Mike Malone, D.D.S. & Assoc. Mike Malone, D.D.S., F.A.G.D. 300 Doucet Road Lafayette, Louisiana 70503 phone: (337) 989-1268 fax: (337) 989-1324 www.mikemalonedds.com mike@mikemalonedds.com A Commitment to Excellence How to Achieve Predictable Excellence in Cosmetic Dentistry
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Mike Malone, D.D.S. & Assoc. - pdsociety · 2012-02-23 · Mike Malone, D.D.S. & Associates 300 Doucet Rd. Lafayette Louisiana 70503 337-989-1268 OUR MISSION STATEMENT We believe
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
We believe that every patient should be offered the highest quality of dental health care that is consistent with their dental needs and values.
The compelling principles for which we stand are service, quality and commitment to excellence.
Our goal is simply to help our patients retain their teeth all of their lives if possible…in maximum comfort, function, health and esthetics…and to accomplish this appropriately.
OUR PATIENTS:Our practice will offer general dentistry of the highest quality for the entire family. We strive to
provide cosmetic and restorative dentistry at a level that equals or surpasses the best available in the world.
STAFF:The employment of the highest caliber people is of utmost importance to our purpose. They
must always be willing to strive to improve technical skills, interpersonal communications, and team interactions. These are people who are excited about what they are doing, are motivated to achieve results, and have high standards of quality and integrity.
CONTINUING EDUCATION:A commitment to excellence in patient care is the key to our mission. Attending continuing
education courses is essential to develop every team member to their highest potential. The journey towards excellence requires growth and openness to change.
BUSINESS GROWTH:A profitable business will allow everyone to concentrate on delivering superior dental care. A
fair fee is one that the patient will pay with gratitude for the care, skill and judgment necessary to deliver the appropriate service.
LEADERSHIP:The practice will provide support, feedback, and appreciation to promote growth and long-term
commitment from each employee.Our standards will always be set high so that our employees can achieve higher levels of
expertise and self-esteem. We will strive to make our employees happy with their jobs and attempt to help them end each day feeling like a winner.
Mike
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Telephone Script
MAKE APPOINTMENT
Go to initial report form. “In order for me to make………………”
Answer Phone: “Good Morning/Good Afternoon, Dr. Mike Malone and Associates. This is ____________, how may I help you?
“How long has it been since you were seen in our office?” “So you would be a new patient in our practice. We offer General Dentistry for all ages with a special emphasis on preventive, as well as cosmetic and restorative dentistry. Our #1 priority is excellent and affordable dental care in a relaxed and comfortable environment. Is this the type of dental practice you are looking for?” “That’s great! For our adult new patients we dedicate your entire appointment with the doctor. You will start with a one-on-one discussion with the doctor about what your needs and expectations are, followed by a very thorough comprehensive examination. Is that the type of care you were looking for?
“Dr. Malone’s practice is limited to patients requiring cosmetic or complex restorative care.” “Dr. _________ sees patients of all ages for comprehensive general dentistry.” “Would you like to schedule with Dr. Malone or Dr. _________? “The fee for your comprehensive examination, including all necessary X-rays, other records, and the follow up consultation appointment is $_______. For your convenience we accept all Major Credit Cards, Cash, or Check. Would you prefer morning or afternoon?”
“You only want your teeth cleaned? We can do that for you. I would be happy to make an appointment for you with the dental hygienist for what we call an adult prophylaxis. This is a dental cleaning above the gumline for patients who have no signs or symptoms of gum disease. The fee for that type of appointment is $________. Would you prefer morning or afternoon?”
“If you are not certain what your dental needs are, I would be happy to schedule a complimentary consultation with either Dr. Malone or Dr. ________.”
“We would be happy to help you by collecting your portion of the dental cost at the time of the visit and bill your insurance for their portion, however our system does not allow us to do that on the initial visit only. The fee for that appointment will be $________. For your convenience we accept all Major Credit Cards, Cash, or Check.
1. “In order for me to make the proper appointment for you, may I ask you a few questions?”
Name Pronounced/Preferred NameAddressHome Phone Work Phone DOB:Chief concern
Referred By; Fee Quoted:Initial Reaction to Patient:� Fearful � Talkative � Quiet � Aggresive � Polite
2. “Are there other family members you would like me to schedule an appointment for?”� Yes � No If so, who?
3. “Is there anything else that we should know that would make your visit more comfortable?” (Medicalconditions that may require antibiotic premedication?)
4. “In order to save you valuable time, I will mail your dental and medical forms to you. Please complete andbring them with you. Remember that your appointment with Dr. will last 1-2 hours and weusually start right on time! If something should occur that would prevent you from keeping yourappointment, please let me know in advance so I can give the time to another patient.
� Welcome Letter/Packet Sent � New Patient Chart Made
Name Home Phone BirthdateAddress City State ZipSocial Security #: E-mailCheck Appropriate Box ❑ Minor ❑ Single ❑ Married ❑ Divorced ❑ Widowed ❑ SeparatedPatient’s Employer Work PhoneBusiness Address City State ZipSpouse or Parent’s Name Employer Work PhoneWho May We Thank for Referring You?Person to Contact in Case of Emergency Phone
Responsible PartyRelationship
Name of Person Responsible for this Account to PatientAddress Home PhoneSocial Security # BirthdateEmployer Work PhoneOccupationIs This Person Currently a Patient in our Office? ❑Yes ❑No
Dental Insurance InformationRelationship
Name of Insured to PatientBirthdate Social Security #Name of Employer Work PhoneAddress of Employer City State ZipInsurance Company Group # PhoneIns. Co. Address City State Zip
I authorize my insurance company to pay the dentist all insurance benefits otherwise payable to me for services rendered. I authorize theuse of this signature on all insurance submissions. I authorize the dentist to release all information necessary to secure the payment ofbenefits. I understand that I am financially responsible for all charges whether or not paid by insurance.
Mike Malone, D.D.S., F.A.G.D.Accredited by The American Academy of Cosmetic DentistryFellow of the Academy of General Dentistry
A Commitment to Excellence
Mike
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Patient Medical Record
Patient Name DateName and address of physician (Medical Doctor): Name CityHave you been under a physician’s care during the past 2 years? ForHave you ever had major surgery? If yes, date and procedureDo you smoke or use tobacco in any form? If so, what type and how much?Are you now taking or have you taken any prescription drugs during the past year? Please list
Women:Are you pregnant or think you may be pregnant? ❑ yes ❑ no Nursing? ❑ yes ❑ no Taking birth control pills? ❑ yes ❑ no
Please check any of the following drugs you have ever taken:❑ Penicillin ❑ Blood Thinners ❑ Insulin ❑ Thyroid ❑ Nitroglycerin ❑ Other❑ Cortisone ❑ Tranquilizers ❑ Digitalis ❑ Dilantin ❑ Phen-Fen/Redux
Please check any of the following that you are allergic to or have had a bad reaction to:❑ Local Anesthetics ❑ Codeine ❑ Sulfa Drugs ❑ Iodine ❑ Other❑ Aspirin ❑ Penicillin ❑ Barbiturates ❑ Latex
Place a mark on “yes” or “no” to indicate if you have had any of the following:
Organ Transplant ❑ ❑ Cold Sores/Fever Blisters ❑ ❑
Emphysema ❑ ❑ Herpes ❑ ❑
Cough ❑ ❑ Epilepsy ❑ ❑
Tuberculosis (TB) ❑ ❑ Fainting or Dizzy Spells ❑ ❑
Asthma ❑ ❑ Nervousness ❑ ❑
Hay Fever/Sinus Trouble ❑ ❑ Drug Dependency ❑ ❑
Allergies or Hives ❑ ❑ Psychiatric Treatment ❑ ❑
Diabetes ❑ ❑ Hypoglycemia ❑ ❑
Have you had any disease, condition, or medical situation not previously listed?
Medical Release: I understand that the information contained in my case record is confidential. However, I give my consent for Mike Malone,D.D.S. & Associates to release to my physician any information which may be helpful in his/her understanding of my present health situation.
Patient Signature Dateover
Mike
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Mike Malone, D.D.S. & Associates
Mike Malone, D.D.S.Accredited by The American Academy of Cosmetic DentistryFellow of the Academy of General Dentistry
300 Doucet Road, Ste. A • Lafayette, Louisiana 70503 • (337) 989-1268w w w. m i k e m a l o n e d d s . c o m • i n f o @ m i k e m a l o n e d d s . c o m
DENTAL HEALTHWhen was your last dental visit? How often did you see the dentist?Are you having any dental problems that require immediate attention?Do any of the following cause tooth discomfort? Hot Cold Sweets ChewingHow often do you brush your teeth? Floss? Medicated rinse?Do your gums bleed while cleaning? Do your gums ever feel tender or swollen?Have you had periodontal gum treatment? When?Do you clench or grind your teeth? Do your jaws ever feel tired or ache? Click or pop?Can you chew on both sides of your mouth? Comfortable?Do you have frequent headaches? Earaches? Neck or shoulder pain?Have you had orthodontic treatment (braces)? When?Do you usually have many cavities? Do you lose fillings or break fillings?Do you have any loose teeth? Cracked or broken teeth?Do you have any noticeable wear on your teeth? Food traps?Do you have any missing teeth? Have they been replaced?If so, how? Fixed bridge Removable partial Full denture Dental implantAre you comfortable with the replacement? Please describe
Have you ever had an unpleasant dental experience?
CIRCLE CORRECT ANSWER(S):1. My mouth is A) very comfortable 5. I have A) always done the best that was
B) moderately comfortable recommended for my dental healthC) uncomfortable I B) have not done what dentists have
recommended for my mouth2. I A) think the appearance of my mouth C) rarely go, and don’t care much
is excellent about having any dental workB) am satisfied with the appearance completed.
of my mouthC) am dissatisfied with the appearance 6. I have A) put dentistry for myself and my
of my mouth family high on my priority listB) put dentistry for myself and my
3. I A) will do anything to keep my family low on my priority listnatural teeth C) it’s on my list but hard to find
B) want to keep my teeth, but have acertain budget of time and money 7. I think my present state of dental health is:that I am willing to spend on them A) Excellent
B) Good4. I A) have set goals for my oral health C) Poor
with a previous dentistB) have never set goals 8. I would like a mouth with:
concerning my oral health A) Excellent healthC) want to set goals concerning B) Good health
my dental health C) Poor health
What are some questions about dentistry and oral health that you have never had adequately answered?
(over)
Mike
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SMILE EVALUATIONHold a full face mirror 12" - 14" from your face. Smile to show your teeth; take the time to observe your teeth carefully. Thenanswer the following questions. (It is helpful to have a friend ask you the questions).
DateLast First Middle
1. Do you like the overall appearance of your teeth, your smile? ❑ YES ❑ NOIf NO, please describe
2. Do you consider that your teeth are in good alignment (straight)? ❑ YES ❑ NOIf NO, please describe
3. Do you have spaces between your teeth that you don’t like? ❑ YES ❑ NOIf YES, please describe
4. Do you like the color of your teeth? ❑ YES ❑ NOIf NO, please describe
5. Do your teeth have unattractive stains? ❑ YES ❑ NO❑ Tobacco stains ❑ Coffee/tea stains❑ Discolored fillings ❑ Tetracycline stains❑ Silver filling stains ❑ Other
6. Do you like the shape of your teeth? ❑ YES ❑ NOIf NO, please describe
7. Do you think that your teeth are attractive? ❑ YES ❑ NO❑ chipped ❑ overlapping❑ protruding ❑ excessively worn❑ hidden ❑ artificial looking
8. Do you like the way that your upper and lower teeth come together? ❑ YES ❑ NOIf NO, please describe
9. Do you consider that your existing fillings or dental work is unattractive? ❑ YES ❑ NOIf YES, please describe
10. Do you think that your gums are unattractive? ❑ YES ❑ NO❑ swollen ❑ excessively receded❑ reddened ❑ crowns are ill-fitting❑ bleed easily ❑ difficult to clean between teeth
11. What would you like to change the most in the appearance of your teeth, your smile?
(Over)
Mike
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Mike
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Mike Malone, D.D.S. & Assoc.
Mike Malone, D.D.S., D.D.S.Accredited by The American Academy of Cosmetic DentistryFellow of the Academy of General Dentistry
A Commitment to Excellence
G e n e r a l D e n t i s t r y • C o s m e t i c D e n t i s t r y • R e s t o r a t i v e D e n t i s t r y • I m p l a n t D e n t i s t r y
3 0 0 D o u c e t R o a d , S uite A • L a f a y e t t e , L o u i s i a n a 7 0 5 0 3 • (337) 989-1268
TODAY’S DENTAL EXAMINATION INCLUDED
� Dental History
� Medical History� Discussion of Practice Philosophy� Oral Cancer Examination� Soft Tissue Examination� DENTAL HEALTH EVALUATION
� State of Existing Repair Evaluation� Occlusal Evaluation� Tooth by Tooth Examination� Complete Series of X-rays� Panoramic X-ray� T.M.J. X-ray� Study Models� Face-Bow for Articulator Mounting� Bite Records - to Evaluate Bite Relationship
YOUR NEXT APPOINTMENT will include a discussion of our examination findingsand recommendations for preventive and corrective treatment to return yourdental condition to a state of OPTIMUM DENTAL HEALTH.
The most important service any dentist or physician can offer is a thorough examination, a diagnosis of the existing conditions, and a treatment plan that serves the short-range and long-range needs of his patients. An understanding of the existing conditions provides the patient with the knowledge and information to make proper choices that suit his or her individual wants and needs.
In the past, most dental treatment was carried out without a plan, (“patchwork” or “maintenance” dentistry). Today, our goal of optimum dental health can be achieved because we now understand the causes of dental disease and the objectives for controlling them.
In order to help you keep your teeth all of your life, we take a great deal of time and effort to help you understand your present conditions and develop a MASTER PLAN of treatment. Once our MASTER PLAN is completed, it will be your responsibility to complete the plan in a time period that works for you, and meets the objectives for your dental health. Quality is the constant ... time is the variable.
The following is a written resume of the existing findings that are present at this time, and the recommendations for corrective treatment. While you are reading it, questions may arise in your mind. Write them down, because I want to discuss your concerns with you.
YOUR PRIORITIES:During our examination you told me your priorities are:1. Straighter teeth2. Replace missing tooth on upper right3. Sensitive teeth
*If you have additional concerns or priorities, please let me know.
Mike
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PRESENT CONDITIONS
Tooth Decay – There are 4 areas of tooth decay.
Periodontal Disease – Your Plaque Control Index of 80% and Periodontal Bleeding Index of 63% indicate that there is some active gum disease at the Stage 2 level. Please review your Dental Health Report for a more detailed explanation.
State of Existing Dentistry –. Large silver-mercury fillings in the back teeth; some defective and failing.
Bite Relationship – Jaw relationship and tooth position are adequate, but large silver-mercury fillings are wearing, causing some shifting of the teeth and an unstable bite.
DIAGNOSIS SUMMARY: My findings are that you have periodontal disease (periodontitis), tooth decay, defective fillings, missing teeth, and an abscessed tooth.
TREATMENT RECOMMENDATIONS
Our goal is simply to help you keep your teeth all of your life if possible…in maximum comfort, function, health and esthetics…and to accomplish this appropriately. Suggestions for your master plan of treatment are listed below.
Phase I - Multiple appointments to initiate the correction of your periodontal problems.Phase II -Treat abscessed teeth.Phase III - Restore the teeth with appropriate restorations for optimum cosmetics, longevity, and bite stability.Phase IV - InvisalignPhase V - Whitening of the teeth..Phase VI - Active involvement in our Dental Health Program to maintain excellent oral health for a lifetime.
01/12/03
Mike
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PATIENT’S NAME ______________________________________________________ DATE DUE FOR REVIEW ________________________________________________
DEFINITIONS
Tooth Decay: _______ Periodontal Disease: Plaque _______% Bleeding _______% Category _______. Existing Dentistry: _______ Adequate _______ Large silver-mercury fillings in the back teeth; some defective and failing. _______ Discolored and defective composite resin fillings in the front teeth. _______ Defective crowns. ________________________________________________________________________ ________________________________________________________________________ Bite Relationship: _______ Adequate _______ Excessive wear of the teeth and fillings has resulted in an unstable bite relationship and tooth mobility. _______ Multiple missing teeth have caused some tooth shifting , resulting in an unstable bite and excessive force on the remaining teeth. _______ Deep overbite and poor jaw relationship have resulted in an unstable bite and tooth mobility. _______ Jaw relationship and tooth position are adequate , but large silver-mercury fillings are wearing, causing some shifting of the teeth and an unstable bite. ________________________________________________________________________ ________________________________________________________________________
Mike
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Diagnosis: _______ Periodontal disease (gingivitis) _______ Periodontal disease (periodontitis) _______ tooth decay _______ defective fillings _______ defective crown (crowns) _______ missing teeth _______ fractured teeth _______ abscessed tooth (teeth) _______ discolored teeth _______ unstable bite _______ TMJ symptoms ________________________________________________________________________ ________________________________________________________________________ Treatment recommendations: _______ Multiple appointments to initiate the correction of your periodontal problems. _______ Bite correction. _______ Treat abscessed teeth. _______ Remove wisdom teeth. _______ Restore the teeth with appropriate restorations for optimum cosmetics, longevity, and bite stability. _______ Active involvement in our Dental Fitness Program to maintain excellent oral health for a lifetime. _______ Whitening of the teeth. ________________________________________________________________________ ________________________________________________________________________
Mike
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Mike Malone, D.D.S. & AssociatesPatient: Jill SwitzerDoctor: Dr. MaloneDate: October 11, 2002
w w w. m i k e m a l o n e d d s . c o m • i n f o @ m i k e m a l o n e d d s . c o m
Mike Malone, D.D.S. & Associates
Mike Malone, D.D.S.Accredited by The American Academy of Cosmetic DentistryFellow of the Academy of General Dentistry
A Commitment to Excellence
For:Date:
Today’s Score Previous Score
Plaque Score:Bleeding Score:Fitness Category:
Plaque Score - The number of surfaces of plaqueat the gumline are counted and converted to apercentage of fitness.
92% - 100% - Excellent Fitness87% - 91% - Marginal Fitness86% and lower - Active Gum Disease
Bleeding Score - Gums that bleed afterattachment level measurement are unhealthy.Bleeding areas are counted and converted into apercentage of fitness.
92% - 100% - Excellent Fitness87% - 91% - Marginal Fitness86% and lower - Active Gum Disease
Fitness Categories - Optimum Dental Health isthe ideal - the absence of disease.There are five stages of gum disease determinedprimarily by the gum attachment level.
Recommendations for Optimum Dental Health:
DENTAL HEALTHREPORT
FITNESS CATEGORIES(Stages of Health and Gum Disease)
Optimum Dental Health- Minimal or no plaque, calculus, or bleeding.- Attachment level 3 mm or less.
Stage One (Gingivitis)- Plaque, some calculus, and bleeding gums.- Attachment level 1-4 mm.
Stage Two (Early Periodontitis)- Plaque, calculus, swollen and bleeding gums.- Attachment level 3-5 mm.- Beginning bone loss.
Stage Three (Moderate Periodontitis)- Plaque, calculus, swollen and bleeding gums.- Attachment level 5-7 mm.- Moderate bone loss, beginning tooth mobility.
Stage Four (Advanced Periodontitis)- Plaque, calculus, swollen and bleeding gums.- Attachment level 7-9 mm.- Advanced bone loss and increased tooth
mobility.
Stage Five (Refractory Periodontitis)- Plaque, calculus, swollen and bleeding gums.
- Attachment level 10 mm or more.- Advanced bone loss that does not respond
to therapy, severe mobility, often hopelessprognosis.
Mike
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FITNESS CATEGORIES(Stages of Health and Gum Disease)
The following is your treatment proposal with estimated fees. It is not a binding contract. You should be aware that clinical findings might necessitate a change in the treatment plan, with a possible change in cost. For your benefit, we would like to make definite financial arrangements before treatment starts. This treatment proposal will remain valid for 90 days.
__________________ _________________________For Dr. Mike Malone Patient Signature
Mike
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Smile Design - Mike Malone D.D.S.
Review of Smile Design Review of Smile Design ConceptsConcepts
Jeff Morley, DDS, Jimmy Eubank, DDSJeff Morley, DDS, Jimmy Eubank, DDSRonald Goldstein, DDS, David Garber, DMDRonald Goldstein, DDS, David Garber, DMDMaurice Salama, DDSMaurice Salama, DDSAACD AACD –– Guide to Accreditation CriteriaGuide to Accreditation Criteria
Smile Line
• The smile line is an imaginary line along the incisal edges of the maxillary anterior teeth which, in an ideal situation, mimics the curvature of the superior border of the lower lip when smiling.
Reverse Smile Line
• A reverse smile line is when the incisors are shorter than the cuspids resulting in a reverse curve.
Lip Line
• The lip line refers to the inferior border of the upper lip during smile formation.
• The lip line is generally considered ideal when the position approximates the gingival line of the maxillary teeth.
Acceptable Lip Line
• The lip line is generally considered acceptable when the gingival line is within 2 mm above or below this line.
Deficient Lip Line
Operatory 3
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Smile Design - Mike Malone D.D.S.
Excessive Lip Line Uneven Lip Line
Tooth Reveal – Relaxed Lip “M” Position
• Young people show 2-4 mm of the central incisors when lips are relaxed.
• Mature or older people show less or even none of their incisors when lip is relaxed.
Tooth Reveal – Broad Smile “E” Position
• Maximum extension of the lips in a broad smile.• Intercommisure line is a straight line through the corners of the mouth.
• A youthful smile typically shows 75-100% tooth reveal below this line.
• A lower percentage of reveal ages the smile.
Incisal Length
• Typical or average central incisor length is 1/16 of the facial height. (Use Trubyte Tooth Size Indicator)
• The average central incisor is 10-11 mm long.• The central width is typically 75-80% of the length.
Incisal Length
• The Smile Line, in conjunction with phonetics, function, and esthetics, will determine the incisal edge position and in most cases, the central incisor length.
• Incisors that are too short may be lengthened incisally or gingivally, depending on lip line position, maximum reveal, and phonetics.
Operatory 3
Operatory 3
Operatory 3
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Smile Design - Mike Malone D.D.S.
Midline
• The interface between the two maxillary centrals should be perpendicular to the incisal plane and parallel to the midline of the face.
Facial Midline
• The facial midline is best determined by a line connecting the center of the nasion with the philtrum of the lip.
Midline Deviation
• If the incisive papilla is not in line with the philtrum, a true midline deviation exists.
• A midline deviation that does not bisect the papilla is more noticeable than one which does not bisect the philtrum.
Horizontal Plane
• It is very important for the horizontal plane of the maxillary teeth to be perpendicular to the facial midline.
• A properly aligned, or “corrected”, face bow is the best way to communicate the dental horizontal plane.
Axial Inclination
• There should be a progressive increase in the mesial inclination of the maxillary teeth from central to canine.
• Even relatively small deviations in this element can produce noticeable problems with the smile.
Incisal Embrasures
• The incisal embrasures of the maxillary anteriors should displaya natural, progressive increase in size from the central to the canine.
Operatory 3
Operatory 3
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Smile Design - Mike Malone D.D.S.
Connector
• The contact area, or connector, can be defined as the area between two teeth where they appear to touch.
• The “50-40-30” rule, as defined by Jeff Morley, is when the connector between the centrals is 50% of the central length, 40% between central and lateral, and 30% of the central length between lateral and canine.
50{40{30{
Principles of Golden Proportion
• The suggested mathematical ratio of the apparent widths of the anterior teeth when viewed from the front is 1.6 : 1 : 0.6. Dr. David Garber suggests using a range of 1: 1.3 to 1 : 1.9.
• Many clinicians prefer to develop proportions by eye rather than use a strict mathematical proportion.
.6 1 1.6
Buccal Corridor
• Buccal corridor refers to the area distal to the maxillary canine visible during the smile.
• It can be affected by lip shape and position, arch width, bicuspid position, and the color and value of the posterior teeth relative to the anteriors.
Gingival Height and Position
• The gingival position of the centrals should be symmetrical and relatively similar to the cuspid’s gingival height.
AACD Criteria Guide
Gingival Height and Position
• The lateral incisor’s gingival height should be the same, or preferably, slightly less than the centrals (never higher).
AACD Criteria Guide AACD Criteria Guide
Gingival Shape and Zenith
• The gingival shape of the maxillary lateral incisors and the mandibular incisors should be a symmetrical half-oval or half-circle with the zenith in the center.
• The zenith of the maxillary centrals and cuspids should be distal to their long longitudinal axis.
AACD Criteria Guide
Operatory 3
Operatory 3
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Smile Design - Mike Malone D.D.S.
Shade Progression
• The maxillary central incisors have the highest value of all the teeth.• The laterals have a similar hue, but slightly lower value.• The canines have greater chroma and the lowest value of all the
maxillary teeth.• First and second bicuspids are similar in chroma and value to the lateral
incisors.
Tooth Morphology
• Line angles are found on the proximals of the anterior teeth when the facial surface turns into the inter proximal area.
Tooth Morphology
• The outline form is the shape of the tooth when you connect the mesial and distal line angles with incisal and gingival lines.
• Outline forms can be square, ovoid or tapering, or shapes in between.
Labial Anatomy
• Labial anatomy is affected by the lobular development of naturalteeth.
• The central incisor is developed from three lobes, the lateral from two and the canine from one lobe.
AACD Criteria Guide
Factors That Suggest Age
• Shorter, more square teeth give the impression of an older smile (centrals usually wear the most).
• Age and the resulting wear also create sharp and angular corners and smaller incisal embrasures.
• Teeth also darken with time.
Factors That Suggest Gender
• Lateral incisors are the most gender related teeth.• Feminine Lateral Incisor:
• Masculine Lateral Incisor:- Wide gingival width- Almost as wide as central- Parallel proximal line angles- Flat incisal edge- Sharp incisal corners- Convex gingival embrasures
Factors That Suggest Personality
• Shape of cuspids- Pointed cuspids are aggressive; rounded suggest passivity.- A flat cuspid profile is also more aggressive.
The Smile Design Appointment
• The comprehensive cosmetic patient is appointed to make decisions necessary for the development of their pre-planned esthetic wax-up.
• We use photographic guides such as Bill Dorfman’s The Smile Guideand any photos the patient may bring.
The Smile Design Appointment
• A direct composite resin mock-up can be used instead of a laboratory wax-up.
The Smile Design Appointment
• Cosmetic computer imaging is another communication tool for helping your patient make smile design decisions.
The Smile Design Appointment
• Explain concept of designing first, then implementing change at the preparation appointment with their “prototype” provisional restorations.
• Prototype provisionals give your patient a chance to experience their smile changes before the final restorations are even started.
Operatory 3
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Thirteen procedures to insure an ideal restoration‐Dawson
1. Do a thorough examination.
2. Visualize your end result.
3. Outline the treatment in the proper sequence.
4. Make sure the tissues are healthy before beginning final restorative procedures.
5. Prepare the teeth meticulously.
6. Magnify your vision.
7. Verify the accuracy of your impression.
8. Verify the accuracy of your dies.
9. Verify bite records, both in the mouth and on the models.
10. Fabricate good temporaries.
11. Provide the technician with all the information he or she needs to make a masterpiece.
12. Verify the accuracy of lab procedures.
13. Check the accuracy of the restorations before placing them in the mouth.
Billy Malone
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ESTHETIC WAX-UP CHECK LIST
Mike Malone, DDS, FAGD 300 Doucet Rd. Lafayette, LA 70503 Patient _________________________________ Date _________________________________________ Due date ________________________________________
Tooth Numbers Type of Restoration
1. Central incisor size. Length ____mm. Width____ mm.
2. Move the midline____ align ______mm Right ______mm Left
3. Free gingival line. ___Maintain position. ___Modify position ____mm apically.
4. Incisor shape or Smile Guide___________________.
5. Horizontal plane. ____Change to coincide with desktop (mounted models).
Approval of Prototype RestorationsI have had the opportunity to view the final shape of the prototype restorations. With the exception of the requested modifications noted below, if any, I approve the restoration giving the lab permission to proceed with the fabrication of the final restorations. Any changes in the porcelain material after the final restorations are completed will require an additional fee for remaking the restorations.
Patient Signature:____________________________Guardian (if under 18)_______________________
Additional Requested ModificationsAdditional requested modifications, if any, are noted as follows: _______________________________
Approval of Trial VeneerI have had the opportunity to view the color and shape of the trial porcelain restoration under different lighting conditions, including natural sunlight. With the exception of the requested modifications noted below, if any, I approve the restoration giving the lab permission to proceed with the fabrication of the final restorations. Any changes in color or porcelain material after the final restorations are completed will require an additional fee for remaking the restorations.will require an additional fee for remaking the restorations.
Patient Signature:____________________________Guardian (if under 18)_______________________
Additional Requested ModificationsAdditional requested modifications, if any, are noted as follows: _______________________________
• Take bonding hydrocolloid/alginate impression of prepared teeth.
• Pour up impression with Snap Stone. Allow to set for five minutes.
• Remove the model from the alginate.
• Clean up and try crown form on model. Draw red pencil line at crown form margin.
• Paint two coats of Rubber Sep onto preps, drying each layer (should look like die spacer).
• Coat entire model with thin layer of Liquid Foil Separator and dry.
• Place Radica incisal into crown form and shape for mamelon effect with wax pencil.
• Place Radica body shade into crown form and quickly place into prep model. Press all the way
to the red line and hold until cool.
• Place in Enterra curing unit and cure for recommended time.
• Repair any voids or discrepancies with Radica body placed with wax pencil and cure.
• Separate provisionals between cuspids and first bicuspids on both sides with diamond disk (for
full arch provisionals).
• Gently remove provisional from model, being careful not to break the provisional. (You must
trim excess from lingual of veneers before removal)
• Cure in Enterra oven for 2-4 minutes after painting inside of temps with glycerin (air barrier).
• Trim excess material close to margins on the facial and lingual using preferred acrylic burs.
• Trim and remove excess interproximal from the gingival embrasures using modified green wheel.
• Refine margins using favorite burs.
• Remove internal flash and any existing bubbles.
• Place back on model and repair any deficient margins.
• Transfer to the patient adjusting any other undercuts as necessary.
• Refine facial and incisal embrasures using the Vision Flex 140.
• Paint all exterior surfaces with Radica Sealer and cure at the sealer setting.
• Cement with appropriate temporary cement.
Operatory 3
34
LA Academy of Continuing Dental Education in cooperation with
LSU School of Dentistry
Cosmetic Dentistry Continuum – Level I
BONDING SEQUENCE By Dr. Jimmy Eubank
1.) Clean tooth – Remove prototype cement and sandblast while protecting the tissue and
adjacent teeth. Rinse and remove all grit. 2.) Apply superoxyol with microbrush to stop tissue seepage and clean tooth, leave 10 to 15
seconds – then rinse. 3.) Etch – 37% Phosphoric – scrub with microbrush for 10 to 15 seconds 4.) Rinse and dry – Verify proper etch pattern. 5.) Apply Liner Bond 2V (A & B Primer) – (add Activator if bonding to composite build-up)
scrub with microbrush for 20 seconds then let set for 20 seconds. 6.) Gently air dry until nothing wiggles – this will leave isolated surface areas that are not
glossy. 7.) Apply Photo Bond plus Activator to tooth and blow off excess (no pooling) - establishes
a uniform glossy surface (mix catalyst and activator first). 8.) Light cure 10 – 40 seconds depending upon light source. 9.) Apply Photo Bond mixture to sandblasted, etched restoration and blow off excess. 10.) Place restoration with the appropriate resin cement, verify seat and light cure.
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