Clinical
uneven gingival levels and the basic aesthetic level, the patient was delighted with the result and has continued to maintain an excellent hygiene regime. The treatment was cost effec- tive and fulfilled the patient’s needs and desires. While he understands that composite restorations may require some degree of maintenance, he is willing to accept that. This process of scheduling
the treatment or “progressive smile design” can also be very beneficial in helping patients spread the cost of treatment over time, particularly impor- tant at these difficult economic times. Employing this approach will almost always ensure a more natural result and certainly produces a solution that is appropriate to meet each patient’s individual needs and desires. In order to develop a staged treatment plan, it is very important to understand the treatment options that we have available to us together with the tools and materials that we have at our disposal. Paul attended wanting
to improve his smile while understanding that there was significant structural and biologic damage to his teeth (Figure 1). He was found to have moderate periodontal disease together with erosion, attrition and caries. He also
Fig 1 Cosmetic/aesthetic
4). Elsewhere, composite resto- rations were left in place. The patient was totally satisfied with the treatment provided and maintains his hygiene with renewed vigour.
Biologic Complete Structural Functional/occlusal
wanted to improve his smile for a trip to America in just three weeks’ time! Based on a thorough examination and records process, together with listening carefully to the patient’s requirements, we were able to develop a suitable treatment plan that would allow us to continue to work on the patient’s peri- odontal needs while at the same time improving his smile and helping him to envision what could be achieved. Initial periodontal therapy
was commenced and a diag- nostic wax- up produced on mounted models. After ensuring that the patient understood the limitations of
the procedures to be provided, together with the need for further treatment, single layer hybrid composite restorations were placed in accordance with a stent constructed from the diagnostic wax-up (Figure 2). We were able to meet his dead- line for his journey to America and at the same time help him to see how his appearance may be improved. The patient returned a
month later delighted with the result and highly motivated to further improve the aesthetics. After his periodontal condition had been stabilised, porcelain crowns were placed 12,11,21,22 and 23 to restore structure, function and aesthetics (Figure
Treatment options and timeless principles Forty years ago, Dr Peter Dawson spoke about the concept of complete dentistry. He became known for function and occlusion not because it was the only part of compre- hensive dentistry that he taught but because he explained those concepts so well and how they had an impact on every other aspect of dentistry. The tools and materials that we use may have changed but the balance that he spoke about (Figure 1) is just as important today as it was back then. Similarly, he listed the treat-
ment options that are available to us: • reshape • reposition • restore • reposition bone (surgery). At first glance, the above
treatments look just to be a list of options, but if consid- ered in this order at the treatment planning phase, it will enable us to prac- tise truly minimally invasive
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