Clinical Trends versus
Ian Buckle addresses the issue of meeting the expectations of clients against practicalities
ver the years, there have been many trends in dentistry and as they come and
go they leave their mark – some positive, some negative. As a result, our experience will be greater and dentistry will be advanced and/or changed in some way. Most recently, we have ridden the cosmetic wave, with an emphasis on creating the perfect smile at almost any cost. Patients’ desires for immediate results coupled with most dentists preference to pursue a restorative option has probably resulted in some over-zealous tooth preparation. However, patients who
timeless principles O
ability of dentistry rather than dentistry being seen as a necessary evil. With an ageing population who want to look good and expect to keep their teeth for a lifespan that has never been longer, the expec- tations of dentistry have never been greater.
required restoration will undoubtedly have benefited from dentists’ greater under- standing of smile design. Also the profile and perception of dentistry have been enhanced with patients now appreci- ating the benefits and desir-
Trends Trends in dentistry tend to be introduced around new dental tools. For example, the devel- opment of increasingly thinner, stronger and more beautiful porcelains, together with improved bonding techniques, have propelled the cosmetic wave. We need to remember that while it is very important to move with the times and embrace new technologies, it is also essential to appreciate the concepts that underlie good dentistry and never forget the timeless principles that have stood the test of time. These days, much is
written about “comprehen- sive dentistry” as a concept, but what does that mean? Comprehensive or complete dentistry is about treating the patient as a whole rather than as a “mouth” and under- standing the balance that exists between function and aesthetics, biology and structure. It is also about understanding the psychological and psychosocial ramifica- tions that exist for each patient. Sometimes we dwell
too much on just one aspect. While patients may ask us to create a beautiful smile, I doubt there are many patients who don’t expect health, comfort, function and
50 Scottish Dental magazine
longevity to be delivered at the same time. Similarly, there are few patients who would accept a functional result that did not at least look reasonable. Understanding and managing the patient’s expectations is without doubt the most funda- mental part of any treatment plan. Taking the time to do this is crucial to a satisfactory result and a happy patient. We also need to remember
that a patient may not share the vision that we have of how their treatment may end up. There are many tools at our disposal to do this, from digital imaging and diagnostic wax ups to showing examples of completed treatments. It is also often possible to develop a treatment plan in stages, allowing a patient to stop at the point where the result is appropriate for them.
Scheduling treatment Barry’s main concern was that his front teeth continued to break down and he was afraid of losing them. He presented with erosion, decay and attrition together with mild periodontal disease. He was unconcerned about the appear- ance of his teeth at this stage. However, often such patients desire a more aesthetic result once their initial concerns have been met. In this case, after initial periodontal therapy and tooth whitening we were able to restore the teeth with a simple single layer composite system to achieve the patient’s struc- tural, functional and biological requirements. Once these parameters had been met, the patient was able to reassess his aesthetic goals with a more positive approach. Despite
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