An excerpt from: A Cup of Coffee with 10 of the Top Cosmetic Dentists in United States.
Over the years, many of my patients at the Miami Center for Cosmetic and Implant Dentistry have expressed their thoughts on the importance of an attractive smile, and many more patients desire an attractive smile even if they don’t bring it up in conversation or think they may not be able to afford it. It is indisputable that the importance and value of an attractive smile is immeasurable. It falls into categories, such as a “first date”. When you meet that special someone, you do not want to feel the need to hide your smile or be self-conscious about first impressions. An attractive smile is one of the first things that people notice about us. It is important for succeeding at work and getting the job of your dreams. It helps you make new friends and be more socially active. In our current society, people are more likely to accept someone with a nice smile. They often believe that having bad teeth is indicative of bad personal hygiene, low social status, or even lack of intelligence. Smiles are important, especially in the social arena. Your smile is one of the very first things that a person will notice about you, and bad teeth can overshadow the rest of your appearance, from your pretty eyes to your nice hair. It’s unfortunate but true that having a nice smile (versus an unattractive smile) tremendously influences one’s self-esteem. In today’s world, what accentuates the negative impact of an unattractive smile is that achieving a remarkable “before and after result” is often easily and quickly attainable.
Most of my patients already know the main problem with their smile, but they often overlook a few other aspects that need enhancing. If I only fixed the things that my patients initially wanted to be changed, the end result would often be unsatisfactory. My job is to review everything with them so that they see the big picture, which also helps me to see what the patient wants to achieve. Some patients want absolute perfection while others just want an improvement. Also, some patients have several things cosmetically wrong with their teeth but just want one thing fixed. While I ultimately need to give my patients what they want (it’s the patient’s mouth, not mine), at the same time, I need to do what is best for them and give my best guidance.
What is extremely important for the patient to understand is that cosmetic dentistry requires an artistic acumen and talent that separates this facet of dentistry from all other categories of dental treatment. I believe a true cosmetic dentist must be an artist and have a unique appreciation of the many components that contribute to attaining the desired state of perfection. One may argue that perfection is unattainable. However I suggest that striving towards a goal of perfection will ultimately yield results well beyond the patient’s expectations.
My initial goal is to create an immediate cosmetic change on the very first visit. It is a regular and common occurrence for my patient to leave after the first visit with a beautiful smile. This is achieved by the fabrication of temporary crowns or veneers that create an extreme improvement of the patient’s initial smile. It is extremely gratifying to see the metamorphosis my patient goes through after just a few hours of treatment. Although we give the patients initial before and after photos prior to beginning treatment, most find it hard to believe that they are really going to be the recipients of that incredible change they’ve always dreamed of having. My greatest personal reward is the exuberance my patients express when they see their end results. The myriad of emotions they express on that final day when they look into the mirror is priceless. To think that I have been so blessed to have been the beneficiary of this experience from thousands of patients over the years is a true gift for me.
During the first evaluation, I ask the patient to open his or her mouth and smile for me. I then step back a few feet to assess the mouth the way that another person would look at him or her on a casual basis. Without focusing on an individual tooth, I get a broad sense of his or her smile line. Are the teeth long or short, narrow or wide? Do the teeth slant off to one side or dip down? This gives me a sense of which route to take when developing a plan for a smile makeover. It may involve straightening the teeth with Invisalign®, following a simple re-contouring and bonding route, or applying porcelain techniques. As I continue to take a closer look, I may determine that the patient has significant tooth damage (worn, discolored, or fractured) or that an asymmetrical gum line is adding to his or her dental problems.
During the consultation, I use “before and after” photos of my prior cases. Patients can look through them, make sure that they view the end results of a variety of my previous makeovers, and appreciate the type of transformations that can be made in the mouth. One of my favorite things to mention to patients during a consultation is the fact that, unlike any other cosmetic procedure, cosmetic dentistry allows patients to see the end result before it is brought to completion. This allows the patient to give final approval for an end result that lives up to expectations and is exactly what is wanted. In some cases, I use study models so that patients can get a mock-up of their own mouths to use in the process of designing customized cosmetic procedures.
With prototypes, patients can see how their new smile will appear in their mouth before we apply the permanent produce. A patient can give the green light and say, “Doc, I’m thrilled with what I see. Let’s finish it off.” We can then permanently bond the veneers or crowns to the teeth. However, a patient may say, “I really like everything I’m seeing except one or two aspects. Can this be changed? Can the veneer be made wider or longer?” As always, any aspect of the case can be changed. Patients return for a subsequent appointment to see the change. If that is acceptable, we place it in the mouth for a final bonding or cementation. Patients appreciate the fact that they get to approve their cosmetic end result before it is completed in the mouth. That is why I never have a patient leave unhappy: in the end, everyone is always thrilled.
Our patients are usually overwhelmed when they see themselves for the first time after we finish the work. When I hand the patient a mirror, he or she is overjoyed, seeing a new smile for the first time. Words cannot describe the feeling I get, seeing my patients overcome with joy and tears, seeing themselves as they always dreamed they should look. Countless patients have come back to tell me that they wished they had “done this sooner.”
A patient in her 50s came to see me about a smile makeover. I did a full mouth upper and lower arch porcelain veneer reconstruction. She was ecstatic with the results and said it was the best thing she had ever done. Recently, she came into my office and told me that her only problem is that her cheeks hurt from smiling so much. She found herself walking past windows and mirrors smiling at herself all the time. For years prior to her treatment, she had to cover her mouth every time she smiled because she was so self-conscious about her teeth, and now she has self-confidence when talking with people. During one of her regular six-month cleanings, she started crying with gratitude and appreciation for what we had done for her.
In my office, for years I typically saw more women than men who want a smile makeover. However, there’s been a significant increase in the number of men wanting aesthetic dental treatment. Often, I see younger men in their 20s to 40s who are starting careers, seeking a different job, or looking for new relationships. However, in recent years, we’ve experienced a noticeable increase in baby boomers and seniors seeking cosmetic improvements with their smiles. Ultimately, most people are looking to elevate their self-esteem and cosmetic dentistry affords the solution.
For example, one patient came to my office because he felt uncomfortable applying for jobs with his current smile. This 42-year-old gentleman was unhappy, had low self-esteem, and was very self-conscious. He always had felt that people were staring at his mouth. After his smile makeover, he had the courage to reapply for a sales job that he wanted and had been turned down for the previous year. He told me, “Dr. Ziegler, the same person that interviewed me a year earlier remembered me and at the end of the interview actually commented about my infectious smile. I was shocked we he told me that, but the end result was that I got the job!” My patient told me that he has turned into a real extrovert and has much more self-confidence when initially meeting people. He gives full credit to his new smile for his personality-altering transformation and I am the recipient of his thanks and appreciation. How much better does it get! The following week, two of his coworkers came to see me and began cosmetic treatment.
An additional advantage that we offer patients at the Miami Center for Cosmetic and Implant Dentistry is the wide scope of dental implant treatment we provide. Often, my patients’ treatment involves not only cosmetic treatment with porcelain veneers and crowns, but dental implants as well. In our office, I work in tandem with Dr. Gonzalo Barrantes, whose focus is on every aspect of implant dentistry and all the latest “state of the art” implant procedures. The end result is that, together, in a short period of time, we can achieve results in our single office location that are truly spectacular. There are some patients whose teeth are not salvageable due to extensive decay or advanced periodontal disease. They simply are not candidates for cosmetic dentistry utilizing some or all of their natural teeth. In these cases, rather than subjecting a patient in this category to treatment and an expense which is doomed to failure, working together, we are able to achieve predictable, stable, and beautiful long term results utilizing dental implants. Patients in this category, who initially arrive in our office downtrodden and depressed, leave feeling they have a new lease on life.
Outside of the office, I personally enjoy playing piano, basketball, traveling—and most importantly, my family. Inside the office, my reward is giving patients a reason to smile again. This may be a cliché statement but it is true all the same. Of course I enjoy changing a patient’s perception of dentistry, but mostly, I enjoy the new sense of confidence that patients receive with their smile makeovers. I feel that I am a cosmetic architect for the mouth. As a member of the American Dental Association, Florida Dental Association, South Florida Dental Association, American Academy of Cosmetic Dentistry, and others, I keep up-to-date on all of the latest advancements in cosmetic dentistry. Dentistry is my passion and helping people is my purpose. I tell my patients that there are six ways to improve the appearance of their smile using cosmetic dentistry: teeth whitening, bonding, porcelain veneers, porcelain crowns, Invisalign®, and gum reshaping (aka “gingival reshaping”). The route that I choose to help a patient improve their smile will depend on that specific patient.
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