Regardless of which chart you use, a tooth-by-tooth examination is essential to verify functional as well as esthetic limitations for the desired treatment. As basic as it may sound, there is no substitute for an extremely sharp explorer.

It is impossible to visually determine the soundness of each individual tooth. Saliva, plaque, and food deposits can too easily fill a defective margin and make it appear “perfect.” The absence of stain around a leaking or defective margin may make it easy to overlook the necessity of including that tooth in your treatment plan. Therefore, each surface of each tooth should receive a thorough evaluation. Magnifying lenses of 2.5 diopter or greater (available through Designs For Vision, Inc.) are extremely valuable tools in being able to properly detect defective restorations as well as other defects. In addition, the use of an intraoral camera (see page 29) will not only support your findings but also may reveal to you other deformities not seen by either the naked eye or with the aid of magnifying loops. The intraoral camera also has the ability to easily transilluminate and photographically record hidden microcracks that could easily alter your treatment plan. This photographic or video examination of the mouth can also make you aware of potential pit and fissure problems or hidden surface caries that could be overlooked in your visual examination or even missed with the explorer. Finally, an intraoral camera provides for easier and more accurate communication with your patient so that he or she can more readily understand the reasons for your treatment recommendations. Pay particular attention to facial and incisal erosion as well as large, defective amalgam restorations. At what point do you suggest crowning versus the more conservative treatment of bonding or laminates or 2 to 3 surface porcelain inlays? Esthetically and functionally, it may be much better to conserve the labial (or lingual) enamel rather than reduce it to place a crown. This is one instance where patients should be given a choice after being informed of the advantages and disadvantages of each treatment option. Frequently, informed patients will opt for the most costly but more conservative procedure.

Arch alignment. Arch integrity should be evaluated both vertically and horizontally. Although orthodontics can correct most arch deformities, restorative treatment frequently can provide an acceptable esthetic and functional compromise.
Determine the plane of occlusion and analyze just how discrepancies will affect the ability of your ceramist to create occlusal harmony. Slight irregularities in tooth-to-tooth position can make such a difference in the final arrangement that it always pays to take adequate study casts and then double-check your initial visual analysis to ensure that you can achieve the occlusal and incisal plane you wish.

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