Smile-Imaging: The Key to More Predictable Dental Esthetics Lawrence E. Brooks, D.D.S.

Smile-imaging is a new concept in dentistry that offers an impressive level of predictable and successful esthetic results. It is useful in the diagnosis, communication, and treatment phases of esthetic cases regardless of the treatment plan. Smile-imaging builds esthetics into the case instead of adding them on at the end. It is available to any dentist without having to spend time learning a computer program or investing in equipment. Full-face pictures of the patient are all that are required from the dentist.

DOCTOR-PATIENT COMMUNICATION

lective dental procedures compete for the same discretionary dollars as

1 ordinary consumer goods. There- fore, dental services need to be offered in an appealing and compelling manner in order to command the atten- tion of the consumer. The use of words, models, and mockups alone often fail to convey information to the patient in an understandable and convincing manner. However, pictures of the patient as helshe will appear with the proposed esthetic changes is a powerful com- munication and motivation aid.

Successful dental esthetics depend on achieving a result that is pleasing to the patient and is compatible with good dental health. Smile-imaging allows the doc- tor and patient to evaluate several esthetic options and to select the most suitable option-before treatment has begun.

Informed choices can be made with smile-imaging. It uses easy to understand, full-face pictures to show treatment results. Previously the dentist may have cho- sen an excellent esthetic result that the patient or the patient’s family and friends would not like. Now the most pleasing esthetics can be selected by the patient from among several options. Many people need support in making an important decision. They feel more com- fortable consulting with relatives or friends about the proposed esthetic changes. Smile-imaging makes this possible.

DIAGNOSIS Smile-imaging provides a great deal of information

about esthetics, which is useful in diagnosis and case planning. It enables various esthetic options to be

Founder and Director, Professional Laboratory Service, Warenown, Mas- sachusetts. (Profesbnai Lnboratory Service offers dentists anywhere the benefits

Address reprint requests EO Dr. Lawrence Brooks, 125 Walnut Street,

0 1990 B. c Decker Inc.

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Watertown, MA 01272

studied and compared by the dentist. Smile-imaging is to the diagnosis of esthetics as a clinical examination, x-rays, and models are to conventional dental diagnosis. Smile-imaging is intended to be used in conjunction with conventional diagnostic procedures-not instead of them.

Treatment Smile-imaging photos have measurements and text

showing how an imaged result was achieved. The mea- sured photos show, in tenths of millimeters, the changes necessary to arrive at a specific result. It is the doctor’s responsibility to analyze the imaged pictures.

The impact of the projected esthetic changes on clinical factors such as occlusal, periodontal, and pulpal health must be considered. The doctor should be con- vinced that the chosen esthetic result can be achieved before starting the case. If necessary, models of the selected esthetic result can be made to provide more information. If the desired esthetic result is not possible to achieve, a more realistic goal should be selected.

Smile-imaging provides a blueprint for esthetic success. During tooth preparation the dentist uses smile-imaging measurements as a guide. In the labora-

Figure 1. Before imaging.

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Smile-Imaging

Figure 2. The right lateral incisor is removed.

Figure 3. The six maxillary anterior teeth are whitened and reshaped.

tory, smile-imaging measurements are related to the case by using accurately articulated preoperative mod- els. The esthetics of smile-imaging cases are as prede- termined, with a minimum of chairside adjustment and laboratory remakes.

How It Works Full-face (eyes-to-chin) photos of the smiling pa-

tient must be available to be imaged. The pictures can be on videotape or conventional prints or slides.

Videotape is a good source of pictures for smile- imaging because the subject’s movement and speech are recorded. Individual frames are taken from the video- tape and stored in the imaging system as still pictures.

A videotape interview can easily be conducted in the dental office. It requires the use of a video camera and a color monitor (or TV). The interview can be conducted in the dental treatment room or in an area set aside for that purpose. Best results are achieved when the patient is seated on a dental stool or straight chair. Although normal lighting is adequate, additional natural or incandescent light will improve the color and detail

Figure 4. The smile before imaging.

Figure 5. The two maxillary central incisors are treated.

of the picture. The interviewer should be seated about 4 feet from the subject. A monitor should be connected to the camera and placed next to the subject so the interviewer can see the subject and the monitor simul- taneously. The subject will not see the monitor during the interview and so will not be distracted by it. The camera can be placed on a tripod or held in the hand and braced on the dental stool.

The interview should consist of leading, but non- technical questions such as, “What do you think about the length or color of your teeth?” The patient should be given plenty of time to answer each question and allowed to speak without interruption. Most interviews take 5 minutes or less.

Patients generally react favorably to a video inter- view because it provides them with an opportunity to tell the doctor everything they expect from treatment without being hurried or interrupted.

After the interview is completed, the patient should be asked to review the video tape on the monitor. Patients now can see their smile as others see it, often for the first time. Most will leave the office witb

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Figure 6. All anterior teeth whitened and reshaped. Figure 9. body.

The interviewer braces a video camera against her

Figure 7. slightly longer than in the previous photo.

All anterior teeth whitened and reshaped. They are

Figure 10. ATV monitor is placed next to the subject during the interview. The subject’s image appears on the monitor as it is being recorded.

a heightened awareness of their current appearance-a first step for some people in recognizing the need for change.

The doctor can also use the video for case evalua- tion. It can be replayed at slow speed or paused for study. The patient’s words and gestures can be reviewed again and again. The video interview contributes a great deal of information for the doctor in the diagnosis and treatment planning of a case. When smile-imaging is indicated, the videotape can be used as a source of “before” pictures.

Photographic prints or slides can also be a source of pictures for smile-imaging. They must be clear and

] ~ i ~ ~ 8. M~~~~~~~ photo. The upper smile is taken from the before photo. smile is taken from an after photo. Text describes the dimensional changes that have been made (from h More to the after photo) in order to achieve the pictured result

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Smile-Imaging

evenly lighted. Full face photos of the smiling subject should be used. Pictures of teeth and lips alone don’t present the correct information for smile-imaging.

Photographs are made of the completed imaged case and arranged in a folder showing the “before” appearance along with several treatment options and measurements. The imaged case is now ready for pre-

sentation by the doctor. If the doctor or patient require more information or wish additional changes made to the pictures, they can be altered and reprocessed.

Smile-imaging has tremendous potential for benefit to both dentists and dental patients. It’s now up to interested practitioners to incorporate it into daily practice.

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