Same Day Smile Makeover: Selecting the right patients

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. 

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 dental technology 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.

This is not meant to imply that porcelain veneers 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. 

At the Silverman Institute of Cosmetic Dentistry 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 Smile Gallery 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 LifeLike Veneers – 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.

Think like a patient

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. 

Choose your patients wisely

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.

The solution

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.