This dual form of recording information will capture simultaneously the pretreatment full face and smile of the patient as well as the conversation relative to his or her perceived condition or problem. Both an audio and video recording are extremely helpful if there is any future question about the exact condition with which the patient originally presented. The camera is mounted on a track above the patient and is remotely controlled to show and record all desired aspects of the patient’s face and mouth. A monitor in the room shows the recording in real time, or you may record without the monitor for future viewing only. Viewing the two-dimensional full-face aspect on a television screen makes it easier for both you and your patient to accurately see the silhouette form. This is also true when recording the patient’s right and left profile, and close-up smiling and speaking. Most patients are amazed by what is revealed in these views. They become acutely aware that this is what everyone else sees and they want to make sure these views eventually present them in the most flattering way possible. The result is a greater potential for a more comprehensive treatment plan.
X-Rays. Although the typical full-mouth radiographic series is indispensable to patient examination, there are times when some patients will object to the extent of the radiation or to x-rays, period. In these cases, it is extremely valuable to have technology like radiovisiography (RVG). Because it accomplishes the same service at 80 to 90% less radiation, it can effectively overcome patient objections to traditional x-rays. Computerized radiographs are also used to take multiple different-angle views of problem areas, and the fact that it is instantaneous can save time in diagnostic procedures.
This technology is also helpful when fitting inlays, onlays, crowns, posts, and virtually all other fixed prostheses where try-in adjustments are usually necessary to obtain perfection in fit. Patients will not object to further radiographs when they realize how little radiation the process involves. This means you can continue to fit your prosthesis and repeatedly check the margin with additional x-rays until it is perfect.
T-Scan Occlusal Analysis. Although there are innumerable methods of evaluating your patient’s occlusal problems relating to esthetics, one device (T-Scan) is of particular help in both diagnosing and demonstrating occlusal difficulties to your patient. The T-Scan is a computerized system that uses sensor technology to identify the location, timing, and relative force of occlusal contacts. You will also find it indispensable when treating patients who have a difficult time explaining their problem to you. While it may be difficult for you to see occlusal articulating marks on a tooth, it is easy for both you and your patient to visualize and understand occlusal trauma areas when displayed three-dimensionally by the T-Scan on your monitor.
Periodontal Charting. No part of the esthetic examination is more important than ascertaining the condition of your patient’s supporting bone structure.
The most perfect restoration in the world will fail if placed in a tooth with a weak supporting structure. Therefore, functionally, esthetically, and legally you are required to thoroughly examine full-mouth radiographs as well as probe teeth in six locations. This can be done with a traditional periodontal probe or by an electronic device, where the data can be recorded electronically using a voice-activated system.
One major advantage in producing a color, 8 × 10 easy-to-comprehend chart (Victor, Prodentec) to give to the patient is to make him or her feel more responsible for any diagnosed periodontal problems. It is far better to give your patients tangible evidence of their periodontal problems rather than merely orally informing them of your findings. Voice activation makes it easy and quick for your hygienist to perform this periodontal charting on virtually every patient and also enables you to provide periodic progress charts when necessary.
Computer Imaging. One of the most exciting new diagnostic and treatment planning aids in esthetic dentistry is computer imaging. Used first in 1986 by plastic surgeons and beauty companies, the computer makes it possible to digitally alter the pictures of a patient’s teeth and face, and to produce a picture of how they might look after cosmetic treatment. This visual prediction of potential treatment solutions to esthetic problems offers an unparalleled method of letting you and the patient look at how your intended esthetic correction will not only change your patient’s smile, but also in many cases, his or her entire face. It also accomplishes the following:
1. It allows you to do a better job of treatment planning by allowing you to visualize a possible result, which can then be studied to determine its esthetic effect.
2. The patient is able to view your intended correction and make suggestions on how he or she would like to see it modified.
3. Based on feedback from the patient, further computer imaging allows you to show the patient how they can look with any number of additional or different esthetic changes and improvements. You, therefore, are limited only by your creative ability.
4. It increases patient motivation by demonstrating the positive aspects of an improved appearance and enhanced self-image, and reducing patient uncertainty and anxiety.
5. It helps to establish the fact that your office employs state-of-the-art diagnostic and communicative tools and techniques, making a positive statement about the type of dentistry you practice. The real value in enabling a patient to see proposed changes is ensuring that both dentist and patient envision the same result. If, for any reason, they do not have the same expectations, this is the proper time to make any changes regarding results. Certainly, unmet expectations after your treatment can require either redoing or altering the correction; or even worse, they may establish a defensive position with the patient, which frequently causes a wider communication gap. At the very least, one can avoid discovery after the fact, which is expensive. Retreatment of the patient is usually done at a loss for the dental office. It does not take too many losses of this type to realize that computer imaging can be a valuable asset when a major esthetic correction is being planned.
There is a legitimate question raised when turning to the decision of who is to perform the imaging. Obviously, many dentists like to make their own computer changes while others prefer to have a computer imaging therapist assist in providing this service. Unfortunately, time, or lack of it, may help make the decision. In our office, this certainly is a major reason why we chose to not only have a computer imaging therapist on staff but also one who is a practicing hygienist. This fact makes her more capable of understanding our intended changes, plus she is artistically qualified and has excellent ability to communicate with the patient. This last fact also saves the doctors considerable “explanation” time. However, the imaging therapist can be a hygienist, assistant, or another person knowledgeable about dental procedures. When you state what your intended correction will encompass, the computer imaging therapist must understand sufficiently to make the proposed changes in the computer. The patient must be made to clearly understand that the image produced by the computer is only an approximation of intended results the dentist feels he or she can reasonably attain. If you plan to give a copy of the computerized image to the patient, remember to always print, in color, a disclaimer clause on the copy. This clause may read as follows: “This picture is for purposes of illustration only. It does not represent a guarantee of any kind.”
The following is a good example of just how important computer imaging can be:
A 26-year-old professional athlete was concerned about his crowded teeth. Clinical examination revealed a high lip line with gingival tissue covering the cervical third of the teeth. This combination resulted in a disproportional smile/tooth relationship to the full face.
The patient’s previous dentist stressed the ideal solution of orthodontics but did not give him any alternative. The patient felt there must be an alternative, such as crowning. When orally discussing the various options for improving his appearance, the patient could visualize how straight the teeth would look, but he had difficulty understanding the need for cosmetic periodontal therapy.
Computer imaging was used to show the patient what could be expected of cosmetic periodontal surgery plus ten porcelain laminates. When he saw the intended result through computer imaging, his immediate question was, “How fast can the treatment be accomplished?”. Computer imaging played a major role in convincing this patient of the importance of both procedures to obtain maximum esthetic results.
Other major uses of computer imaging are as follows:
1. You can show the patients views of their teeth and smile that they would not normally see.
2. You can provide full-face frontal and profile views that can help you and your patient visualize what effect proposed changes to the teeth and gingival tissues can have on the face.
3. Imaging may reveal to you and to your patient what not to do. Not infrequently, certain intraoral changes can have a detrimental effect, instead of the desired one, by being too perfect or too imperfect. Equally damaging is making teeth too light or too dark. Although not guaranteeing a perfect shade, the computer can help illustrate to the patient an acceptable, approximate shade range. A critical consideration for imaging occurs when orthodontic treatment achieves occlusal success only to destroy facial balance. For example, moving anterior teeth lingually either with orthodontics or through prosthetic means may make for occlusal success, but it may cause more prominence to the patient’s nose. Your patient may like his or her nose as it is. Making the proposed change could produce an esthetic disaster from the patient’s point of view.
4. When restorative treatment consists of bonding, laminates, or crowns, imaging can be invaluable during the try-in phase when the patient or dentist is not absolutely certain of the optimal length or width of the new restoration. Rather than blindly removing existing porcelain incisal edges on the restoration, which could ruin your esthetic result, it is easier to image your patient and make the changes on the screen. You and your patient can then come to a mutual agreement on what looks best.
5. Another critical area where computer imaging can make a significant difference is in the communication between the dentist and the off-site laboratory technician. That communication is most often in the form of models, impressions, and written notes. If an actual picture reflecting what you and your patient expect is given to the laboratory technician, the probability of a successful result is greatly improved.
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