The Quest for Esthetic Perfection
By Dr. K. William Mopper DDS, MS
Dr. Mopper, the 2003 recipient of the NYU Irwin Smigel Prize in Esthetic Dentistry, is Cofounder and Chairman of Cosmedent, Inc., an Illinois-based corporation dedicated to training dentists in the field of esthetic dentistry and to developing and marketing esthetic dental materials to the profession.
Global Health Nexus (GHN): Based on your 30 years in practice, what would you say has been the biggest boon to dentists in their quest for esthetic perfection?
Dr. Mopper: That would have to be composites. I am convinced that composites are dentistry’s most versatile material. Not only in the quest for esthetic perfection, but in all areas of restorative dentistry, I believe that compos- ites yield the best possible results.
I have found composites to be more biologically compatible than all other dental materials, when used properly. In observing the effects of composites in patients over decades, I have found minimal recession of tissue, no appearance of toxicity, and that the gingival tissue responds to the direct composite resin in a manner similar to normal tooth structure. Another benefit of using composite resins is that they allow the dentist to fabricate the tooth structure directly in the patient’s mouth, without sending it to a lab. This puts the dentist in control of the material and mini- mizes the need for laboratory fabrication. Since lab fees are always going up, this is a practice management plus.
Composite resins are here to stay; they are getting stronger all the time; and they offer many more uses than just veneers. Dentists should be able to use them for virtu- ally any restorative or esthetic procedure, including class 3, 4, and 5 restorations, a diastoma closure, to invisibly restore an enamel defect, or for any desired restorative orthodontic technique.
GHN: Are there any problems using composites?
Dr. Mopper: Problems arise because many dentists don’t have a sufficient understanding of the science of compos- ites and how to use them to achieve consistent, reliable, durable results every time. Instead of mastering one system, there is a tendency to switch every few years, whenever a new system comes along. This is a case where overreliance on new technology can be counterproductive.
Another problem is the belief that there’s one material that can do the job. The reality is that no one material can produce a perfect esthetic result. What’s required is a combination of multiple composite materials that have different properties in order to achieve an optimal esthet- ic result. For example, microfill is a very important part of the system because it replicates the enamel structure beautifully. Hybrid is a necessary component as well, because it replicates the dentin both in strength and opacity. So the use of the two materials in combination provides the best possible results. I’m very proud to have played a role in producing many of the composite mate- rials now available that allow dentists to achieve any color, any opacity, any translucency necessary to create a realistic tooth surface and accurate morphology.
GHN: How would you sum up your philosophy of esthetic dentistry?
Dr. Mopper: My philosophy is very simple: Esthetic dentistry is both an art and a science. The art depends on the skill of the dentist and the science on understanding composites and the proper application of these materials.
The key is continuing education based on materials that are systematic and concepts that are presented in a cookbook- type format that demystifies the process and makes it easily accessible.
GHN: Now, let’s say that the dentist has mastered the art and science of composite resins. The next step is get- ting the patient to say yes. What is your approach?
Dr. Mopper: Patients select a dentist because they believe that person to be an expert in the field. Show the patient that you care. Listen to the patient and to the patient’s expectations. Then express confidence in your ability to give the patient what he or she wants and outline the benefits of your proposed treatment plan. Show the patient many examples of your treatment results and especially those that relate to the treatment that you have proposed for the patient.
But actions speak louder than words, so I also recommend demonstrating your expertise by creating a mock-up of the esthetic results directly in the patient’s mouth. You can do this with an intraoral camera and imaging, but I don’t think it has the same impact. Using a material called “show off,” which self-adheres to the tooth structure, I prepare a three-dimensional mock-up that very rapidly shows patients what they will look like. Fully 99 percent of my patients say yes on the spot.
This article was reprinted with permission from Global Health Nexus, a publication of New York College of Dentistry.