Surveying the landscape

02 October 2014
Volume 30 · Issue 1

Koray Feran reviews the current state of aesthetic dentistry in the UK.

I am reaching the end of my 10th year on the committee of the British Academy of Aesthetic Dentistry, with six of those as treasurer and two as incumbent president. In this time, the world of dentistry has changed dramatically. It has not been sudden, rather a multitude of small steps, but it is very gratifying to see that all the roads are, so to speak, leading to Rome.

The last decade years has seen a plethora of new organisations, academies and societies suddenly erupt out of seemingly nowhere. We have thankfully discarded the pursuit of the American fridge door smile and indeed, together with our European and South American colleagues, appear to be exporting the desirability of beautiful natural looking dentistry back across to the land of B0.

What has changed?

 I think we can summarise it as follows:

  • A humbling awareness of the longer term toll of iatrogenic damage that was being done in the name of cosmetics. It is now indefensible to cut away healthy tooth tissue to make room for porcelain purely for cosmetic reasons. It was not that long ago that very heavy tooth preparations with significant longterm endodontic repercussions were being carried out up and down the country. The rapid moral rejection of this type of dental mutilation is a credit to a forward thinking profession which I am sure will never return to those days again.

  • The invention of better and stronger materials that allow less invasive dentistry and bright, beautiful and durable results. The strength and beauty of modern dental ceramics when they are properly utilised can be breathtaking. A debt of gratitude is owed to those researchers and companies that provide us with the materials that make our day-to-day life so predictable and so rewarding.
  • The digitisation and sophistication of dental manufacture that allows consistent results in quality. CAD-CAM and digital imaging is here to stay. Current methods of manufacturing light, strong and durable dental restorations for a ?reasonable cost is the new revolution in dental care and will only get better and more costeffective as modern technology is applied.
  • The increased use of magnification. If we can see it better we can treat it better and most dentists will now accept that magnification whether it is through loupes or microscope, and illumination in addition (or perhaps even replacing) the dental light are prerequisites to quality dentistry. I would venture to say that no dental treatment (including hygiene sessions) should be carried out without magnification and coaxial illumination any more.
  • A revolution in new, quicker and targeted orthodontic techniques. The ability to rapidly align teeth with minor crowding has saved acres of enamel from being cut away and a multitude of pulps from an ignominious end. Modern orthodontics is absolutely indispensable part of restorative and aesthetic dentistry and should be used more and more frequently.
  • Implant, bone augmentation and mucogingival surgery have become more sophisticated and commonly utilised in laying the foundations and providing long-term tissue stability around restorations. We now know that cutting corners at the start leads to problems later on and placement of hard and soft tissue grafts as part of implant placement has become the norm rather than the exception.
  • Improvement of photographic techniques and documentation. Better digital cameras and the ability to process and distribute images and video have raised the bar on our patients’ expectations and provided clinicians with a benchmark to improve their own abilities and results. The dental digital camera must be ready and set up in every surgery as part of the clinical record, medicolegal defence and learning.
  •  An increase in social media and available platforms for the display of one’s work. It is difficult to go even one day without being regaled by proud clinicians posting on social media networks and websites the results of beautiful painstaking work that spurs the rest of the profession to get better at what they do. This is welcome and admirable (within the constraints of patient confidentiality).
  • A massive increase in the number of courses, lectures, hands-on teaching. Dental education is now an industry in itself. There is no excuse for not learning and by organising themselves into groups and academies and giving of their free time to organise educational activity clinicians and technicians of our profession that have had the vision are rapidly pulling up the standards of the rest of the profession to their eternal credit. Most importantly, all of the experienced clinicians and technicians that have been doing this for a long time have finally come to a consensus as to what is aesthetic. Whether you are a cosmetic academy, aesthetic academy, orthodontic academy or a technical academy, the targets and treatment methods are coalescing more or less into a uniform plan for each patient treatment outcome.

 

What is holding us back?

In my view, there are three issues that still need addressing:

1. Could the profession please sort out the whitening debacle? It is an absolute travesty that such a safe and useful treatment has effectively been outlawed and could lead to some of the profession going back to the bad old days of cutting down teeth to achieve aesthetic results when we know that there is a much safer but arbitrarily restricted technique of high concentration whitening. This simply is not acceptable.

2. We need more high-end ceramicists with an understanding of dental anatomy, colour and light to achieve consistent high end results. The dental technicians in this country have been decimated and been falling behind their international counterparts for a variety of political and financial reasons. Support your lab technicians and work with them to raise standards!

3. Finally, and possibly most importantly, the use of our profession by successive governments to provide our expertise at unsustainably low fees which breaks the spirit of young practitioners. They and their patients deserve better. But that is a big can with lots of worms for another occasion….