Functional Cosmetic Dentistry The Best Way To Go
By Lois Thomson

Functional aesthetic dentistry is a step above regular cosmetic dentistry. But to perform it properly, your dental practice must also be a step above. And that describes the practice of Dr. Steven R. Crandall, DMD, who gained expertise in the post-graduate dental program at the Pankey Institute in Florida.

Dr. Crandall described the concept of functional cosmetic dentistry: "It requires additional information to be gathered during the exam, and a lot more is involved with the diagnosis, treatment planning and case presentation. We have about 10 different stages we go through to accomplish getting the optimal makeover."

He said the first step is to have a conversation with patients to discover the outcome they are looking for.

"It's very important to get feedback on their expectations, although we do want to make sure their teeth are positioned functionally to last a long time. So after a discussion with the patient, we go through a very comprehensive examination process. It takes approximately an hour-and-a-half to gather the information we need, and it typically includes models and photographs and X rays, as well as an examination of their muscles and joints."

Following the evaluation, Dr. Crandall does what's called a laboratory wax-up on the patient's study models. He then waxes the teeth to the shape he and the patient would like them to be. "So we get the form (esthetics) and the function established on these models." This is done using the photos that were taken.

He clarified his comment by saying that when a person's jaw moves in different directions, the front teeth are supposed to interact with one another in a certain manner. However, dentists in other practices don't often take the time to do that, and just hope for the best.

"But it's very important to work all of those things out, and we typically do that on models prior to doing any dentistry," he said, adding that the patient then usually goes through a temporary restoration. "That's something we make out of acrylic, and it's based on the pre-approved wax-up we already did on the model.

"So the teeth are restored with provisional restorations, and patients can 'test drive' it. They come back in and we evaluate, to see if the bite is correct and if they like the way they appear cosmetically. We modify the provisionals to establish the look the patient is hoping for and fine-tune the function."

Dr. Crandall concluded by saying, "It's a little more elaborate than what typically goes on in a dental office. In an insurance-driven practice, a lot of these steps don't take place. People do not consider the functional portion of dentistry very often, and that can lead to failure and discomfort if it's not integrated into the restoration."

For more information, call (412) 833-6166 or visit www.stevenrcrandalldmd.com

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