Aesthetic Dentistry Archives

Before and After 2021: Smile Design 2.0 (Part 1) – Performing a smile makeover for dental professionals

Apr 08. 2023

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...

PUBLICATIONS

Smile Bible: A Communication Tool Between Dental Clinicians and Technicians, Clinicians and Patients and Technicians and Patients

Sep 17. 2021

Labline featured Yugo’s article for the ‘ACADEMY’ in 2016 (originally published in English and Hungarian). There is a story behind every article I’ve created, and I cherish every single one of them. However, this particular piece is a standout because it compiles my philosophy into a single work. The contents include: Dental Material Selections The Aesthetic Articulator Digital Dental Photography Shade Taking and Smile Design Consultation I felt that the missing link in Dentistry was the communication between the clinicians and technicians with our patients, and how to educate our patients through effective correspondence to make each treatment step transparent and visually assessable. The clinical philosophy is the driving force, and the clinicians should remain the captain of the ship, no doubt. However, the...

PUBLICATIONS

Masterpiece – Visualisation with Precision: The Aesthetic Articulator

Sep 03. 2021

QDT featured Yugo’s article in 2016 (originally published in Japanese). Having trained as a dental technician in Japan (at Osaka University Dental Hospital), being featured in the ‘masterpiece’ section of QDT is an honourable achievement. It is a privileged benchmark that the high-end ceramists in Japan aspire for recognition and respect within the field. The actual storyline of the article is very similar to my previous post presenting the Aesthetic Articulator (https://smilevirtuoso.com/the-aesthetic-articulator-australian-patent-au2013100527/). However, the aesthetics of the presented case/restorations are probably the best I have ever presented from a technical perspective. The patient desired the highest level/degree of incisal translucency/characteristics, which mimics the complex nature of natural dentition. The outcome is so satisfying that even dental professionals cannot distinguish them from natural teeth. When I design...

PUBLICATIONS

Extreme Masking: Achieving Predictable Outcomes in Challenging Situations with Lithium Disilicate Bonded Restorations

Aug 20. 2021

The International Journal of Esthetic Dentistry featured Yugo’s article titled 'Extreme Masking: Achieving Predictable Outcomes in Challenging Situations with Lithium Disilicate Restorations' in 2014 (originally published in English, German, Italian, Spanish and Greek). Aesthetically speaking, metal-free restorations are proven to be superior alternatives to traditional porcelain-fused-to-metal (PFM) restorations. However, one of the most significant challenges in metal-free dentistry is the reproduction of natural dentition without the influence of a ‘negative stump’ – i.e., a very dark or metalcore showing through the final restorations. This article presents a unique ‘outside of the box’ technique that provides consistent, predictable and durable restorations, which provide the best possible aesthetic outcome. If you ask me to nominate the milestone in my career, this is undoubtedly one of them...

PUBLICATIONS

Aesthetics of a Single Central Incisor with Soft Tissue Management

Aug 06. 2021

Clinica: International Journal of Brazilian Dentistry featured Yugo's article titled 'Aesthetics of a Single Central Incisor with Soft Tissue Management' in 2014 (originally published in Portuguese). Meeting patients’ expectations is our goal regardless of the types of cases we treat. An ‘aesthetically pleasing outcome’ is ultimately judged by the patient. Without their satisfaction, the case should be considered unsuccessful even though there might be no fault with the outcome in the dental professionals’ eyes. Regardless of who you are or where you are from when it comes to restoring a single central incisor, the desire comes down to one thing – we aim to blend the restoration with the surrounding natural dentition. Today, accurate colour matching is not as challenging as in the past,...

PUBLICATIONS

Fusion of Modern and Ancient: Feldspathic/Refractory Veneers using Zirconia Porcelain

Jul 09. 2021

As a young technician over a decade ago, I searched for ways of mastering the refractory veneer technique to achieve the ultimate aesthetics. When I found the refractory die material for Zirconia, the 'aha moment' came to me, and the rest is the history. The presented technique remains how I fabricate the refractory veneers today, and it is beneficial for some instances with conservative/minimum preps. It was an honour to participate in a book chapter amongst prominent dental professionals and pioneers such as: Oliver Ahlers, Paulo Battistella, Michael Behm, Gilberto A. Borges, Oliver Brix, Julian Conejo, Daniel Edelhoff, Fàbio Fujiy, Will Geller, Galip Gürel, Axel Gütges, Sascha Hein, Ralf Janda, Akito Kani, Manfred Kern, Peer Kulzer, Karl-Heinz Kunzelmann, Klaus Möller, Klaus Müterthies, Patrick...

BEFORE AND AFTER

Before and After 2020: Missing Tooth Replacement on Lateral Incisors (Part 2)

Jun 18. 2021

A Caucasian male patient in his youth was introduced to me upon a failure of the previous Maryland-Bridges on 13-11, 21-23. The restorations only lasted for a few months (done by another technician), and I couldn’t identify its cause or never given a specific reason by the treating clinician. In part 1 of the ‘missing tooth replacement’ (click here to read), I presented implant restorations in Zirconia with Ti interface abutment to replace the lateral incisors. For this case, I present more of a conservative and cost-effective option – Maryland-Bridges in lithium disilicate (e.max) for optimum bonding strength. Figs 1-2 show the pre-op condition. Fig 3 shows my standard protocol in shade taking. I make sure to use three different shade guides to identify the...

PUBLICATIONS

The Aesthetic Articulator (Australian Patent AU2013100527)

Jun 04. 2021

QZ featured Yugo’s article titled ‘The Aesthetic Articulator (Australian Patent AU2013100527)’ in June 2015 (published language: German). Introduction: Contemporary dentistry is increasingly using digital technology to plan and communicate treatment, and, in many cases, to aid in its delivery. CAD/CAM technology is a prime example of how high tech can be melded into the dental laboratory’s workflow and, increasingly, the dental clinic. This once novel process is now commonplace throughout the mainstream dental community. Advancements in digital technology have also helped clinician and technician to communicate more clearly and precisely to achieve better patient outcomes, and involve the technician in delivering care. More and more, technology is also employed to help clinicians understand and deliver on patient expectations. Due to the increasing dental knowledge...

BEFORE AND AFTER

Before and After 2019: Missing Tooth Replacement on Lateral Incisors (Part 1)

May 28. 2021

A Caucasian female patient in her 20s was introduced to me upon completion of extensive orthodontic treatment to create enough space to replace the missing laterals. It has been a long journey for the patient to get to the point having the implants on the laterals and hoping to achieve the smile that she never thought was possible. There were a few technical challenges that I encountered: the angulation of the screw channels colour matching with the surrounding natural dentition. 1: Today, close to 100% of my implant restorations are requested as screw-retained rather than cement-retained. When the angulation of the implants are not ideal, then my primary choice is to use dynamic abutment – an alternative to the genuine Ti interface...

BEFORE AND AFTER

Before and After 2018: Smile Makeover – Replacement of Existing Restorations

May 14. 2021

A Caucasian female patient in her 40s flew in from Switzerland and stayed in Sydney, Australia, over the Xmas break for the smile makeover. Her existing veneers were only done 4-5 years ago by another technician, and she was unhappy with them due to being over contoured. The treating clinician modified the shape clinically before sending the patient to my studio for a smile design consultation. Thus, her condition was close to ideal, and she was happy with them in general. My job was to identify where we can improve and determine the number of units required to achieve the best possible outcome. Figs 1-3 show the pre-op condition. Upon detailed discussion, I observed the following information. Shape: As noted above, the treating clinician improved...

PUBLICATIONS

Ultimate Zirconia Coping Design: Understnding Aesthetics and Function

May 07. 2021

eLABORATE Magazine featured Yugo’s article titled ‘Ultimate Zirconia Coping Design: Understanding Aesthetics and Function’ in Sep/Oct 2012 (published language: English). Introduction: It has been a decade since Zirconia became available to the dental market, and it is now one of the premier alternatives to Porcelain Fused to Metal (PFM) restorations. There are always pros and cons in selecting any material, and dental professionals need to treat their chosen material properly to ensure the longevity of the restorations. One of the common issues facing Zirconia is the potential fracture of the layering ceramic/porcelain (Fig 1 & 2). The general causes of the problem are: Firing program/conditions, Parafunctional stresses, Ceramic-Zirconia compatibility, and Insufficient support in the sub-structure. Understanding of function/occlusion, visualisation of the outcome and an appropriate...

BEFORE AND AFTER

Before and After 2017: Smile Makeover – Achieving Super-bright Life-like Restorations

Apr 23. 2021

A Caucasian female patient in her 30s visited me for a consultation with temporary restorations in the mouth. She had her first set of veneers, which was about 16 years old. She recently had Invisalign, but the teeth moved out of the alignment. She is also concerned about the root exposure and uneven gingival level. She had missing second premolars and wished to have a brighter smile, in fact, as bright as possible without making them look artificial. She commenced bleaching on her lower dentition to reduce the contrast. We decided to replace the existing restorations from 13-23 – right canine to left canine, and place conservative veneers on 14&24 – right and left first premolar, a total of 8 units...

Technical/Clinical Tips & Tricks

Establishing Protocol in Digital Dental Photography: Essential Communication Tool for Dental Professionals and Patients

Apr 09. 2021

Digital photography provides good clinical evidence and is an essential communication tool for dental professionals and patients. Therefore, capturing correct information is critical when exchanging digital images. The quality of the captured images significantly reflects the quality of the final restorations. In an ideal scenario, the technician/ceramist should receive the necessary information from the treating clinician to perform to the best of their abilities, and provide the best possible outcome for their patients. The image captured by the treating clinician needs translation into the language/perspectives as the way the technicians/ceramists see and apply within their workflow – i.e., the clinician should be able to explain why they are capturing the specific photos, and the technician/ceramist should be able to understand the...

BEFORE AND AFTER

Before and After 2016: Smile Makeover – Full Mouth Reconstruction with a Heart-warming Testimonial

Apr 02. 2021

A female patient in her 50s was referred to me for a consultation, who literally got ‘hit by a bus’ in an accident. Multiple facial reconstruction and surgeries had been performed, yet she was dissatisfied with the dental work provided. After a lengthy discussion with the patient and the treating clinician, we decided to restore her brand-new smile with confidence by performing a full-mouth reconstruction. There were existing implant restorations from 12-22 – the right lateral incisor to the left lateral incisor, replaced in Screwed-Retained Implant bridge. The rest to be done in lithium disilicate (e.max). Fig 1 shows the pre-op condition. The patient’s lower lip was still hanging down at this point (due to the trauma), and thus she showed more...

PUBLICATIONS

Unbreakable Zirconia Abutments: New Lava and NeoLink Zirconia Abutments

Mar 26. 2021

eLABORATE Magazine featured Yugo’s article titled ‘Unbreakable Zirconia Abutments: New Lava and NeoLink Zirconia Abutments’ in Jan/Feb 2010 (published language: English). Introduction: Strength and aesthetics are foremost in the mind of today’s ceramist. The longevity of restorations has always been an essential factor. In the past, however, aesthetic compromises may have been tolerated, particularly in the posterior region. Thankfully today, achieving a lasting, highly aesthetic result technically has become far more accessible due to the development of new technology and materials. In the burgeoning field of implant dentistry, to maximise aesthetics, it is essential to create a customised abutment instead of using ‘off the shelf’ abutments. Custom abutments are necessary to control the emergence profile, as well as the Sub-Gingival Contour (SGC). Customised Zirconia...

BEFORE AND AFTER

Before and After 2015: Smile Makeover – Replacement of 2 Teeth on 1 Abutment with Pink Ceramics

Mar 12. 2021

A Caucasian female patient in her 20s was just about to get married and wanted to look the best. She was missing laterals with vampire-like fangs that bothered her. Because of the timeframe, orthodontic treatment was not an option. Since the teeth are all vital, we need to be conservative in prep generally, but the aggressive prep is necessary where required. Boding strength is another element we must consider. Thus, we decided to go with lithium disilicate (e.max) restorations – veneers on the central incisors and first-premolars, with joint crowns to replace the laterals and canines off one abutment for each quadrant. Fig 1 shows the pre-op condition. When working a case like this, the communication between the clinician and technician is...

BEFORE AND AFTER

Before and After 2014: Smile Makeover – Addressing Mid-line Cant and Proportion with Lateralised Canines

Mar 05. 2021

A Middle Eastern female patient was concerned about her smile’s asymmetry, cased by the midline cant and shift with missing laterals. The lateralised canines are as wide as the central incisors, so the overall proportion needs improvement. It is not visible in the initial smile photo, but the patient has a gummy smile, which she would like to address simultaneously. When working on a case like this, initial planning is crucial to visualise the outcome from the beginning, and thus, diagnostic wax-up is a must. We have decided to idealise the gingival level by crown-lengthening/gum-contouring, to begin with, then lithium disilicate (e.max) veneers from 13-23, right upper canine to left upper canine, a total of 6 teeth. Figs 1-4 show the pre-op condition. The...

BEFORE AND AFTER

Before and After 2013: Smile Makeover – Implant Zirconia Bridge with Gum Porcelain

Feb 19. 2021

An Asian patient in her 40s was depressed about the aesthetics of her smile. She had several attempts to replace the restorations to achieve natural aesthetics, which she found difficult. She was looking for “a durable, functional and, most of all, a beautiful smile” in her words. The treatment plan is to replace the existing restorations – 12-22 Screw-Retained Implant Bridge, and crowns on the canines - 13 and 23. To maintain the same property and material in the superstructure, we decided to use Zirconia with Ti interface abutment for the implant connections. Fig 1 shows the pre-op condition. The aesthetical and functional issues we need to address are: correction of the midline cant achieving a sense of symmetry on the central...

PUBLICATIONS

Reproducing Nature Part 4: Smile Design

Feb 12. 2021

LVI Visions featured Yugo’s article titled ‘Reproducing Nature: Smile Design in 2008 (published language: English). Introduction: Today, creating a natural-looking smile is essential in cosmetic/aesthetic dentistry. As I mentioned in the first part of this article (European Journal of Eesthetic Dentistry Winter 2008), many people think that white “Hollywood Smiles” look fake but is it true? Have you thought about bleached natural dentition? I think it looks healthy and attractive but doesn’t look fake at all. That is the type of benchmark I set for myself when the patient is after a perfect smile – i.e., bright yet natural. Now, what is the definition of “perfect” anyway? Does it mean that it’s perfectly in proportion, perfectly adapted to the patient’s desire or could...

BEFORE AND AFTER

Before and After 2012: Smile Makeover – Achieving Significant Change in Proportion with porcelain veneers

Feb 05. 2021

A Caucasian male patient in his 30s was deeply concerned about the aesthetics of his smile. There are several issues we had to address: most notably, changing the proportion and tooth size within the aesthetic zone, crown-lengthening/gum-contouring, and a replacement of a missing tooth on 14 (right first-premolar). We selected a Zirconia bridge on 15-13, and lithium disilicate (e.max) veneers for the rest – 12-26 (missing 25), from the right second-premolar to the left first-molar, a total of 10 units. I must admit that this case was one of the most challenging smile makeovers I had encountered at that time, but the result spoke for itself. The patient was “over the moon” with the outcome. The key to achieving such a result was...

BEFORE AND AFTER

Before and After 2011: Setting a Benchmark in Digital Photography

Jan 29. 2021

A male patient in his 30s presented with the aesthetic concerns on the gummy smile and prominent hypocalcification on the central incisors. Hypocalcification is a condition where your tooth’s enamel has an insufficient amount of calcium. When this happens, the enamel still covers the tooth’s surface but parts can be thin and weak, giving teeth an opaque or chalky appearance. We decided to proceed with crown-lengthening, to begin with, and lithium disilicate (e.max) veneers on the central incisors for the better blend with the rest of natural dentition. Figs 1, 3 and 5 show the pre-op condition. Figs 2, 4 and 6 show after completion of the crown-lengthening for the upper arch. See the consistency in the provided photos – retracted view,...

PUBLICATIONS

Reproducing Nature Part 3: Tooth Replacement with Root and Colour Matching Using Digital Photos

Jan 15. 2021

eLABORATE Magazine featured Yugo’s article titled ‘Reproducing Nature Part 3: Tooth replacement with root and colour matching using digital photos in 2006 (published language: English). Introduction: The technology available in dentistry in 2006 has improved significantly since I became a dental technician even though it’s been only eight years. Patients’ dental IQ and desires for beauty have also increased through exposure in the media. Thanks to the advancement of software such as Adobe Photoshop, we can now give patients a new smile digitally/virtually before the commencement of work to provide them with a great idea of the final result with the projected outcome. Material-wise, the trend has moved to metal-free restorations over traditional PFMs – higher aesthetics with less effort to achieve life-like restorations....

BEFORE AND AFTER

Before and After 2010: Treatment of Cleft Lip and Palate – a “Pro-bono” Smile Makeover

Jan 08. 2021

A female patient in her early 20s presented with congenitally missing upper lateral incisors, and one canine, a total of 3 teeth seeking a fixed replacement. The patient has a cleft lip and palate bilaterally, which has been treated several times over the years with surgery to repair it. Implants are not possible as there is no bone in the surgical repair sites, and in fact, she still has an oro-nasal communication. The patient had limited resources to pay for treatment and hoped that the federal Cleft Lip and Palate Scheme would cover the costs, which turned out that only extractions and dentures are eligible for the claim. Thus, the treating clinician – Dr Michael Mandikos and I had decided to treat...

PERSONAL