As the perception of esthetics and beauty is extremely subjective and largely influenced by personal beliefs, trends, fashion, and input from the media, a universally applicable definition is not available. Hence, smile aesthetics is a multifactorial issue that needs to be adequately addressed during aesthetic treatment. As more information becomes available to patients through different forms of media, they become more critical of how their goals are achieved. A common concern expressed by patients is the amount of healthy tooth structure removed in the process of reaching their desired aesthetic goals. Dental professionals have also expressed their concern over the excessive removal of healthy tooth structure for the sole purpose of upgrading a patient’s appearance.When patients state their preference of more conservative approaches, minimally invasive treatment options can be considered.
Pre-op photo showing dark left central, unsatisfactory form of the laterals for the patient. Treatment goals: improve color on all teeth by in-office bleaching and walking bleaching on left central, replace all composite fillings and improve form on laterals with direct composite veneers.
Pre-op RTG showing big periapical lesion.
After in-office bleaching and two weeks of walking bleaching on upper left central.
Shade taking with composite buttons.
Isolation of the preparation.
Immediate post-op, after polishing and removing the rubber dam.
Check up after two weeks for control of composite integration after rehydration.
Control after 3 months.
RTG control after 3 months.
Control after 5 months, note integration of composite fillings and color stabilization.
RTG control after 5 months, note the reducing of the periapical lesion.
Note improvement in color on all teeth and form of the laterals.
One of the goals of dentistry is to develop new approaches in restorative dentistry that will reduce the amount of tooth removal during treatment. With advances in material science and restorative techniques, we are able to attain these ideals and recreate nature and improve esthetics with minimal removal of tooth structure.
Delivering a desired smile in an evidence-based manner while meeting the patient’s preference of a minimally invasive approach can be professionally fulfilling to the dentist and, at the same time, very valuable to the patient. During the course of designing and treating smiles, uncovering patients’ concerns before finalizing any treatment plan, involving patients in the choices made, and basing decisions on the available scientific evidence can create confidence and guarantee more successful outcomes.
1. Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health. 2011;11:6.
2. World Congress of Minimally Invasive Dentistry. Minimally invasive dentistry (MID). Accessed January 10, 2012.
3. Scarlett MI. Evidence-based dentistry makes practice more predictable. Inside Dentistry. 2007;3.