As more patients are saving their teeth into their golden years, the desire for a more beautiful smile has become one of the most powerful incentives for a visit to the dentist. The essential ingredient to success in dental esthetics is the commitment to the best interests of the patient. It is our responsibility therefore to adhere to a protocol designed to ensure not just beautiful teeth, but comfort, function and long-term stability as well.
Because a foundational principle of The Dawson Academy is “the better the function, the better will be the smile design”, our protocol for predictability is centered on the functional matrix, a sophisticated system that relates the optimal contours of the anterior teeth to the TMJs and the muscles of mastication. It teaches us that every specific contour of the anterior teeth is designed for a specific function.
The protocol of the functional matrix is composed of four stages: functional-esthetic analysis, three-dimensional treatment planning, prototype restorations and finally definitive restorations.
The process always begins with a complete examination and an understanding of the patient’s desires. Our responsibility is to study the data collected during the exam and make recommendations for treatment based upon the existing signs and symptoms of dental disease. Once the data has been gathered, a four-stage process is followed regardless of the complexity of the case.
Stage 1: Functional-esthetic analysis.
This stage begins by following a checklist. Section 1 evaluates the health of the TMJs and the five requirements for occlusal stability followed by evaluations for macro and micro esthetic goals. These steps begin with evaluating how the smile relates to the face and lips and proceeds through evaluating the shapes and contours of teeth and their relationship to each other.
Stage 2: Three-dimensional treatment planning.
In this stage, which also utilizes a checklist, uses reductive reshaping and/or additive wax on diagnostic mounted models to develop a dental “blueprint”. The result is than tested on the articulator to determine if it meets the functional parameters for stability and predictability. A specific set of matrices is then fabricated from this blueprint, to be utilized chair-side, allowing for efficient and conservative preparations. However, no matter how good a diagnostic wax-up looks, it must be verified in the mouth with prototype restorations, commonly known as provisionals or temporaries.
Stage 3: Prototype restorations.
The prototype restorations play a far more important role than simply a transitional phase while the laboratory fabricates the definitive restorations. Prototype restorations allow for the verification of two important criteria related to function and esthetics: the customized anterior guidance and the length and position of the incisors using phonetic analysis. Once final adjustments to the prototypes are completed and approved by the patient and doctor, an impression is taken and thus a copy of the desired end result is sent to the lab for creation of the definitive restorations.
Stage 4: Definitive restorations.
The laboratory now has the information needed to produce predictable, beautiful restorations. The restorations can be placed with a high level of confidence and with very little modification and no surprises!
Predictable, durable, and esthetic dental restorations can only come from the implementation of a reproducible protocol. This protocol must honor the functional and esthetic parameters that are found in nature. In the end, each case is treated via four different methods:
• visually, through the tools of functional esthetic analysis
• virtually, through the use of mounted models and a diagnostic wax-up
• through the use of prototype restorations as a trial test in the patient’s mouth
• with definitive restorations. The commitment to a successful protocol will eliminate errors and help to ensure a functional, beautiful result.