plan need to be coupled with precise esthetic templates or images, patient involvement in the design process, and systematic execution of the patient-agreed-upon treatment to ensure treatment success.

We have assembled some well-recognized clinicians who focus on multidisciplinary esthetic dentistry. In this issue, we will attempt to refine the diagnostic process involved in esthetic dental treatment.

* Stephen R. Marquardt, DDS, is an oral-maxillofacial surgeon who was trained as a mathematician prior to entering dental school. For more than a decade, Dr. Marquardt has been analyzing beautiful female faces in an attempt to discover a measurable and objective code of female facial beauty. It is now more possible to quantify the precise elements that make a female face more beautiful and less beautiful. Even more significant for dentistry, the same mathematical principles can be applied to the proportions of the teeth as they are exposed during smiling. He will share with us some of the conclusions of his research that can be incorporated into final restorative design.

* Robert G. Keim, DDS, EdD, PhD, brings his expertise in the science of orthodontics to further develop the concept of treatment planning for esthetic success. His paper will serve as a guide to determine how orthodontics can be helpful in the overall esthetic treatment process.

* W. Peter Nordland, DMD, will illustrate the contributions that the periodontist can make as a key member of the esthetic multidisciplinary team. He will discuss procedures that can enhance a patient’s esthetic result by "creating the picture frame" for the teeth by way of periodontal microsurgical techniques.

* Edward A. McLaren, DDS, and Robert Rifkin, DDS, will give a systematic flow chart for evaluating the restorative treatment options that are appropriate to solve esthetic problems.

* Jacinthe M. Paquette, DDS, and Cherilyn G. Sheets, DDS, will discuss how to use multidisciplinary care to create improved oral health, enhanced restorative results, and maximum esthetic improvements. Results of multidisciplinary esthetic reconstructive dentistry will be shared as examples of more complex esthetic/cosmetic treatments.

The exciting aspect of helping a patient achieve esthetic goals today is the power of synergy that is available through a multidisciplinary approach. For the patient, it often appears as if magic has occurred. Yet, there are times when the patient can achieve his or her goals through simple procedures that also carry a powerful impact -- procedures such as bonding, bleaching of teeth, and esthetic reshaping. Whatever the treatment plan and outcome, it is always important to remember three guidelines when doing esthetically driven care:

* Use the most conservative treatment that will accomplish the patient’s esthetic goals.

* Leave the patient in a healthier state than when you began.

* Teach the patient how to maintain the result.

We hope that you enjoy this issue and that you will keep it for a reference for your future esthetic treatment planning process. We also hope that it will stimulate you to delve further into some of the philosophies and techniques presented to refine your esthetic skills. Most of all, we hope that you enjoy yourself and have fun as we explore together the fascinating world of facial beauty and the role that dentistry can play in achieving it.

Contributing Editors

Cherilyn G. Sheets, DDS, maintains a full-time private practice in Newport Beach, Calif. She is the founder and executive director of the Newport Coast Oral Facial Institute and founder and chairman of the board of the Children’s Dental Center in Inglewood, Calif.

Jacinthe M. Paquette, DDS, is a prosthodontist who maintains a private practice in Newport Beach, Calif. she is associate clinical professor at the University of Southern California School of Dentistry and education director for the Newport Coast Oral Facial Institute.