Before and After 2021: Smile Design 2.0 (Part 1) – Performing a smile makeover for dental professionals
I’ve been meaning to work on my publications for a while but was occupied with my GAMSAT studies, plus the establishment and stabilisation of my new business – Smile Virtuoso, in Pyrmont, NSW. It’s been a year and a half since I updated my blog posts, and now I finally have an opportunity to work on some exciting projects to share and be published in 2023!
I want to kick off the blog post in this Before and After section, titled ‘Smile Design 2.0 (part 1 and part 2)’. These blog posts serve as sneak peeks of the cases presented in my upcoming article, where I present a standardised protocol in smile design, explaining the requirements in digital photography and communication method between dental professionals and patients. I won’t get into much detail here within the blog posts, but you’ll get an idea of the overall workflow for an ultimate smile makeover experience for my clients and patients.
The presented case shows a Caucasian male patient, a retired dentist originally from the UK. Under normal circumstances, dental technicians/ceramists receive cases from their dentists or prosthodontists; however, the patient directly contacted me to treat him in this situation. I enjoy working with and performing on dental professionals because it shows the credibility and authenticity of my skills, knowledge and reputation gained within the industry. The patient also had a treating clinician in mind that he could trust, who coincidentally turned out to be one of my best clients! It is a small world we live in when it comes to the high-end market, and let’s see what we can do to manage patients with the highest expectations:)
Temps in Situ:
Feedback from the patient: Dr Myles Lear (a retired dentist)
Having been born and raised in Manchester, UK, a city of unfluoridated water, and enjoying unfettered access to a sugary diet in my youth, it was no wonder I attended Liverpool University Dental School in 1979 with restorations in most of my teeth. Several RCTs followed, as did a post-crown to tooth 22 in 1993. I consequently have consciously not shown my teeth when smiling for as long as I can remember.
I moved to Australia in 1997, and it was around 2008 when I crossed paths with Yugo. I decided that if I were ever to undergo a dental makeover, I would entrust the technical work to him, period.
Fast forward to 2020, and having looked at my smile of patchwork dentistry in the mirror once too often, I decided the time to act had more than arrived. Unless Yugo could talk me out of it, I had intended to have my friend and ex-dental partner, Dr Andrew Prideaux of Mosman, Sydney perform the clinical side of things. Having worked with Andrew, Yugo didn’t try.
I had my pre-treatment consultation with Yugo in August 2020. After numerous photographs and extensive discussions of a mainly aesthetic nature followed. Heartbreaking as it would be, I was tempted to include the virginal 13 and 23 in the treatment plan for aesthetic completion. Yugo, confident in what he could achieve, considered their inclusion unnecessary. Subject to clinical considerations, a provisional plan was agreed upon – we’d fill the buccal corridors and enhance the anterior sextant with more aligned, longer and more youthful lithium disilicate (e.max) restorations to 17, 16, 15, 14, 12, 11, 21, 22, 24, 26.
The treatment plan was finalised with Andrew – all of the teeth would be crowned, except 21, which would receive a veneer. Lithium disilicate (e.max) for all units. Yugo produced a diagnostic wax-up and putty key.
The teeth were subsequently prepped, and high-quality temps were fitted. The aesthetic improvement was instant and vast.
I returned to Yugo for the ‘temp consultation’, during which we discussed the changes we both felt were necessary for the definitive restorations. We agreed upon a rounding of the disto-incisal corners and an appropriately flattering degree of wear and tear to the insical edges of the anteriors. More photographs were taken for reference. Yugo’s challenge was the root-filled and darkened 11, the existing proclined black carbon-fibre post of the root-filled and darkened 22 and the slight palatal inclination of 23, relative to 13.
Cementation was uneventful, all units seating with good contact points without adjustment. A minimal but anticipated occlusal adjustment was performed. The shade match (brightness and warmth) to the existing canines is excellent. The anteriors are aligned and, although considerably longer than my pre-prep teeth, are in harmony with my lips and stature. Filling the buccal corridors has broadened my smile. The labial lobes/concavities and wear and tear of the incisal edges of the anteriors are the decorations on the cake.
Root-filled teeth 34 and 46 subsequently received Zirconia crowns, 34 being built to achieve guidance with 23, taking the load away from the root-filled and post-crowned 22.
I saw Yugo for a post-treatment appraisal and photo shoot soon after. Family and friends (some dental) comment on how natural things look, even the dentists being forced to question exactly what I’ve had done. I could not be happier, and of course, I wish I’d done it earlier.
I’m grateful to Andrew and Yugo for their efforts and skills and now smile freely and broadly.
Feedback from the treating clinician: Dr Andrew Prideaux (Mosman Fine Dental)
I was introduced to Yugo in 2001, soon after he found his permanent hometown of Sydney, Australia.
Yugo was highly recommended by colleagues and had excellent technical qualifications, but even so, like most dentists, I was quite cautious in sending my crown and bridge work to a new ceramist.
My careful assessment meant starting with simple cases, but very soon, I was able to see that his quality was exceptional.
So nearly 20 years later, I can say that we have a very close and positive working relationship, particularly on complex cosmetic cases.
It is with these more comprehensive cases that I enjoy Yugo’s individual management of the patient and case from start to finish.
Most of my cases will start with me sending full records to “Smile by Yugo“ and then our patients are booked in for a smile/shade consultation at the laboratory prior to a second consultation with myself.
I can say that in almost every case, Yugo is able to communicate and educate the patient to a much better level than I can in dental surgery.
His careful assessment and excellent photography allow him to discuss ideal treatment in a less clinical setting.
This translates, in most cases, to my patients coming back to me with a very clear understanding of the value in treating their smiles comprehensively. Instead of focusing on a single problem or obsessing about the shade of a single central incisor, I can then plan for a full case, whether it be 4,6 or 12 teeth in the one arch.
Once I have confirmed the final decision with Yugo (on how many teeth we will treat), he will complete a digital smile design and a diagnostic wax-up.
Many patients are happy to proceed straight to treatment because their trust levels are very high after meeting Yugo and our own team.
For those needing further confirmation, Yugo will produce a digital smile design of their new smile so patients can visualise the changes in shade and form of the new crowns or veneers. This is a powerful marketing tool and can be emailed or shared at the cosmetic consultation, where we show the before and virtual after photos.
Occasionally I will go one step further and place a provisional “mock-up” using temporary crown and bridge material so the patient can have more certainty on our final smile destination. Of course, this is only possible in cases where the veneers are mostly additive – i.e., minimal preparation is required.
From here, it is usually easy to progress to treatment and place provisional veneers over the prepared teeth.
Yugo’s input continues during the provisional phase with a 2nd consultation to ensure that his design and wax-up are perfect when seen in the mouth. Again, having a second pair of eyes to check over the design gives me great comfort that when I come to cement the final ceramics, everything will be flawless, and we will have a very happy patient.
It is a real pleasure to work with Yugo, and I can’t believe it is over 20 years since we met.
Dr Andrew Prideaux (Mosman Fine Dental, NSW) – https://mosmanfinedental.com.au/