American Academy of Cosmetic Dentistry Criteria Workshop

Part 1 - Criteria overview part 1

Instructors:

Dr. Bradley Olson, DDS

Dr. Bradley Olson, DDS

Dr. Olson is one of approximately 300 dental professionals internationally to achieve Accreditation status in the American Academy of Cosmetic Dentistry. In addition, Dr. Olson has achieved the AACD’s highest credentialing honor by becoming the 39th member awarded Fellowship in the Academy.

The criteria to begin the AACD accreditation process will be reviewed as well as principles of smile design.

For those of you who weren't here this morning, my job is to of course give you some background information and give you the protocol of what accreditation is about. This afternoon we're going to spend time talking about criteria for accreditation. But you know again my job is to make sure that you understand that this process is attainable. So it's approachable as you're finding and it's attainable as you saw a case this morning. So we looked at the positive cases this morning, a little bit this afternoon, we're going to look at more where some of the stumbling blocks are, where are some of the places that can make you struggle a little bit as we're going through this process. So we will move forward with that. It's interesting when I did the criteria workshop. This is always, I won't say it's a challenge but one of the issues that we deal with in a criteria workshop is that the criteria guide is all about smile design. And so the criteria workshop for the first hour here I'm going to basically be doing what you would see in the criteria guide with some extra hints and some different ideas and showing you some various cases that aren't in the guide. But it's a challenge giving a smile design lecture to a group that has varying skills across the board. So I've had responses to this workshop or at least the first part of this workshop that vary anywhere from it was as dry and boring as they can possibly imagine, because they're well well-versed in smile design principles, all the way to people taking copious furious notes and coming up afterwards and saying that was, you know, so well-organized. You put it in such a great light for me that I organizationally now can see how to put some of this stuff together. So it does cover the gambit. I'm going to keep it fast pace and I'm going to keep it moving it along. So as always just as with this morning, stop me, ask questions, discuss a case that you see up there, anything you want to go through with that. Let me know. Because this is a require workshop so you do have to hang in there with it so, let's without further ado more forward. So as we talked about this morning, accreditation. It's a credentialing process that sets the standard as far as we're concern for excellence in cosmetics dentistry and this is the place you get it, the AACD. And here are your requirements. So you have to attend half the scientific sessions. So at least every other year you need to be attending a scientific session but in actuality as we talked about this morning is I can't imagine you going through the process and not wanting to be at every scientific session. There's just too much there. There's too much information to pass up, too many opportunities to grow your knowledge and be staying in tune with this process and what's going on the academy. So I can't imagine you missing one of them. We're doing the criteria workshop this afternoon, accreditation workshop. For those of you who did not do the accreditation workshop this morning, what you're seeing with all these lights and wondering what's going on with that, as I turned and look into them, I'm blinded now, is that we're filming this for e-learning. So you would be able to take the accreditation workshop on e-learning. You've got to pass a written exam. You've got to pass your clinical case exam. You've got to pass your oral exam. And that's where accreditation leads you. Okay. So what are we going to work on here Principles of smile design. I'm going to show some cases related to that. I'll get some tips related to what I've seen in my years as an examiner related to some of these different criteria and some of the smile design items. We'll talk about examiners. What examiners, how their perspective is. What they're doing as they go in for cases and we'll close with the top 10 reasons that candidates struggle. The top 10 criteria that wind up showing up more often than any of the other criteria for failure spots in the accreditation process. Okay. So here are the two, today we're working more in terms of this criteria guide right here. The criteria guide has an index that goes through in here and these can be broken down. I've actually seen some candidates go and take the criteria guide and they actually write the criteria numbers right outside these and use it as one of their regular references as they go through their cases. It's up to you however you want to approach it. You do have your criteria list in your packet. So if you want to have that out at all today during the course of what we're doing here to refer to what should be I believe to be a yellow sheet in your packets. So you certainly are welcome to have that out and kind of look at that as we work our way along and that's what itlooks like only you can actually read it as opposed to what's up there on the screen. Okay. This morning we talked about where the direction of the academy is headed and where our profession is headed. And our profession went from that stage of ultra conservative dentistry to moving in to newer and cooler materials that required a lot more room in order to fabricate them but they really look nice. So as a result we tended to start to move in a direction of preparing teeth more and more and more to get end results. As we all know that pendulum has turned back again the other direction. As you see on all the signs out here and the new direction or actually it's always been the direction just the new found statement of direction for our academy is responsible aesthetics. What that means is finding the most conservative method possible to give our patient the most outstanding result possible. So a new criteria has been added. So I'm not sure I didn't see any hands of anybody who's ever taken the workshop before maybe one possibly but there is a new criteria on there and its no. 67. In criteria no. 67 says is the tooth preparation inappropriate or excessive. This comes in to play especially in case type no. 5 cause in case type no. 5 for the dentist you actually have to show your preparation as one of the technique steps. So we're actually going to see your preparation on here. Preparations like this will be considered catastrophic failures. There will be, there's no doubt and it does not matter how beautiful these resin veneers will come out. It will not matter because this will not be considered acceptable. So that's the direction we're heading. We've talked about, I spend a lot of time this morning on case type 5 so I won't rehash all of that again. But again it comes down to finding the most conservative method to get the most outstanding result. So keep that in mind as you're looking at your cases and again what we talked about this morning is case selection being so important. Broken the smile design criteria into two groups. One group are more the macro smile design issues. That's you see on the left hand side. So we're talking about smile line, midline, axial inclination and buccal corridors. Then we're going to talk about in the next grouping we're looking at more the micro smile design issues. So we're looking at incisal embrasures, proportionality, cervical embrasures. Think back as we're looking at these, think back to the five case types and what each case type is testing. So we know that with case 1 and case 5, we're going to have the macro smile design issues come into play as well as the micro smile design issues. When we talked about case type 2 and type 4, we're going to be probably leaning more into the micro smile design issues because obviously if you're treating a single central incisor, buccal corridor is not going to play a huge rule. If you're doing a class 4 resin on no. 9, your smile line will play somewhat of a role but it's not going to be huge, it's going to be following more in the position that that patient is in currently. So that's how they're broken down and that's how we'll work our way through it. Smile design we're going to look at three issues starting number one with the smile line. And the smile line is basically the relationship of the teeth to the incisal edge and the lower lip and how that frames in. We'll look at some cases of how areas where you, just specific case before you need to be careful in how your patient profiles that smile and how you're determining that, because there are other factors that come into play with that incisal edge and they are aesthetic and phonetics. So aesthetically how does it play; how does it work with the lower lip. Phonetically how does that work for that patient We talked about that one case this morning where that case kind of bug me a little bit in terms of edge position because somehow in my eye it didn't fit my eye in terms of how the centrals were set and how that lateral incisor was set. But if we look back at it and we remember where the smile line was and the smile position, it was in harmony. So just because something doesn't meet your eye as individual examiner, we have to put that kind of situation aside. We have to look at the principles that are involved as we saw with that case it was beautifully handled, the resin was handled magnificently and all the principles basically were in place. So you have to be careful where we go with that. Lip line is the display and lip line is how much you're going to show and we know it's about 70, 20, 10 in gross numbers. 70% of the folks have a smile line position that looked just like that. The top lip it finishes its rest position in a full smile right about the cervical edge o the central incisal maybe just slightly below that. 20% of the folks are going to be low. So no matter how big they smile its never going to come up high. Then we got the other 10% that give you the full money. So you're going to get everything. My wife is one of those folks, you know, when I did her veneers, man everything had to be on the money cause she shows it all. So you get everything on up. And it wasn't really a hypermobile lip situation or maxillary, vertical maxillary excess. It wasn't anything like that. Its just that's the way her lip position goes. It works fine for her. But you have to keep that in mind. We also talked about treatment planning these different lip positions. So when we talk about, when you're talking about the 70% and the 10% so that's 80. For most of these folks, how you set this gingival position is very very important. But when you talk about that other 20% you have to decide is this truly an accreditation case. Cause when they smile you can do a beautiful result for them. You can get a fantastic end result from their smile position. You've done your job. You've been paid for your time and services and you have a very happy patient. That's a win, win, win. Everything good across the board. That doesn't make it an accreditation case. Remember accreditation is testing all the parameters of smile design. So you have somebody with a low lip line and they have varying gingival symmetry positions, how much surgery are you going to put them through or what orthodontics are going to put them through to level this gingival positions and they don't display it. So if that's a situation that you're facing you simply deliver your outstanding result and you just understand that that's not something that fits the accreditation criteria because that patient doesn't fit that. So, not every case has to be wedged in for accreditation. So what you're watching for, here are the big things that I, these are the things that I'm adding that aren't going to be in your criteria guide and they're just things that I've watched, first of all just observing generally in dentistry, but second of all in terms of what candidate struggle with a little bit. And one of them is a reverse curve and the reverse curve is always tough both from a finished standpoint because this is rarely going to let you pass accreditation if you're doing a smile design case and you end up with reverse curse. But it's also a challenge in your treatment planning. I see folks send me lots of time as a mentor, they will send me cases and say I'm thinking about using this case what do you think. Well the first thing I tell them is what are you going to do about this reverse curve. Because if you decide that you're going to surgically move all the tissue up to chase these central incisors and then you're to restore up to that, you're doing a lot of work and not necessarily creating a very good end result. If you're dragging these teeth down, you might not have a very good proportion anymore. So you have to watch that struggle between proportionality and gingival architecture when you're starting off with a reverse curve. Watching lip asymmetry, lip asymmetries create a scenario where examiners struggle a little bit sometimes in looking at your work, because the lips are asymmetrical enough. It doesn't give you the best display of the work. Now experienced examiners can work their way pass that but you need to be careful in treatment planning your case of where you're going. Are you chasing after an asymmetric lip And lastly watching mathematical formulas, I've seen those guides that fit the face and everything gets measure off of this and this so that tells us this has to be this big and this measure says this has to be that big and at the end of the day, you have teeth that are hanging down like that. You said but the math worked out. We don't care about the math. We care about the end results. Okay. So, here's a great situation of the same patient preoperatively and here postoperatively of how it's been handled. Now either we can either say that this lip position, they've created a scenario where the edge position is not set correctly because the lip is hiding the incisal edge position, so that these teeth are not in the correct spot or we can say these teeth are not in the correct spot because this is fairly flat with a very curve lower lip. Well the answer is wrong and wrong. Because when we look at this, right here is a great example cause we have a bigger smile. We watched the proportionality of this of these teeth being virtually ideal. They took a disproportion gingival architecture. They set it in a correct position. They got correct proportions of the teeth. This comes out to be a very nice case. We're not chasing the lower lip. So being careful how we're assessing that lip position and lip asymmetries when they smile. So again what would you, so the question I've got in the past is which one of these would you have shown as your after shot in accreditation because this one matches this one but this one shows everything better. And my argument would be probably either one is fine. I usually lean more towards liking to see the before and after smiles similar positions. But when I tell you that, don't take that as law because we also know something else happens. What happens when you take somebody who isn't happy with their smile and you rejuvenate it And they don't do it on purpose. They do it because they feel good. They do it because they're confident. They do it because they like what they see now and they're not consciously thinking about it. You know one of my earliest cases I remember doing, she came to me every shot she took, stuck a tongue in between her teeth. She kind of laid it out there. And I said, Tanya can you just for one of the shot, just rest your tongue back. She goes I don't like to do that. So why don't you like to do that. She says because you can't see all the unevenness of my teeth when I stick my tongue up like that. Look and she's kind of right. I'm sure she practiced this enough times to know. We did her veneers, her tongue never sets up there, ever. I mean any shot I've taken of her after then never once is that tongue push up in that position. And I'm not sure she consciously was making an effort. I think it just naturally happened that way. So anyway general rule, try to keep before and afters about the same but if somebody goes to a bigger broader smile with a beautiful end result, there's nothing wrong with that. Okay. So idea of all this is at the end of the day everything is framed in harmony with the lips.