CDE0111

I 35 MICD _ Inman Aligner I cosmeticdentistry 1_2011 dent) was built up free-hand on the incisal edge and palatalsurfacetomatchtheoutlineoftheothercen- tral. A small amount of white opaquer was dotted in tomatchthefacialsurfaceandwassimplyfilledwith a nano-hybrid composite (Venus Diamond, Heraeus) forhighpolish.Thecompositewaspolishedvertically usingrubbersticks(PoGo,DENTSPLYDeTrey)totryto blend in with surface anatomy to mask the join. The process was repeated on the lateral. Thepatientwasheldinretentionusingheraligner andanimpressionwastakenforawireretainertobe fittedtwoweekslater.Itwasespeciallynicetoretain the natural aesthetic characterisation of this pa- tient. Ceramic work, as beautiful as it can be, would certainlyhavechangedherappearancemore—some maysayforthebetter,butthatwasnotwhatthepa- tient actually wanted. She wanted her own teeth to have correct length and look straighter and whiter. _Shared responsibility of treatment The ABB concept can truly be described as mini- mally invasive. At the same time, it actively involves thepatientinthetreatment,givinghim/herafeeling of being in control and taking responsibility for his/hertreatment.Thishasbeenproventobeofgreat significancewhenmeasuringpatientsatisfactionof treatment results.4 There are many anecdotal stories about patients who had technically beautiful veneers placed but foundthatthesesimplydidnotmeettheirdesires.The problemisthatevenwithno-preparationveneers,an irreversible procedure has been undertaken and this has been done mainly based upon the treating den- tist’sopinion,withthepatienthavingverylittleinput. In my experience, every patient that I have treated according to the ABB concept has accepted the result happily,eventhoughtechnicallyitmightnotbeperfect fromasmiledesignpointofview.Nowadays,withris- inglevelsoflitigation,onewouldhavetoquestionthe wisdomofselectingatreatmentpaththatcouldresult in conflict over one in which the patient participates inkeydecisionsandseeshis/herownteethimprove. IbelievethisapproachfirmlysitsalongsideMICD coreprinciples,whichrecommendamoreminimally invasive and patient-led approach. _Conclusion I understand the controversy in challenging the traditional approach to smile design, but the new mantraofprogressive smile designisvitalwhenwe are looking to give our patients what they actually want. Previously, pre-whitening was always a way of giving our patients an alternative view of their teeth. Now, and more significantly with alignment techniques, patients can make their own decisions and massively reduce the risks by breaking down the process of a smile makeover into stages and re- assessing at each point. With ABB, it is possible to align, whiten and bond a case in less than twelve weeks, which previously might have required eight to ten veneers, four times the cost and significant tooth preparation. Thus, a dramatic contrast in pathways has been created. If a patient is happy after alignment, whitening and minimalbonding,thenthishastobeviewedasasuc- cess. This UK technique is now a significant new treatment discipline in itself and cosmetic dentistry will be better for it. After all, what would you choose to have?_ Editorial note: A complete list of references is available fromthepublisher. Dr Tif Qureshi Straight talks Seminars 40–44 Clipstone Street, Ground Floor East London,W1W 5DW UK info@straight-talks.com www.straight-talks.com cosmeticdentistry _contact Fig. 26 Fig. 25Fig. 24