To accurately diagnose a patient’s problems and then create the best esthetic treatment plan, an esthetic evaluation chart is helpful. It can be a simple one-page form as developed by Goldstein or a more elaborate version. The comprehensive charts developed by Abrams and Dawson  incorporate both esthetics and function in their evaluation criteria. All critical areas of the teeth, mouth, and face are nicely displayed in an easy-to-understand diagrammatic fashion. Whether you use one of these charts or develop one of your own, they can be valuable diagnostic tools in your treatment planning.

TRANSILLUMINATION

Large tooth fractures can usually be observed clinically, but enamel microcracks are usually not seen unless the affected teeth are either transilluminated or viewed with an intraoral camera. Therefore, you should allow sufficient examination time to transilluminate or view each tooth and record whether there are vertical, horizontal, diagonal, or no microcracks present. This will help you predict the probability of future problems.
The presence of microcracks does not mean it is necessary to bond, laminate, or otherwise restore the tooth. The greatest percentage of teeth with vertical microcracks are not restored and rarely offer problems. However, teeth with horizontal or diagonal microcracks, usually the result of substantial or unusual trauma, may warrant repair. At the very least, bonding over the microcrack, if sensitive, can be useful in reducing discomfort and help to seal the defect and hold the tooth together.

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