Dr. Harvey Silverman, Founder of the Silverman Institute of Cosmetic Dentistry

Over the course of the next several months, Dr. Harvey Silverman, the dentist behind 

, will provide short tips to help you expand your cosmetic dentistry practice in this 'New Year, New You' Cosmetic Dentistry Web Series.

Here's the first tip: How to financially pre-qualify your patients based on budget concerns and cosmetic dentistry needs.

In this new web series, I will be sharing tips every week that build your cosmetic practice.

You are busy; therefore, each tip is designed to be read in 10 minutes. To get the most out of this series, consider me to be your cosmetic dentistry coach. Check back each week for a new tip. Post your questions in the comments section of this article.

Here’s the scenario: You did a cosmetic dentistry case presentation. You have a motivated patient who is excited about having work done. He wants to proceed with veneers. He asks what it will cost. Once you state the fee, your patient’s enthusiasm suddenly wanes and he says,  “Let me think about it.” 

For many dentists this is a familiar scenario.

All too often this means the patient will probably not go through with the cosmetic dentistry treatment. However, this does not have to be the case if you understand the forces at work behind your patient’s comment.

The issue boils down to affordability. Even with patient finance programs, spending $5,000 to $10,000 may exceed what your patient feels he or she can afford.

 that expands your cosmetic practice and eliminates fees from being a roadblock.

Here’s how to do that: First, designate a team member as your Smile Care Advocate™ (SCA). The SCA is the team member most excited about cosmetic dentistry. The SCA advocates for the patient, sharing what the patient wants with other team members before you see the patient.

Another function of the SCA is to pre-qualify financial concerns. Most patients have a budget. When your fee exceeds that budget patients are hesitant

 Therefore, the SCA needs to find out what your patient is hoping to invest. Once you discover this expectation, create a plan that provides optimum results at a fee that matches the patient's comfort level. Remember this is an elective service and patients have options.

Keep in mind that pre-qualifying is not diagnosing. In later articles I will describe other forms of pre-qualifying. In this context, financial pre-qualifying will help you tailor a treatment plan that solves the patient's cosmetic needs and budget concerns.

: When finances are an issue consider combining in-office whitening with one or two in-office veneers.

I have coached dentists who had done zero elective veneers in the past 6 months. By using this suggestion, these same dentists have increased their elective veneers cases up to 52 in two weeks.

Albert Einstein once said that the definition of insanity is doing the same thing over and over and expecting different results. If you want to do more cosmetic dentistry, evaluate and modify your cosmetic presentation.

Articles

Over the course of the next several months, Dr. Harvey Silverman, the dentist behind The Same Day Smile Makeover Web Series, will provide short tips to help you expand your cosmetic dentistry practice in this 'New Year, New You' Cosmetic Dentistry Web Series. Here's the first tip: How to financially pre-qualify your patients based on budget concerns and cosmetic dentistry needs.

10-Minute tips to build your cosmetic dentistry practice

In the second installment of this new Web series, Dr. Harvey Silverman provides tips on how to determine if the veneers you’re placing will look natural.

In the last edition of The 10 Minute Easy Smile Makeover, I discussed how your Smile Care Advocate (SCA) can help work-up patients who want to transform their smile but cannot afford it or do not want to have a conventional smile makeover.  

This week’s tip is how to accurately determine if your veneer will look natural.

We have all seen patients with artificial looking veneers. The teeth appear so prominent or opaque they stick out when the patient smiles. So, how can veneers look natural?

Coaching tip: Computer imaging is one technique many dentists use to share what a veneer might look like. However, with non-invasive in-office veneers I suggest doing a Smile Preview with a mock-up. This preview of the veneer is more accurate. By doing this you’ll also know if your skill set matches the patient’s expectations.  

After the mock-up is done, evaluate it for size, shape and color considerations.  Did you achieve the desired esthetic transformation (meeting your critical eye and the patient’s expectations)? Does the veneer look like it was born with that tooth?  

If it does you will have a natural looking veneer. If it doesn’t, take a pass.

Tip for docs who think out of the box: With the EasySmile® approach, there are clinical scenarios where you can actually first place the veneer and then do in-office whitening immediately after that.  

Indications: When trying to achieve 2 to 6 shades of color change with in-office whitening. It can also work with transformations of 6 shades or more but with less predictability. That’s because we know most patients (but not all) achieve up to 6 shades of brightness based on the Vident’s VITA Classical Shade Guide. But we cannot always count on 7 shades plus of improvement.

Let’s consider how this works for a patient whose teeth are C1 and wants to have teeth that are B1: A 5-shade change with the shade guide arranged in value order:              

B1, A1, B2, D2, A2, C1, C2, D4, A3, D3, B3, A3.5, B4, C3, A4, C4

Imagine this same patient had endo on a central incisor and is shade A3.  

The patient wants a veneer that also will be B1. 

Here’s a tip for docs who think out of the box. Before bleaching do the Smile Preview (mock-up) without using opaquers. Is the mock-up color B1? If it isn’t take a pass. If it is B1, then consider doing the in-office veneer first as it will blend in with the bleached teeth.  I’m sure you’re thinking this is unconventional, right?  

In a few weeks I’ll explain more. It is really a cool system.

As a result of advances in technology and in material sciences I now do more in-office veneers than porcelain veneers. Using our Smile Preview system I coach docs to create in-office veneers that look gorgeous. It’s a simpler, more esthetic approach and patients routinely say, “Can I have this done today?”  

Will the veneers you're placing look natural? Here's how to tell.

Don’t think any of your current patients are interested in veneers or other cosmetic dentistry? Dr. Harvey Silverman explains why that likely isn’t the case.

I discussed how to determine if your veneers will look natural before starting the case. This week, I want to address how to determine where the latent demand for cosmetic dentistry exists in your practice.  

Let’s face it … many general dentists believe the demand for cosmetic dentistry is largely tapped out in their own practice. Here’s a surprise-that is 

 you have many patients who are interested in veneers.

I often train doctors who think they need to advertise to do more cosmetic dentistry. I then show that isn’t necessarily the case.  

 patients still want to change the size, shape or appearance of 

. That’s a lot of untapped cosmetic cases!  Advertising is fine but let’s look at your patients before looking elsewhere.

Here’s one way you can immediately determine the latent demand existing in your practice:  

First, have you noticed how few patients ask if they are a candidate for cosmetic dentistry? Some do but most do not. Many have asked about tooth whitening but most do not bring up cosmetic dentistry with veneers.

Even patients with obvious smile issues often do not bring up veneers. These same patients wear nice clothing and pay attention to their hair and skin.  However when they smile or talk their teeth are a distraction.  

Why don’t they have some cosmetic dentistry done? The answer to that question and 

to that will be evident as you read this series.  Use the EasySmile

 approach and you will expand your cosmetic practice. You’ll definitely enjoy seeing how effective and easy it is to do.

Here’s how you can professionally determine which patients in your practice still want to have cosmetic dentistry. First, 

 that any patient interested in cosmetic dentistry already had it done. Some docs have said that to me. You need to learn how to tap into this latent demand. It’s really not hard. I will show you how.

 and I'll send you a complimentary copy of our 

(SD Form) that you can use in your practice.  

Once you receive it have every new and recall patient fill out the form.  Remember the essential role your Smile Care Advocate™ has in this process.

As your coach, I want you to highlight any answer where the patient said 

.  Review the responses and you will notice that if your practice is like most offices, 8 out of 10 patients will check 

to at least one question in our SD Form. This is the 

in professionally determining which patients in your practice still want to discuss cosmetic dentistry services with you. That’s where the latent demand is.

Patient Demand: How to find the hidden interest for veneers

Looking to get more patients interested in cosmetic dentistry? Get your team involved.

 series, here's how to get your team members to enhance the cosmetic dentistry experience.

I addressed how receptionists can use the information obtained in the 

 (SD Form). If you have not requested our SD Form, contact me at incrediblesmiles@aol.com. Please include your name, professional degree and where you practice.

This week, I want to discuss how your team members can enhance the patient’s cosmetic dentistry experience using the EasySmile

 approach by making certain they share information gained about the patient’s experience with other team members.

Once the receptionist determines where the latent demand exists for cosmetic dentistry in your practice it is imperative that information is known, reinforced and augmented by the next team member. Your SCA is the key individual that needs to supervise and coordinate this activity. 

Before the next team member escorts the patient from the reception area to the treatment or hygiene room, that team member must first check-in with your receptionist. Quickly review 

 on the smile enhancement form and ask the receptionist what concerns and degree of interest the patient had about the cosmetic services discussed.

If the receptionist is busy with another patient that is not a problem. In the back of the SD Form there is a section where the receptionist can summarize important information so the next team member can be quickly brought up to speed. It only takes 

 for the receptionist to fill out the back of the SD Form.

When a patient shows strong interest in cosmetic dentistry the receptionist will place a silent indicator on the SD Form. For instance, place a mark with a green highlighter on the back of the form to establish this message. 

If the patient indicates he or she is not interested in cosmetic dentistry, the receptionist will place a mark with a red highlighter. This will facilitate good communication and informs the next team member how to proceed with the educational phase.

Finally, share the doctor’s expertise in cosmetic dentistry with the patient.  Show lots of before and after photos describing and reinforcing the dentist’s cosmetic skills. Think of principles or actions that inform, educate, differentiate and distinguish your cosmetic practice based upon true feelings when communicating this to your patient.

As your coach, I want you to work at this every day for the next 30 days. If you do, this will become part of your daily routine. 

I coach offices to implement this and I know the system works with great predictability once your team believes you are committed to achieving results.  Your actions and words must convey your desire to succeed. 

Monitor your team. Share feedback. And watch your cosmetic practice grow!

Looking to get more patients interested in cosmetic dentistry? Get your team involved. As part of DPR's 10 Minute Easy Smile Makeover series, here's how to get your team members to enhance the cosmetic dentistry experience.

Get your team members to enhance the cosmetic dentistry experience

There are untapped cosmetic dentistry opportunities waiting for you in your practice. Here’s how you can instantly increase patient awareness of your cosmetic dentistry services… starting as soon as tomorrow!

Do you enjoy doing cosmetic dentistry? How often has a patient thanked you for giving them the smile he or she always wanted? What a rewarding feeling that is!

The dental profession has embraced cosmetic dentistry because it has proven to be a simple, yet sensible solution to providing patients with more self-confidence when they smile. 

Ten to 15 years ago, nearly every dentist positioned himself or herself as a “cosmetic dentist” in his or her marketing efforts. Unfortunately, that has created an issue for many patients. While any dentist can do cosmetic dentistry, sadly, not every dentist is skilled in the art and science of cosmetic dentistry. 

Here are ways you can distinguish yourself as a cosmetic dentist and power educate patients about the outstanding services you can provide them.

How do you know what your patient’s cosmetic dentistry needs are? In other words, how do you determine what your patient does or does not like about his or her smile?

This can be a potentially awkward topic to bring up if your patient responded “no” to your health history form question: “Do you like your smile – Yes or No – and if no, please explain why.”

If your health history form includes the above question, change your form immediately. Instead, switch to a form that provides more input about whether your patient likes the size, shape, color, appearance, and positioning of his or her teeth.

This will open up a dialogue between you and your patients as you gather more information about what they would like to improve about their smiles. 

 How is your dental assistant’s smile? You can also include your receptionist, office manager, hygienist and other team members in that query.

The key point here is that your patients are looking at the smiles of your staff members. If any team member on your staff has some cosmetic dentistry needs, do it for them – complimentary of course.

How do you know if any of your team members have cosmetic needs? Have them fill out the same smile enhancement form as your patients and find out what they might like to have transformed. 

 Are you offering and staying current with advances in non-invasive cosmetic dentistry services?

One objection that patients have when it comes to cosmetic dentistry is often: “My teeth are healthy. I just do not like the way they look, but I do

 want to destroy my healthy teeth just to make them look nicer.”

We can all understand that concern. That is not meant to challenge your philosophy of doing preps when placing veneers. However, it is meant to encourage you to stay current on new advances in non-invasive veneers that provide outstanding clinical results while also maintaining an excellent emergence profile. 

Continue to take courses and learn how recent advances in technology and materials can help solve your patient’s esthetic problems.

 Where do you keep your smile transformation album? Is it collecting dust under a stack of magazines in your reception area? Is it hidden behind papers in your treatment room? That’s where I have often found these albums when I consult in general dental offices. Have your team members place your smile transformation album in a clearly visible location where patients have easy access to viewing it.  The smile transformation album can be a powerful educational and motivational tool.

Tip: Don’t forget to include your team's before and after photos in the album.

Do you feel that all the patients in your practice who were interested in cosmetic dentistry already had it done?

If your answer is yes, you are not alone. The good news is this is not the case. I have consulted in dental offices that feared that anyone interested in cosmetic dentistry already had it done. I was able to prove them wrong each and every time.

To overcome this concern, let’s start by changing your mindset. Instead of prejudging what your patients want or do not want to have done, let’s go back to tip #1 and give your patients an opportunity to share how they feel about their smile. Have every new and recall patient fill out a well-designed smile enhancement form. You will be surprised by their responses.

Dr. Harvey Silverman is the founder of the 

Silverman Institute of Cosmetic Dentistry

 - offering on-site consultations, regional seminars and a Cosmetic Dentistry Boot Camp to take your cosmetic practice to the next level using highly advanced, simplified technical skills combined with team friendly patient education systems. Dr. Silverman can be reached at 

 or contact him directly at 216-256-4599.

5 Steps to increase cosmetic dentistry awareness among patients

This final installment in Dr. Havery Silverman's Same Day Smile Makeover Series introduces the EasySmile Preview System and explains how less cosmetic dentistry can be the best cosmetic dentistry.

In the first installment of this series, The Same Day Smile Makeover, I described an optional treatment to conventional porcelain laminate veneers when doing elective cosmetic dentistry. 

In the second installment, I provided tips on how to select the right candidate for this system. 

In this installment, I would like to share how doing less cosmetic dentistry can actually be the best cosmetic dentistry. Surprised by that statement? Read on and I believe you will agree that in today’s economy the optimum in cosmetic dentistry may be the least cosmetic dentistry that provides your patients with a self-confident, memorable smile.

During the early 1980s when I was asked to help refine and develop one of the original porcelain veneer systems I found that doing four to eight veneers for the maxillary arch was relatively standard. However, patients often came to the office wanting to fix the size, shape or appearance of just one tooth. Unfortunately it was almost impossible to restore that tooth with an individual porcelain veneer since it was very difficult to match the veneer to the adjacent teeth. Thus making it so I had to place veneers on the adjacent teeth for symmetry and esthetics.

I always thought there could be a better way to treat these patients. 

Over the next 25 years I limited my practice to esthetic dentistry in the hopes of developing a non-invasive technology to solve this problem. All too often I heard my patients say, “My teeth are healthy.” “I just don’t like the gap. Why do I need to file my tooth down just so it can look nicer?” I understood their concerns.

As a result, I finally came upon a process called the EasySmile® System. What I like about EasySmile® is that in almost all cases we can restore a single tooth and match the adjacent teeth in one visit at an affordable fee without requiring tooth preparation, tints or opaquers. Additionally, it simultaneously creates a perfect emergence profile and requires minimal finishing and polishing.

When a patient comes to my office I have him or her fill out our Smile Enhancement Form. After reviewing what the patient would like to improve (with a caveat that the patient has good periodontal and oral health) I check for evidence of bruxism. Next, I check for lateral and protrusive interferences and finally I ask the patient to show me which tooth or teeth he or she would like to change.

I then use the EasySmile® Smile Preview System to determine if my skill set matches the patients expectations. This Smile Preview System uses advanced, simplified technology to produce an actual veneer. If the veneer does not create the desirable transformation, I would prefer to know that before taking on a case. Wouldn’t you? 

The Smile Preview System is not computer imaging. It actually creates the real EasySmile® LifeLike Veneer chairside in minutes. As I became more experienced doing Smile Previews I found that I was could create the actual LifeLike Veneer™ in about 60 seconds. How amazing and enjoyable that was for me, as well as for my patients! I felt like David Copperfield and my patients were amazed by the painless smile transformation that was demonstrated to them in just minutes.

Don’t misunderstand my point. I have nothing against the use of computer imaging.  However, would you prefer to create a real veneer with almost no down time and see the impact it will have on the patient’s smile or would you rather use computer imaging to anticipate what you hope might be the final outcome? The answer to that question was a no brainer for me. 

As a practicing clinical dentist I look for simple solutions for complex problems when it is appropriate and indicated. That is the value of theEasySmile® Smile Preview System.  Now patients can determine if doing a single veneer solves the problem. More often than not I find that I only need to do one to two veneers. As a result, more patients say yes to treatment than ever before.

For those patients who do not like the color of their adjacent teeth, I found that I could often solve their problem without having to place annoying isolation materials or use light. The EasySmile® System offers in-office tooth whitening to whiten teeth without the need for barrier isolation. Depending on the stain it whitens teeth from two to 10 shades without sensitivity. However, I still use conventional light activated in-office tooth whitening for difficult stains. 

Placing an EasySmile® LifeLike Veneer requires about ten minutes of chair time.  More challenging cases takes about 20 minutes. The entire procedure is stress free as a result of the Smile Preview. The final results are incredibly durable, natural looking veneers that often surpass what I am able to achieve with porcelain veneers.

The attached before and after photos demonstrate how a patient who had orthodontia as a teenager was treated with two EasySmile LifeLike Veneers™ and in-office tooth whitening. The entire process was completed in one visit and the patient was thrilled with the end results. 

However, here is the interesting lesson to be learned. When the patient came into the office for an evaluation, my initial reaction was that there would be no way that I could create a pleasing smile for her with EasySmile LifeLike Veneers™. I suggested that she visit her orthodontist. She informed me that she was not interested in going having ortho treatment again and that she wanted to explore other options.

After doing the Smile Preview I found that the patient rated the transformation a 10 out of 10. I honestly thought that could never be accomplished with this system.  However, to my surprise, it was achievable.

Don’t place limitations and stretch your imagination. Instead, do the Smile Preview and see if you have the skill set to solve your patient’s problem. The EasySmile® System is so universally applicable it may solve even challenging problems.

The EasySmile® Smile Preview System allows us to essentially guarantee results for patients before they commit to having any work done. That was a tremendous advantage to me. I was able to guarantee results because the EasySmile® System creates the actual veneer before committing to any work. It takes the guesswork out of the entire smile makeover process for both the patient and the dentist.

If you would like to be trained in the EasySmile® System you must take a course. It is relatively easy to master, but like Invisalign™, you need to be educated about the technique. It is not a product that you can simply purchase from your dental supply company. Regional seminars and on-site consultations can be arranged, both nationally and internationally. The system includes a No Selling Marketing and Management system that creates instant patient demand within one week of becoming certified. To become a provider contact incrediblesmiles@aol.com and you will receive information on how you can transform your cosmetic practice with this revolutionary, exciting new smile enhancement technology.

I believe that we have all seen how the concept of optimum cosmetic dentistry has evolved over time.  Advances in technology have made this possible. The need to always remove healthy tooth structure just to enhance a patient’s dental appearance may no longer be necessary.  I have certainly come to embrace that philosophy and so have my patients. Maybe you should too.

Cosmetic Dentistry: The Same Day Smile Makeover, Part 3

This second installment to Dr. Havery Silverman's 

 provides tips on how to select the right candidate for this cosmetic dentistry procedure.

In the last issue of this series, I described an optional treatment that works as an alternative to conventional porcelain laminate 

 when doing elective cosmetic dentistry. 

For nearly thirty years, porcelain veneers have been considered to be the gold standard in aesthetic restorative services. Having been involved in the refinement and development of one of the original porcelain veneer systems in 1983, I believe I have a fair understanding of the benefits, liabilities, and history of that technology. However, after restoring numerous smiles with a superior, non-invasive same day veneer procedure for the past five years, I have been wondering, “has the time come to re-evaluate the gold standard in elective cosmetic treatment?” Thanks to recent advances in 

 you, too, may feel it’s time to hit the smile solution pause button and take a fresh look at the options available in today’s cosmetic dentistry landscape.

 do not have a role in your aesthetic restorative dentistry armamentarium. If you are able to achieve natural looking results with single unit porcelain veneers (which is a real challenge), or if you find that patients can still afford to have six to ten porcelain veneers, this article is not meant to challenge your comfort zone. It simply offers a new perspective. 

 we found that dentists whom we have coached noticed a significant surge in demand for their smile enhancement services immediately after being trained to offer single unit, same day veneers. These veneers are created chair-side in literally 60 seconds. I know that sounds close to being impossible - until you see for yourself how simple it is to do and how beautiful these new veneers look. Feel free to check out the 

 in my website to see examples of these un-retouched smile transformations.

In the spirit of full disclosure, the reason I created this new veneer system stemmed from my disappointment with conventional porcelain veneers. In contrast, this new veneer system that I was developing – known as 

 – never disappointed my patients or myself.

Taking your cosmetic practice to the next level

I have also discovered that dental teams are in dire need for a tool that can educate patients in a professional, ethical manner about cosmetic dentistry. Brochures alone do not effectively motivate patients about new modalities to enhance their smile with non-invasive or minimally invasive procedures. The evidence: Every practice I have gone into still has a large, untapped base of patients who have at least one tooth they would like to aesthetically enhance. 

The good news is that our system corrects that problem in less than 30 days. With minimal stress and no disruption to your daily routine. Demand for cosmetic dentistry typically increases by over 100% in the first week alone. That is a track record of success that we are proud of and you can do the same if you make a commitment to taking your cosmetic practice to the next level. If you are ready to make that commitment it’s time to roll up your sleeves and get to work! That is what I will be sharing with you in this series. 

While the dental profession does an superb job informing, educating and motivating patients about the need to maintain exemplary home care, it falls short when it comes to utilizing this same triad with smile transformation procedures. The bottom line: An uninformed, unmotivated patient often represents an underserved patient population. 

Here are a few tips to help you determine if you need to educate your patients about advances in dental technology.

Let’s start the process by learning to think like a patient for a minute. What concerns or unspoken objections do your patients have about cosmetic dentistry? Feel free to make a list of two to three concerns and hidden objections that you sense your patients have.

For example, intuitively speaking, you know that many patients would love to have a smile makeover that does not require, as one patient called it, “grinding down your tooth." That would be one concern that you would add to your list.

If we continue to think like a patient, another concern is expense. Isn’t that always the case?  For most of us, the answer is yes, it is. Fees often motivate your patient to say "yes" to treatment or "I’ll think about it" when they cannot afford to have the service done. In today’s economy high fees associated with conventional porcelain veneers are often out of your patient’s budget. This results in the underutilization of your aesthetic dental services and certainly does not benefit your patients.

With our new LifeLike Veneer System or using an in-office veneer procedure of your choice, you will eliminate the laboratory fee. This cost savings will immediately increase patient acceptance of treatment plans. However, most in-office veneer procedures are either too technique sensitive, take too long to do or the aesthetics just don’t look that great. 

Another unspoken concern that our patients have is how will their smile look. Will the veneers look natural or will they look like they had their teeth fixed? The good news is the LifeLike Veneer 60 Second Smile Preview lets you actually see how the veneers look directly on the teeth before deciding to proceed with treatment. Computer imaging is fine, but

customizing the real veneer and trying it out on the tooth in only 60 seconds can be much more enlightening, as well as motivational.

This also eliminates any guesswork and angst from both a patient and operator perspective. To the best of my knowledge, the LifeLike Veneer Smile Preview procedure is simpler, easier and faster than any other procedure in all of dentistry and any dentist can be trained to do this with ease. Best of all, it allows you to obtain more natural looking, esthetically pleasing non-invasive veneers with predictable results before beginning. 

In my practice I have been providing non-invasive and minimally invasive aesthetic dentistry for over 25 years. It would be wonderful if I could say every patient is a candidate for this type of dentistry. However, that would not be fair and would be far from accurate. While I found that more patients were candidates than I initially thought would be, there are many patients who definitely are not candidates. Let’s discuss candidate selection since this is a key factor in determining who might benefit from the Same Day Smile MakeOver using an in-office veneer system of your choice.

I have found that one of the most critical elements in candidate selection starts with the elimination of operator bias. Think about that. How many times has a patient come into your practice and you made an instant judgment about his or her smile? I use to do that all the time.  What I discovered was that my personal bias actually hindered me from accurately determining what I could do to help my patient obtain a more pleasing, self-confident smile. 

Here’s an example. When a patient asked me about what I might do to enhance their smile, I would assess their bite, look at the size, shape, color and alignment of their teeth and then make appropriate recommendations. That is how I diagnosed cosmetic dentistry problems about 25 years ago.

I quickly learned that when it comes to cosmetic dentistry, the above assessment was missing a critical element. You may already be guessing what that is. The answer is that a patient's input regarding what he or she wants is critical in cosmetic dentistry. However, 25 years ago, the dental profession was not as receptive to patient input as it is today. 

When it comes to candidate selection, knowing what your patient wants to enhance or transform is the critical piece of information you need to have in order to determine who is going to be a good candidate. Having your patient assist in co-diagnosing elective needs is essential in candidate selection.

After your patient has filled out a well-designed health history and smile enhancement form, hand your patient a mirror and say the following:

“While I reviewed your health history form and noticed a few things you would like to enhance about your smile, let me give you this mirror. Now look in the mirror and give a big smile. As you are doing that please point out which are the teeth you would like to change.”

I found that by doing this I could eliminate my bias. Bias is an interesting concept because when it comes to our patient’s teeth we typically feel that we do not have bias. But that may not be the case.

For example, when a patient checked off in the smile enhancement form that they did not like the shape of their teeth, I would often look at their smile and determine which tooth was the problem. I would do a smile preview on that tooth. In some cases, I found that I guessed wrong about which tooth they did not like the shape of.

The next step in candidate selection is to do an evaluation of your patient’s oral health.  Needless to say you will want to have healthy teeth, free of periodontal issues. 

After evaluating periodontal health, the next element is to check the occlusion, paying special attention to signs of wear due to bruxism. I have been amazed by how many of my new patients have wear facets on their lower anterior teeth. This needs to be evaluated prior to taking on a cosmetic case. Furthermore, in about seven out of 10 cases where there is loss of enamel on the lower incisors, many of these patients deny being aware of this or ever being told by another dentist that they have a potential bruxism condition that requires evaluation. The bottom line: evaluate your patients for bruxism patterns before taking on the case or you may have a frustrated patient if chipping occurs.

After having this conversation with my patient I then evaluate the patient in excursion movements. I have found this to be one of the critical steps to do prior to accepting a patient for treatment. If, for example, you want to lengthen one of the maxillary central incisors and do not consider the deleterious impact that protrusive excursions might have on the durability of the veneer, you could find that chipping will result. However, if you determine that protrusive interferences exist, you can come up with an approach to solve that prior to commencing treatment.

The same is true regarding lateral excursion movements. I have consistently avoided post treatment problems by doing a thorough assessment of these issues prior to accepting a patient for treatment. Even if the smile preview looks magnificent, long term success rests in the proper evaluation of these essential elements.

The final step in candidate selection is to determine if your skill set matches your patient’s level of expectations. First do a smile preview on your patient’s teeth. Then hand your patient a mirror and ask your patient to rate the smile preview on a scale of 1 to 10. If the patient gives you a score that indicates that his or her level of expectations exceed what you were able to accomplish, then maybe this is a case that you should pass on. 

I have done that many times myself. For example if a patient rated my smile preview a six out of 10 (and while that rarely occurs it has happened), I know that I do not have the skill set to create a result that would please my patient. That is the best news you can find out prior to accepting a patient for elective cosmetic dentistry. When that happens I politely inform my patient that I appreciate his or her honesty and that the grade they gave me was essentially an F (that is what 60% amounts to) and that I am sorry to inform them that they are not a candidate for LIfeLike Veneers.

Using this approach is not only fair to your patient, it also eliminates the potential "headache patient" that you can never satisfy. That is one of the best benefits of the LifeLike Veneer Smile Preview System. By having your patient rate your smile preview you will know if you can match their level of expectations and if you can, then you will have a cosmetic dentistry practice that is stress free with happy, joyful patients for many years to come.

This second installment to Dr. Havery Silverman's Same Day Smile Makeover Series provides tips on how to select the right candidate for this cosmetic dentistry procedure. In the last issue of this series, I described an optional treatment that works as an alternative to conventional porcelain laminate veneers when doing elective cosmetic dentistry. 

Same Day Smile Makeover: Selecting the right patients

In this new series, The Same Day Smile Makeover, the goal will be to share how recent advances in 

 can help your patients have a more self-confident smile in one easy visit. 

There is one caveat that I want to share with you about providing same day smile makeover services for patients. Quite frankly this is not always possible and you will find that careful patient selection is the key in performing a same day smile makeover.  
	
	It also requires fine-tuning your patient education systems to inform, educate and motivate patients about the benefits of this new treatment modality. Once you learn how to both perform the technique and educate your patients about its benefits, you will notice a surge of interest / demand from your patient population pool.


	
	Incorporating the same day smile makeover system into your practice requires several new skill sets. The first key starts with attitude. If you are stuck in a traditional mind-set, offering patients same day smile makeover services may be a challenge for you. That does not mean that traditional 

 is better, or worse, for your patients. It simply means that traditional cosmetic dental services are more familiar and thus, more comfortable for you.  
	
	Here is one example of how the same day smile makeover requires a new mind-set. I will take you through a brief clinical scenario. When a patient is interested in brightening his or her smile and having one or two teeth transformed relative to the size, shape or appearance, which service do you typically offer first to your patient?  
	
	After doing a thorough examination and checking for periodontal, restorative and other considerations you will probably agree that if you are like many of our colleagues, you would start with “tooth whitening." That is fairly traditional treatment for a case like this. Whiten the teeth first and then place veneers to match. I have done many cases like this with outstanding results as well.
	
	After the whitening is completed, the patient will most likely return in two weeks for an evaluation of regression. If the color is stable and the patient is pleased with the results from whitening, you will most likely instruct your patient to continue to maintain excellent oral hygiene, not use any tooth whiteners during the next two weeks and return for their veneer appointment in fourteen days.

Watch Dr. Harvey Silverman discuss the Same Day Smile Makeover with radio personality Trapper Jack below. 

	
	Once the desired whitening has been achieved, the traditional approach would be to treat the teeth with porcelain veneers. After the patient returns you will probably use / do many of the procedures listed below to provide the patient with a veneer to complete their smile makeover:

The list goes on and on. Unless you have an 

, most patients will be seen again for a try-in appointment in about two weeks. After the veneer is returned from the laboratory, you will try it in to check for size, shape and color considerations. If it matches the bleached teeth and the fit is good, you will probably bond the veneer to the tooth that day. If there is a problem with any of the above, the patient will have to return for another try-in appointment.
	
	Having had the privilege of refining and developing one of the original porcelain veneer systems for the dental profession in 1983, I have successfully performed numerous smile makeovers and placed many porcelain veneers using this traditional approach. I have also taught this technique at many CE programs. It is a good system. There is absolutely nothing wrong with that approach.
	
	However, I always thought that it would be so much better for my patients if a system was available that made it simpler, easier, faster to obtain more natural looking, esthetically pleasing veneers with predictable, almost guaranteed results before beginning. Combined with the benefits of in-office tooth whitening, instant smile transformations might be possible. That was a lot to accomplish but having refined several bonding systems for dental manufacturers, having invented / patented one of the original OTC tooth whiteners that started today’s whitening explosion and knowing the technical and procedural issues with porcelain veneers placed me in an unique situation to tackle that challenge. Over the past twenty years I worked on developing exactly that system, which allows dentists to provide patients with same day smile makeovers.
	
	Does this mean that I never use the “traditional” approach and don’t do the whitening first? The answer is absolutely not. I still do in-office whitening prior to placing LifeLike Veneers™ when it is indicated. As I write this article I am in the process of treating one patient using the traditional approach. However, I am finding that in approximately 75 – 80% of all cosmetic cases, that the same day smile makeover system has become the treatment of choice.  
	
	The same day smile makeover gives me more control of the final outcome with long lasting, durable, aesthetically pleasing results. It also provides my patients with what they always desired. A self-confident smile with a combination of gorgeous veneers and tooth whitening all done in one day – without compromising bond strength and creating the appearance that my patients were “born” with this beautiful smile. That has been very gratifying to both my patients and to me.
	
	My suggestion is to read the series over the next several months and try to maintain an open mind and attitude. Let’s be honest, when confronted with a new system we often tend to defend our previous habits. It’s only natural and I, too, tend to resist change as well. However if we can think outside the box for a minute and become open to how technological advances can provide simpler, more natural looking and affordable solutions for what was previously thought to be a complex problem, we might discover a true breakthrough in creating self-confident smiles for our patients. Over time, once you have an open mind, you might find that you will be doing more same day smile makeovers than you originally thought possible.

In this new series, The Same Day Smile Makeover, the goal will be to share how recent advances in dental technology can help your patients have a more self-confident smile in one easy visit. 

Cosmetic Dentistry: The Same Day Smile Makeover

	A Smile MakeOver can transform your patient’s self-image in one or two easy visits.  Popularized by television shows, our patients have learned that this can be done with minimal tooth reduction and without the conventional angst patients often feel about dental visits.  Some patients actually refer to it as “fun dentistry”.  And it is.  For the patient, the dentist and the entire dental team. 

	I also know a little bit about the genesis of smile makeovers since I was fortunate to pioneer, refine and teach C.E. courses on how to perform one of the original non-invasive smile makeover systems back in the mid-1980’s.  As described in the previous article I wrote in DPR’s Best Cosmetic Dentistry Practices, I had been working with the beauty industry since 1982.  Developing the smile makeover concept was a natural consequence of combining dental and facial beauty.   However, conventional smile makeovers today are typically thought of as using porcelain veneers – which is fine – but it may be out of the price range for many patients in today’s economy. 

	Let’s look at an innovative approach that allows you to provide your patients with beautiful, natural looking, non-invasive and affordable Smile MakeOvers – without using porcelain veneers.
	
	


	One morning the following patient came into my office and wanted to know what I could do to improve her smile.  As you may know from the articles I have been writing in DPR I do not always advocate the use of smile makeovers.  When possible I prefer to do one or two LifeLike Veneers™ in conjunction with in-office tooth whitening to provide dramatic results.  However, there are times when a smile makeover is in order.  The following case is illustrative of where I still recommend smile makeovers to my patients. 

	Before Photos taken by Dr Harvey Silverman DMD
	Note: the first thing I did was to find out what the patient wanted to change using
	The Silverman Institute’s Smile Analysis Form.

	After reviewing this patient’s Smile Analysis form I learned she did not like the length, spacing, color, positioning, alignment and overall appearance of her teeth.  This applied to the upper and lower teeth.  She also felt that her canine teeth were too pointed.
	
	What would you do if this patient walked into your office?  In addition to doing routine procedures including an oral examination and periodontal check, the first thing I did was to ask her to hold a mirror and show me what she wanted to have improved about her smile.  Even after reviewing her written smile analysis form I did not want to assume that I knew which teeth she wanted to enhance, which I shared in a previous article.
	
	After reviewing her chief concerns, evaluating her occlusion (including signs of bruxism as well as lateral and protrusive interferences) I discussed the advantages of having orthodontia.  I informed her that was the optimum treatment in my opinion.  However it became quite evident that orthodontia was not the route she wanted to go. She wanted to explore other options.

	Now that I discovered the patient was not going to accept orthodontia, what would you suggest I do to improve her smile?  Porcelain veneers were not an option since the expense would be far greater than the patient wanted to invest.
	
	Any thoughts? Look at the before photos again. What would you do?
	
	Here’s what I did. I knew that closing in the large diastema between the right lateral incisor and canine was going to be a challenge. I also knew that the patient told me that she wanted to have “straighter, more even looking teeth” when she smiled.  However, I did not want to make them look artificially straight and even.
	
	I showed the patient a Smile Preview of what she could expect as an outcome. I discussed in detail that I would use illusion effects to help create the appearance of a beautiful smile, but that under close inspection, she would notice imperfections. This is true especially when a patient looks at the veneers with a 3X or 10X mirror at home.  For example, I knew that I needed to use the concept of color and light reflections so that her right lateral incisor and canine teeth would not appear out of proportion with her other teeth at a social distance.
	
	The Silverman Institute’s 60 Second Smile Preview technique showed me exactly how to accomplish the desired illusion effect so I felt comfortable moving forward. It also showed my patient what it would look like so that her expectations would be met.  She loved the transformation after seeing the Smile Preview. I explained to her that I felt she could experience about a 50-60% improvement. She thought it was even more that that. I documented this conversation in her chart.
	
	Then I began the procedure. And quite frankly it was easy – and fun – to do.
	
	The first thing I did was to treat the maxillary central incisors.  I needed to close the diastema in addition to achieving equal incisal lengths on both #8 and #9.  Her maxillary left central incisor also had a slight distal inclination.  To start the procedure I placed two LifeLike Hemi-Veneers™ on #8 and #9.


	Start with the maxillary central incisors: 2 LifeLike Hemi-Veneers™
	Cosmetic Dentistry done by Dr Harvey Silverman DMD

	Once the proper length and closure was achieved, I moved on to the “challenging teeth” which were #6 and #7 as well as #10 and #11.
	
	My patient already knew that since she was NOT having orthodontia - closing that large a space would necessitate creating two larger teeth. However, she already saw exactly how that was done with my 60 Second Smile Preview technique. Thus, I was comfortable moving forward. I knew from my Smile Preview that I needed to shape the veneers so that the light reflections did not emphasize the width of the teeth.  Just the same, there was no doubt that the teeth would still be larger than ideal.  

	Placing the veneers was actually easy, stress-free and fun to do. Using LifeLike Veneers™ it took about 2 hours to place all of the veneers.  

	After the veneers were finished and polished, I used an in-office whitener, the EasySmile Tooth Whitening System™ that I developed several years ago.  I created EasySmile for patients who wanted in-office whitening but did not want to go through the unpleasant post bleaching experience sometimes associated with conventional in-office whiteners – namely sensitivity.

	Another reason I developed EasySmile was because it provided me with a simple method of achieving tissue isolation for in-office whitening that did not require lip retractors, a face bib, paint-on rubber dam, cotton rolls and a mouthful of gauze. My patients really appreciated the simplicity of doing in-office whitening that no longer required uncomfortable tissue isolation. Depending on what caused the original stain, EasySmile also provided from four to six shades of whitening in one visit.  That made my patients even happier.

	For darker stained teeth requiring six to eight shades of improvement, I still keep a light activated in-office whitening system available in the office as an optional treatment.  However some patients using conventional light activated in-office whitening need additional whitening sessions using if they have dark stains.

	The EasySmile Tooth Whitening System™ whitened and brightened the remainder of her teeth to be in the same shade range as the LifeLike Veneers™, which were already made by me to be 3-4 shades lighter than her natural teeth.  The final result: all of her teeth blended in beautifully.

	Creating illusions to create a more pleasing smile with LifeLike Veneers™ and EasySmile Whitening.
	Cosmetic Dentistry done by Dr Harvey Silverman DMD

	At a subsequent appointment my patient returned and said she was ready to continue her Smile MakeOver.  Now I focused my attention to her lower anterior teeth where she wanted me to close her diastema.

	I placed two LifeLike Veneers™ on her mandibular incisors and her Smile MakeOver was complete.


	Lower anterior teeth can look straighter with 2 LifeLike Veneers™
	Cosmetic Dentistry done by Dr Harvey Silverman DMD

	Smile MakeOvers are often thought as being invasive, expensive and unattainable for many patients.  That is no longer true if you use the principles that I have been sharing in the Best Cosmetic Dentistry Series.  Learn to think out of the box.  Challenge yourself to take courses that stretch your imagination.  Learn to see the forest (the smile) and not just the trees (the teeth).  Listen to your patients and find out what they want, not just need.  Within a short period of time you will be enhancing more smiles than you have thought possible.
	
	Please feel free to contact me (incrediblesmiles@aol.com) if you want help in distinguishing or transforming your office into a premier cosmetic practice.  As always, if you want to achieve excellence in technique or management/marketing for cosmetic dentistry, please drop me an email.  In any event, don’t put off for tomorrow what you can accomplish today.  That’s procrastination and procrastination is not a good recipe for success.
	
	Cheers!  I wish you all the best.  Now get out there and when indicated, transform your patient’s smile with non-invasive veneers combined with in-office whitening.  By doing so you can transform your patient’s life through enhanced self-image and improved self-esteem.

 A Smile MakeOver can transform your patient’s self-image in one or two easy visits.  Popularized by television shows, our patients have learned that this can be done with minimal tooth reduction and without the conventional angst patients often feel about dental visits.  Some patients actually refer to it as “fun dentistry”.  And it is.  For the patient, the dentist and the entire dental team. 