Smile Makeover: Planning Combined Cosmetic Treatments

In general, the dentist first needs to know how healthy your teeth and gums are, how your bite works and what you want. These decide which treatments are suitable and in what order. The General Dental Council requires dentists to explain the options, including delaying treatment or doing nothing, with the risks and benefits of each.

In general, an assessment for combined cosmetic treatment looks at:

• Dental health: decay and gum disease change what is suitable. Gums that bleed when you brush or eat hard foods are a sign of gum disease, and the NHS advises seeing a dentist if this happens.
• The bite: how the upper and lower teeth meet, and whether you grind or clench.
• Tooth position: crowding, gaps or rotated teeth, because moving teeth first can change how much shaping is needed later.
• Existing crowns, veneers and fillings: whitening does not change their colour, so they affect the shade plan.
• What you want: the specific things you would like to change, and what matters most to you.

Records such as photographs and a scan of the teeth are then the starting point for the design. A useful question at any assessment is which treatments are needed for what you want and which are optional.

In general, a smile makeover is designed before any tooth is reshaped, so you can judge the planned shape and agree it first. The design starts from photographs and a scan and is modelled digitally or as a wax-up, a model of the new tooth shapes.

The design can then be tried in the mouth as a trial smile, also called a mock-up. A review of digital smile design describes this as the stage where the patient can evaluate, give an opinion on and approve the shape before irreversible work. A design is a guide, not a promise. The narrative review notes that the final result may not match the digital design exactly, because materials, anatomy and software all have limits, so expectations need to be set against what treatment can deliver.

At Deepcar Dental Care, the planning steps for cosmetic treatment include:

• clinical photographs
• intraoral scan
• digital smile design software
• laboratory wax-up
• trial smile or mock-up in the mouth
• shade taking under corrected lighting
• a written plan before anything starts
• a second consultation before committing

The design software is exocad. Digital shade matching is used, and you may visit the laboratory for shade taking where needed. No laboratory work is sent overseas. Each planning step is explained in more detail in our smile design process, including how the design is approved.

Speak to your dentist before planning cosmetic treatment if you notice signs of a dental health problem, because health comes before appearance. Reasons to book include:

• gums that bleed when you brush your teeth or eat hard foods, which the NHS lists as a reason to see a dentist
• a tooth that is chipped, cracked or broken, which the NHS also lists as a reason to see a dentist
• grinding or clenching your teeth, which affects which restorations suit you
• an existing crown, veneer, bonding or filling that has chipped or come loose