Smile Makeover – From a Well-Informed Patient

In a commercial market driven by advertisements and the desire for instant gratification, patients need to be well-informed about treatments involving cosmetic dentistry.  A successful case must be built on multiple foundations which include:

1.  Your bite

2.  Esthetic principles

3.  Your personal preferences

4.  The science of today’s materials and techniques

The following email was sent to me from a current case in progress.  This patient has done so much research on his own that he knows all the details: from the tooth numbers, to the types of porcelain available, to the characteristic tooth shapes, etc.  This is an example of what every patient should know before making a decision on important restorative treatments.

This type of clear communication enables me to coordinate the work with the ceramists who also need to hear the patient’s concerns and feedbacks. I am privileged to have the opportunity  to work with such well-informed patients.


Email dated Dec 18, 2010

Hi Dr. Alex

Attaches is the “style guide” from where I took the smile that I showed you today.
None of the smiles match exactly what I’m envisioning, but a few come quite close: the Hollywood/Natural/Softened styles.
* Overall: something strong and youthful, but not overly aggressive or mature
* Central incisors: I like the shape/edges on the Hollywood/Natural (actually all three look the same)
* Laterals
* I like the shape on the Hollywood (similar to my current teeth), but they could go in (up) a little more deeper on the corners, especially the edges with the centrals.  Actually, the right lateral (when looking at the photo, tooth #10) on the Natural is what I’m looking for.  But I don’t like the shape of the left incisor (#7) on the Natural–it’s too round especially on the cuspid side
* I would play with the lengths of the central and/or lateral incisor to achieve an ever so slightly larger vertical difference (maybe 0.2-0.4mm more) so it looks like the Natural.  What I said in the point above about the edges going up would probably achieve the look of more difference without really changing the lengths of the teeth all that much.
* Cuspids: I like the shape of the Softened: the Hollywood is too flat, and the natural too pointed/sharp.  I also think the roundness on the Softened would fit in better with the shapes of my Bicuspids
* Bicuspids: I know we only discussed bonding only on #12 for now, but my thinking is that they would end up similar to the ones seen here (they all look more or less the same in all the styles)
I understand it needs to be customized for my mouth/face shape and my bite, but wanted to share my thinking/vision on some details of the cosmetics. Let me know if you have further thoughts/questions. I know its hard to discuss some of these details through email, we can also look at the image when I come in for the next appointment, if its not too late in the process then. I can also stop by sooner if you feel that would be helpful.
Have a good weekend!


Alex Nguyen, DDS is a Saratoga Dentist who practices General Dentistry, Cosmetic, and Implant Dentistry. For over 20 years the practice has been serving the residents of Santa Clara County and San Francisco Bay Area.

About alexnguyen

My career passion is to help enhance, restore, and preserve people's smiles View all posts by alexnguyen

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