Anterior Aesthetic Zone Ratio

January 15, 2019 Lee Ann Brady DMD

There are many different ways to assess and diagnose the aesthetics of a smile. I love learning a different approach, not so I can change to it, but so I can incorporate it into what I am already doing.

I had the pleasure of attending a full day lecture by Dr. Corky Willhite on transitional Bonding. Corky is one of the dentists I respect the most when it comes to composite education, and I had not heard him teach for many years so I was really looking forward to it. With all of the great new tricks I learned about composite, what I came away with that has me most excited is the four Esthetic Zone Ratios, to analyze and improve the attractiveness of a smile.

What Are Aesthetic Zone Ratios?

Esthetic Zone Ratios is an approach to smile design, and can be used in conjunction with or as a replacement for other smile design systems. There are four aesthetic zone ratios:

  • Anterior Aesthetic Zone Ratio
  • Tooth Proportion Ratio
  • Anterior Segment Ratio
  • Central Dominance Ratio

Aesthetic Zone Ratio

The first of the four ratios compares the width and height of the esthetic zone at a full smile. The first thing you will need is a full smile photograph of the patient. I typically ask the patient to say “E” to capture this photo so I do not get their posed smile with less display. I utilize presentation software to do the analysis since the program will do the math for me. I insert the full smile photograph into a slide. I then insert two lines one from for the width from inside the upper to inside the lower lip. I then do the same thing for width taking my line from the commissures, just inside the tissue of the cheek or face. You can then get the pixels length of the two lines by placing your cursor over the end of the line and holding.

Now you are going to divide the two numbers into each other, height divided by width, then take that result times 100 and you now have a percentage. The ideal ratio is between 15-30%. If this ratio is great then 30% we can then focus on a diagnostic cause of the smile being too tall or high. This might be things like Vertical Maxillary Excess or a short upper lip. The ratio triggers me to go back and look through other photos and evaluate the face and sift tissue for diagnostic challenges. If the number is smaller then 15% we may have a long upper lip, reduced lip mobility or a short lower face.

Facial and Soft Tissue anomalies are rarely treated when we fix the teeth, but can have a significant impact on the aesthetic outcomes, and when undiagnosed can often negatively impact our dental treatment plan.

Are you routinely taking diagnostic photos with patients?

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Lee Ann Brady DMD

Dr. Lee Ann Brady is passionate about dentistry, her family and making a difference. She is a general dentist and owns a practice in Glendale, AZ limited to restorative dentistry. Lee’s passion for dental education began as a CE junkie herself, pursuing lots of advanced continuing education focused on Restorative and Occlusion. In 2005, she became a full time resident faculty member for The Pankey Institute, and was promoted to Clinical Director in 2006. Lee joined Spear Education as Executive VP of Education in the fall of 2008 to teach and coordinate the educational curriculum. In June of 2011, she left Spear Education, founded leeannbrady.com and joined the dental practice she now owns as an associate. Today, she teaches at dental meetings and study clubs both nationally and internationally, continues to write for dental journals and her website, sits on the editorial board of the Journal of Cosmetic Dentistry, Inside Dentistry and DentalTown Magazines and is the Director of Education for The Pankey Institute.

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Case Study: Great Patient Expectations

November 20, 2018 Kelley Brummett DMD

Every successful dental case begins with a conversation. 

A Case of Great Dental Expectations

“So what should we do next?” my patient asked. I rolled my chair beside him, excited about the challenge of achieving his preferred future.

I looked him in the eye. “Do you really want to know?”

“Yes!” he said.

I responded, “I don’t know right at this moment. However, may I take some models, photographs, and study your mouth? Taking time to study your mouth with this information will allow me to develop viable options for you to decide what you would like to do next.”

This conversation came after my patient lost #12 and had an implant placed. He had never asked this question before and his past dental history was single tooth dentistry.

Once the records were gathered, I spent some time in my office lab opening up his vertical according to the principles that Mike Fling teaches in his worn dentition course as well as the Pankey restorative footprint and clinical sequence taught in our Essentials 3 curriculum.

From my patient’s diagnosis, I discovered that he had two options: ortho plus restorative treatment or restorative treatment without ortho. Space was needed and form and function would definitely improve with improved space. We met for a conversation.

We looked at photos and models, then discussed the options. He explained to me that he would prefer to do the restorative plan without the orthodontics. My team and I invited him to experience a mock-up of the potential outcome from a wax-up by our own John Lavicka of Dental Ceramics. The patient immediately replied, “Let’s do it!”

Even though the patient understood why I wanted to do the orthodontics, he wanted to attempt treatment without it. I was happy to move forward with a restorative-only treatment with one agreement: If it did not work, I could initiate orthodontics. He agreed.

To be continued …

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Kelley Brummett DMD

Dr. Kelley D. Brummett was born and raised in Missouri. She attended the University of Kansas on a full-ride scholarship in springboard diving and received honors for being the Big Eight Diving Champion on the 1 meter springboard in 1988 and in 1992. Dr. Kelley received her BA in communication at the University of Kansas and went on to receive her Bachelor of Science in Nursing. After practicing nursing, Dr Kelley Brummett went on to earn a degree in Dentistry at the Medical College of Georgia. She has continued her education at the Pankey Institute to further her love of learning and her pursuit to provide quality individual care. Dr. Brummett is a Clinical Instructor at Georgia Regents University and is a member of the American Academy of Cosmetic Dentistry. Dr. Brummett and her husband Darin have two children, Sarah and Sam. They have made Newnan their home for the past 9 years. In her free time, she enjoys traveling, reading and playing with her dogs. Dr. Brummett is an active member of the ADA, GDA, AGDA, and an alumni of the Pankey Institute.

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Individualizing the Hygiene Exam

March 28, 2018 Mary Osborne RDH

The hygiene exam can be a dreaded topic in the dental practice, especially if you’ve been dodging the issue for a while. Depending on your state, there may be specific rules or regulations about how the hygiene exam should be conducted. After meeting these rules though, it’s up to you to determine what style of hygiene exam best suits your goals.

Hygiene exams can complicate your relationship with hygienists if you don’t have an open dialogue about why you conduct them the way you do. There isn’t one right or wrong way to do things. That’s what makes it such a challenge for clinicians.

Conducting a More Effective Hygiene Exam

Commitment to your purpose should help you decide on how you want a hygiene exam to go. Most importantly, don’t do something you dislike simply because you think it’s the only option. Your obligation is to meet your patients’ needs while fulfilling your ethical or moral responsibility.

Patient expectations are where things get tricky. It doesn’t necessarily matter if your style is to put most of the responsibility in your hygienist’s hands or if you prefer to enact a thorough exam yourself. What does matter is that your patient knows what to expect and that you meet that expectation.

If you want to meet with patients for an in-depth exam, then schedule that time. If your hygienist will handle the majority of the exam, give them the tools and the training they need to feel confident. By the same token, if you want to check in on patients, but don’t want to do more than visit, then don’t even put on your gloves.

In the end, you can choose a combination of hygiene exam processes. Just keep your patients and your team informed.

How do you conduct hygiene exams in your practice and why? We’d love to hear from you!

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Mary Osborne RDH

Mary is known internationally as a writer and speaker on patient care and communication. Her writing has been acclaimed in respected print and online publications. She is widely known at dental meetings in the U.S., Canada, and Europe as a knowledgeable and dynamic speaker. Her passion for dentistry inspires individuals and groups to bring the best of themselves to their work, and to fully embrace the difference they make in the lives of those they serve.

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Know Your Work: Examination & Discovery

January 29, 2018 Edwin "Mac" McDonald DDS

The best dentists I know mastered the art of examination and discovery first. They learned to understand their patients’ conditions and how they relate to one another.

Leadership Through Discovery & Complexity

In that process of discovery, highly competent dentists learn to navigate complexity by confidently using reference points. These guide their understanding of what they discover. They train their eyes to see the details of esthetics, tooth structure, function, and periodontal type and status. Their fingers learn to feel the dynamic nature of the patient’s functional system.

They use every available form of imaging and records that add meaning to their discovery. Ultimately, they intentionally, systematically, and thoroughly develop a diagnosis that can determine the treatment plan. They manage complexity by moving toward simplicity.

Absolute and relative reference points serve as guides in designing the optimal scheme for the patient. When the patient’s teeth, gingiva, bone, functional scheme, and esthetics have been lost, those reference points tell you where to start and where to end. They both establish and limit what needs to be created.

Managing Complex Cases

Dentists at this level possess a very sound understanding of the dental functional system and a very detailed understanding of dental esthetics. They specially focus on how these two systems relate to one another.

They also understand their role in coordinating, guiding, and leading their interdisciplinary team in managing the complex case. To be certain, every member has a strong voice in developing and executing the treatment plan. Leadership in knowing your work really becomes visible in this process.

Someone has to decide where the case is going and how it is going to get there. There are many voices in the process, but at the end of the day that someone has to be you the leader, who also happens to be the first and final designer of the beautiful smile that is being restored to health.

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Edwin "Mac" McDonald DDS

Dr. Edwin A. McDonald III received his Bachelor of Science degree in Chemistry and Economics from Midwestern State University. He earned his DDS degree from the University of Texas Dental Branch at Houston. Dr. McDonald has completed extensive training in dental implant dentistry through the University of Florida Center for Implant Dentistry. He has also completed extensive aesthetic dentistry training through various programs including the Seattle Institute, The Pankey Institute and Spear Education. Mac is a general dentist in Plano Texas. His practice is focused on esthetic and restorative dentistry. He is a visiting faculty member at the Pankey Institute. Mac also lectures at meetings around the country and has been very active with both the Dallas County Dental Association and the Texas Dental Association. Currently, he is a student in the Naveen Jindal School of Business at the University of Texas at Dallas pursuing a graduate certificate in Executive and Professional Coaching. With Dr. Joel Small, he is co-founder of Line of Sight Coaching, dedicated to helping healthcare professionals develop leadership and coaching skills that improve the effectiveness, morale and productivity of their teams.

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Is the Patient Ready?

October 11, 2017 Mike Crete DDS

Have you ever recommended treatment to a patient and then gotten the “deer in the headlights” stare with the sound of silence in the room?

This is usually an indication the patient was listening to what you had to say … they just were not ready to HEAR what you said!

Knowing Your Patient and Learning When They Are Ready

One of the aspects of the Philosophy of Dentistry as taught by Dr. LD Pankey is the concept of “knowing” your patient. Do you really know what your patient’s circumstances, objectives, and temperament are?

When you really understand your patient, you are able to meet them where they are. You will then know when they might be ready to hear the recommendations you have to improve their dental health.

Knowing your patient starts with asking the right questions and using active listening skills while getting to know the patient. What are their values, fears, expectations, perceived needs? Do they have an appreciation of dentistry and value what it has to offer? A.K.A., what is their dental IQ?

Do they need more education about their current condition? Does their budget now include dental care? Are they ready to make an informed choice about their treatment options?

I oftentimes find myself initially putting out the “fire” for a patient (ie. repairing a broken cusp or chipped front tooth, getting the patient out of pain) and then easing the patient into care in our office in a way that makes them feel taken care of.

I may take several years to build trust with the patient, educate them about optimum oral health, and help them understand the root causes of their condition. Over time, the patient usually starts to ask more questions and dental health becomes a high value for them. They eventually say something like, “Hey doc, I’m READY … when can we get started?”

Developing your clinical skills is very important to providing excellent dental care. But I find it’s equally important to develop your communication skills such that you can really get to know your patient and know when they are READY to own their condition and get started with the necessary treatment.

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Mike Crete DDS

Dr. Mike Crete lives and practices in Grand Rapids, MI. He graduated from the University of Michigan dental school over 30 years ago. He has always been an avid learner and dedicated to advanced continuing education., After completing the entire curriculum at The Pankey Institute, Mike returned to join the visiting faculty. Mike is an active member of the Pankey Board of Directors, teaches in essentials one and runs two local Pankey Learning Groups in Grand Rapids.

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Funny Things That Happen When a Dentist Has Dental Work

September 20, 2017 Pankey Gram

Having dental work done when you’re a dentist is a strange experience. It can be enlightening, frustrating, relaxing, or a combination of all three.

The phenomenon of dentists treating dentists is one fraught with more than a few commonalities…

4 Things That Happen When Dentists Get Dental Work

1. We Empathize More With Patients

When we’re the one in the chair, we experience dental work from the opposite perspective. We’re bound to think things like, ‘Geez, this grinding really does shake my head.’ What seems like no big deal as a dentist seems much more dramatic as a patient.

2. We Notice the Overlooked Details

Lying back gives us the chance to see the operatory from a whole new angle. We notice all the water spots on the light cover from the disinfrectant and the quality of the safety glasses. We’re sure to have these details checked in our own office as soon as we get return from the appointment.

3. We Get Super Controlling or Super Relaxed

For many dentists it is hard to just be the patient; we understand every little thing that is happening, but can’t keep track of the details when we are being worked on. With nothing else to do, our minds race as we review the procedure, how we do it, and how it is being done right now. We’ll wonder, ‘did they let the etch sit for exactly 25 seconds?’ or ‘did they scrub with the dentin adhesive for 15 seconds twice?’ We can’t help but hold our chosen clinician’s hand throughout the prep, despite vetting and trusting them beforehand.

Other dentists take the opposite approach. You don’t even want to think about what’s going on. For once, you don’t have to make the critical decisions.

4. We Experience Some Miscommunication Issues

Many of us squeeze our dental work in at lunch or other free time during the work day. We end up having to go back and talk to our patients numb. Often times, this creates the best conversations, as patient realize dentists have dentistry too!

What would you add to this list? We’d love to hear from you in the comments!

 

 

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