The examiners evaluate cases based on a point system that identifies minor, major, and catastrophic faults. A passing score is -7 or better. The examiners are also given the latitude to reward the candidate with a +1 point, in situations where the result deserves additional merit. Dr. Shimizu’s case passed unanimously with scores that ranged from -5 to -7. Almost all of the criteria faults were identified as minor and two examiners rewarded Dr. Shimizu with a +1. No case is perfect; the goals of Accreditation are to create a vision and demonstration of excellence, not perfection.

Dr. Shimizu achieved a wonderful result for his patient. The preoperative indications for treatment supported the final treatment plan. Dr. Shimizu extended treatment to include eight teeth because of the clinical indications. The indications for treatment are driven by the functional and health needs of the patient. Dr. Shimizu followed an established treatment protocol that helped to ensure a predictable result.

The examiners identified several common deficiencies in this case; often, these criteria are inter-related:

• One of the initial observations was the excessive length of connectors and the effect this had on the periodontal health and architectural harmony (Criteria #64, #71, and #72). An accepted guideline that is observed in nature relates to the proportion and size of the apparent contact zone or connectors between adjacent teeth. Typically, the ideal connector zone between the central incisors is 50% of the length of the centrals.1 The size of these connectors decreases in a symmetrical fashion as you move posterior. The effect of excessive connector length in this case appears to contribute to the impingement upon the cervical embrasures and the blunting of the papilla.

The comprehensive understanding of materials, preparation designs, and adhesive techniques should facilitate conservation of tooth structure while still meeting the parameters of function and health.

The apparent contact zone between the centrals is ideally 50% of the visual length of the centrals. Connectors between the centrals and laterals are 40% of this length, and the connectors between the laterals and cupids are 30% of this length (50/40/30 rule). The management of the facial line angles can have a significant impact on the visual reveal of the tooth. examiners noted the asymmetry of gingival zeniths, papilla heights, and inflammation of the tissue.

• Criteria #87 focuses on the visual harmony of contralateral teeth. The examiners identified a lack of symmetry of the visual width of the lateral incisors. This requires the careful management of the facial line angles and can be readily identified from the occlusal vie).2 Although the occlusal view is not how teeth are typically viewed in a social setting, it is a valuable perspective in helping to appreciate the impact that these line angles have on the reflective surfaces of the teeth. In this case, the occlusal view is helpful in visualizing why the facial plane of #10 appears narrower compared to #7. The cuspids also lack similar balance in contour and shape.

• Criteria #56 identifies the effectiveness in utilizing translucency to mimic nature and to harmonize with the balance of the smile.3 Several of the examiners found the intensity, volume, and pattern of the translucency to be slightly excessive and not reflective of what would otherwise be observed in nature.
Accreditation presents a consistent measurement of excellence in providing esthetic functional restorations of our patients’ smiles.

Dr. Shimizu has demonstrated his ability to meet this standard. He should be very proud of the result he achieved for his patient.

Although esthetics, in the past sense, is a subjective experience open to artistic interpretation, it is first important to establish a universal set of objective, systematic criteria allowing us to measure and guide our evaluation process.

The revised Guide to Accreditation Criteria seeks to provide information about those criteria. This revised Criteria Guide: Contemporary Concepts in Smile Design, to be released in mid-to late 2012, will be equipped with new diagrams, updated photos and a simplified re-organziation of the criteria.

The original Criteria Guide was published by the AACD in April 2001. The guide is a potpourri of universally accepted parameters of smile design recognized and vetted over the past several decades. In an effort to remain on the cutting edge of our understanding and mastery of smile design, it is the current charge of the American Board of Cosmetic Dentistry (ABCD) to edit and republish a revised update to what has become accepted as the gold standard in dental esthetics. The revised guide will be equipped with the new diagrams, updated photos and a simplified re-organization of the criteria.

The guide begins with the broadest strokes of smile design and the focus progressively narrows to critique the individual characteristics in our attempt to emulate nature. We first introduce the concepts of global esthetics, which focuses on those criteria observed in un-retacted smiles and how the smile orients to the face. As our study continues to narrow, attention is aimed toward the elements of macro esthetics. Macro esthetics identifies the shapes and contours of teeth and their relationship to each other. Our final frame of reference converges on micro esthetics, those criteria related to the sublte intricacies fo shade, textures, translucesies and surface effects to make teeth look like teeth. These criteria aid us in fooling the eye and allowing restorations to blend invisibly into the smile.

The revised guide will continure to serve as an educational tool and provide common language in the assesment of smile design. It will provide measurable criteria to aid in our analysis and reasons for failure or success of a smile. The fianl application of these accepted gold standards will be invaluable, not only for those pursuing Accreditation, but for clinicians and laboratory technicians in creating common ground for interpretation and implementation of excellene in dental esthetics.

Watch the AACD Print Shop for the revised Criteria Guide: Contemporary Concepts in Smile Design!

-The ABCD takes this opportunity to offer special thanks to Dr. Scott Finlay for the countless hours he spent working our new Criteria Guide. His articulate and organized revison will not only be meaningul to our Members in the Accreditation Process (MIPs), but to everyone interested in cosmetic dentistry, for years to come.

Thank you Scott, for this priceless, updated revision!

Going to the dentist should be a part of everyone’s routine health plan. Routine dental care is not only important for oral health, but research has shown it is also important for maintaining the overall health of the entire body. However, despite its importance, some people avoid regular dental checkups because of dental phobias. Dental phobias are intense, sometimes irrational fears that lead to the avoidance of dental checkups and procedures. In some cases, the fear is so intense that it can cause a full panic attack. Sometimes, the fear is unexplained and irrational while at other times it is caused by past negative dental experiences.

Despite the trouble caused by dental phobias, having the right kind of dental care can help in overcoming the fears. Many have overcome their fears by using a dentist who is kind, patient, knowledgable, and who practices sedation dentistry. In sedation dentistry, the patient remains conscious while being relaxed and numbed through the use of oral sedatives, inhaled nitrous oxide gas, or intravenous sedation administered by an anesthesiologist. Sedation dentistry, while being safe and effective, helps create a peaceful dental experience with no pain and no anxiety. This in turn leads to better health, a more attractive appearance, and greater self esteem.

Fortunately, these problems can be fixed and a beautiful smile can be just around the corner. Braces are no longer just for pre-teens and teenagers. More people are taking care of their teeth and beautifying their smile later in life with various methods of cosmetic dentistry. It is not unusual to see adults in their fifties and later, with braces.

Today the finest orthodontic alternative to metal braces is Invisalign. The method is simple, gradual and comfortable. Invisalign custom makes clear plastic aligner trays to fit the client which pop on over the teeth. Every two weeks, the client pops on a new set. Office visits are required only every four to six weeks saving more time. The beautiful smile starts immediately because the aligners are invisible. Most people will not know the client is in orthodontic treatment. Although the end result, that beautiful and confident smile, is the same and the cost is about the same as metal braces, the advantages are hard to ignore. Because the Invisalign trays can be removed, the client may eat any type of food desired and then brush and floss normally. For Invisalign Teen, six replacement aligners are provided free if lost or broken.

Dr. Finlay is a senior faculty member of the Dawson Academy where he teaches other dentists across the country the techniques to provide quality, predictable restorative cosmetic dental treatment that has become a hallmark of his practice (www.theDawsonAcademy.com).

Dr. Finlay has been perennially recognized as the Best Cosmetic and Restorative Dentist in the Greater Annapolis Area by a poll taken of over 220 local dentists.

Dr. Finlay is voted the Top Dentist in the Greater Annapolis Area in 2010

What’s Up Annapolis Magazine polled over 300 dentists in the Greater Annapolis area and asked them one simple question: “If you or a loved one needed the services of a dentist, who would you recommend?” Dr. Finlay has perennially received the designation as the Top Dentist and has once again received the highest number of votes in the areas of General Dentistry and also in Cosmetic and Reconstructive Dentistry. For more information visit www.whatsupmag.com .
Baltimore Magazine recognizes Dr. Finlay as a Top Dentist in the Greater Baltimore area. Over 2000 dentists in Baltimore and the five surrounding counties were polled over the course of a month. An amazing 75% response rate was recorded for the survey. The results were then monitor by professional advisors to validate the authenticity. The poll went right to the source: dentists themselves. They were asked, who is the best in their respective specialty in the area. Only the top vote recipients were listed. Although Dr. Finlay has been perennially recognized by What’s Up Annapolis Magazine as the Top Cosmetic and Restorative Dentist, this is the first time that he has been acknowledged by the Baltimore Magazine.

Allison Cole

If you can’t imagine going to the dentist and having an enjoyable experience then you should definitely visit Dr. Finlay’s office. His staff is not only professional but courteous and friendly too. They go out of their way each and every visit so that your experience is as enjoyable as can be. From the point of walking in the door and being greeted by friendly staff to the dental chair and the comforts of his state of the art equipment gives you the comfort and feeling they know what they are doing. You know when you sit in the chair you have no worries about the process and great result that Dr. Finlay and staff will perform. I would and have recommended Dr. Finlay and his staff too many people.  -

Steve Dannemann

I guess you could say that I have a “love-hate” relationship with Dr. Finlay and his staff! From my very first visit about 16 years ago, everyone in the office has treated me with the utmost respect and has been very sensitive to my needs and fears relating to my dental work. From Mary, Connie and Cindy at the front desk, to the hygienists to Dr. Finlay-they all take the time to listen to what I have to say and always make me feel like I am not just a patient but a friend as well. Believe it not, they make me WANT to go back! That is the highest praise they could ever get from me! As much as I dislike just walking into the dentist office, I realize that without their complete and thorough care, ongoing encouragement, wonderful chairside manor and humor, I would not have the smile that I have today! Thank you, thank you, thank you!

Susan Schmicker

I love the improved me. The entire experience with Dr. Finlay and his staff was exceptional. I can smile again!

Edith Barton

“She always has a smile and a friendly greeting for you,” would be consistent comment from those who know me. Through the care and precision of Dr. Finlay & Associates I will continue to smile confidently and won’t be able to contain my joy over my new smile.   Thanks,

Dawn Carter

Smile design, without careful consideration to functional and biological health of your smile can only be wrought with failure in the longer term. In the proper hands, training and experience, esthetic enhancements to your smile should not only improve the appearance of your teeth, but also improve their health and longevity.    It is our mission to identify these critical issues that are causing this deterioration and listen to what your concerns are to improve your smile.  It is only with this information that we can design a plan that is best for you to create the most predictable results for the long term and improve your dental health.

So how is this process completed, and how do you know what it is going to look like in your mouth when it is completed?  How long will it take and how much will it cost?  How do I pay for it?  Is it the right thing to do?  These are often questions that patients have that create hurdles in achieving the smile that they desire.

The process all begins with a complete exam.  We start with an interview to listen to your concerns and understand what your goals are in achieving a great smile.  After a review of your medical history, we begin to collect data through the use of a clinical exam, dental radiographs, digital photography, diagnostic mounted models and computer assisted technologies to help quantify occlusal forces on your teeth that often result in wear and fractured teeth and restorations.  From a study of this information, the restorative dentist can create a Dental Blueprint that begins to marry the functional health design requirements with the desired esthetic result.  This Blueprint can then be evaluated by the dentist and the patient through two modalities: imaging of dental photographs and a diagnostic wax up of the patient’s actual smile.  This diagnostic wax up is essentially a simulation in 3 dimensions of your smile that allow us to test our design.  From this 3 dimensional study we can then create a series of templates that allows us to be efficient and conservative when we begin that actual preparation of teeth.  All the steps in treatment up to this point are completed without implementing any actual changes to the teeth.

Once the dental blueprint is created, and all the aspects of treatment are understood and anticipated, the definitive treatment can be completed.  We want your visit to be as comfortable as possible.  We understand the anxiety that is normal with every procedure whether it is a single tooth or an entire smile.  We will discuss those protocols and options that are available to you to insure that your time spent in the dental chair is a pleasant one.

Act fast
The sooner you get to stains, the less likely they are to stick. “The tannins and polyphenols in foods such as coffee, tea, marinara sauce and red wine adhere to the surface of your tooth in under an hour,” cautions Jonathan Levine, D.D.S., founder of GoSmile, a dental-products company in New York City. Combined with plaque, which can trap dark pigments and harden into tartar in 8 to 24 hours, stains will become increasingly tougher to tackle over time, so break out the toothbrush as soon as possible after eating culprit foods.

Chew on this
No brush? No biggie. In a pinch, any gum that’s sugar-free (an absolute must for dodging tooth decay) can help keep your pearly whites gleaming. “Both whitening and regular gums work on the same principle—saliva flows over your teeth, flushing away stains,” says Lana Rozenberg, D.D.S., founder of the Dental Day Spa in New York City. Even rinsing with a swig of water or chomping on some crudités does the trick; heavy chewing generates saliva. But make sure you stick with non-sugary options. Sorry, trick-or-treaters, that means caramel chews and nougats don’t count.

Make fluoride your friend
Don’t count on a whitening toothpaste alone to safeguard your smile; it doesn’t have a high enough concentration of peroxide or stay in contact with teeth long enough, according to Debra Glassman, D.D.S., a cosmetic dentist in New York City. Abrasive ingredients like silica or baking soda in whitening pastes gently polish away surface stains caused by foods, but a whitening toothpaste that also contains fluoride is your best bet; it helps strengthen the tooth’s enamel, which is more porous after bleaching. This will also soothe sensitivity and prevent stains and plaque from ruining your smile, Dr. Glassman says.

Brush up on brushing
While most of us probably abide by the twice-a-day mandate, a cursory 30-second cleaning isn’t really cutting it to rid teeth of plaque or bacteria that stain enamel. You actually need to brush for a full two minutes—and cover the entire terrain. “Think of your mouth as divided into quadrants,” Dr. Levine suggests. Then brush each one (upper right, lower right, upper left, lower left) for approximately 30 seconds. But be careful not to overdo it: Scrubbing teeth too vigorously and for too long, especially if you use a hard-bristled brush, can wear away the enamel. Instead, opt for a soft-bristled brush (replace it every three or four months), and keep an eye on the clock. You’ll be able to give all your teeth equal attention, so choppers stay spotless. Now, if only keeping the kitchen clean were this easy.

The examiners evaluate cases based on a point system that identifies minor, major, and catastrophic faults. A passing score is -7 or better. The examiners are also given the latitude to reward the candidate with a +1 point, in situations where the result deserves additional merit. Dr. Shimizu’s case passed unanimously with scores that ranged from -5 to -7. Almost all of the criteria faults were identified as minor and two examiners rewarded Dr. Shimizu with a +1. No case is perfect; the goals of Accreditation are to create a vision and demonstration of excellence, not perfection. Dr. Shimizu achieved a wonderful result for his patient. The preoperative indications for treatment supported the final treatment plan. Dr. Shimizu extended treatment to include eight teeth because of the clinical indications. The indications for treatment are driven by the functional and health needs of the patient. Dr. Shimizu followed an established treatment protocol that helped to ensure a predictable result. The examiners identified several common deficiencies in this case; often, these criteria are inter-related:

• One of the initial observations was the excessive length of connectors and the effect this had on the periodontal health and architectural harmony (Criteria #64, #71, and #72). An accepted guideline that is observed in nature relates to the proportion and size of the apparent contact zone or connectors between adjacent teeth. Typically, the ideal connector zone between the central incisors is 50% of the length of the centrals.The size of these connectors decreases in a symmetrical fashion as you move posterior. The effect of excessive connector length in this case appears to contribute to the impingement upon the cervical embrasures and the blunting of the papilla. The Illustration by Dave Mazierski The comprehensive understanding of materials, preparation designs, and adhesive techniques should facilitate conservation of tooth structure while still meeting the parameters of function and health.

• Criteria #87 focuses on the visual harmony of contralateral teeth. The examiners identified a lack of symmetry of the visual width of the lateral incisors. This requires the careful management of the facial line angles and can be readily identified from the occlusal view. Although the occlusal view is not how teeth are typically viewed in a social setting, it is a valuable perspective in helping to appreciate the impact that these line angles have on the reflective surfaces of the teeth. In this case, the occlusal view is helpful in visualizing why the facial plane of #10 appears narrower compared to #7. The cuspids also lack similar balance in contour and shape.

• Criteria #56 identifies the effectiveness in utilizing translucency to mimic nature and to harmonize with the balance of the smile. Several of the examiners found the intensity, volume, and pattern of the translucency to be slightly excessive and not reflective of what would otherwise be observed in nature. Accreditation presents a consistent measurement of excellence in providing esthetic functional restorations of our patients’ smiles.

Dr. Shimizu has demonstrated his ability to meet this standard. He should be very proud of the result he achieved for his patient.

Dental Implants Can Replace One or All Missing Teeth
Dental implants can be used to replace one tooth, missing as a result of trauma or congenital defect. For patients missing several teeth, dental implants may also be prescribed either alone or in combination with a dental bridge. Some patients who are missing or at risk of losing all of their upper or lower teeth may also be candidates for dental implants. Using the Teeth In A Day procedure, a patient can have all of their teeth replaced using dental implants and a fixed denture to restore natural function and esthetics.

Failing to Plan is Planning to Fail
Ninety percent of all failures are a result of improper, inadequate or absence of planning. Treatment planning is especially critical in the dental implant process. Most dental implants procedures are a coordinated effort between a restorative dentist or cosmetic dentist and an oral surgeon or periodontist. It is important to select restorative dentist or cosmetic dentist who has specific experience working with dental implants. During this process, the restorative dentist will act like a quarterback, mapping out a plan for the whole team to follow to ensure predictable and successful results.

Technology is Great…If You Know How to Use It
While the latest and greatest technology can be very helpful to dentist when performing a dental implant procedure, if you don’t know how to use the technology correctly or interpret the data it transmits, then the technology is useless. Technology can not replace education, practical training and hands on experience. Used inappropriately, technology will only get you into trouble faster.

Dr. Finlay: The Right Training, The Right Experience and The Right Tools
Dr. Finlay & Associates have over 25 years experience treating patients successfully with dental implants. Dr. Finlay can replace one tooth using dental implants or an entire set of upper or lower teeth using the Teeth In A Day process. Comprehensive treatment planning is at the heart of Dr. Finlay’s practice. He carefully evaluates each patient, considering all factors – esthetic, functional and financial to determine the most conservative and appropriate treatment modality.
Never satisfied with the status quo, Dr. Finlay is dedicated to post graduate training and excelling in the field of modern dentistry. He is a Senior Faculty member of The Dawson Academy where he teaches and collaborates with the nation’s top dentists. Dr. Finlay is also an Accredited Fellow of the American Academy of Cosmetic Dentistry, an esteemed title held by fewer than fifty dentists in the entire United States. He is the only Accredited Fellow in the Annapolis area.
To remain on the cutting edge of dental implant technology, Dr. Finlay works with the finest dental laboratories in the country and the leading oral surgeons in the Baltimore Annapolis region. This team approach ensure the best results for each patient. Dr. Finlay employs state-of-the-art technology including iCat radiographs for 3-D imaging and CAD/CAM, computer aided design and manufacturing for creating precise restorations. His training, experience and collaboration with other top professionals within the dental industry ensure he has the skills to put these technologies to their best and fullest use.

If you have missing teeth, contact the office of Scott Finlay, DDS & Associates, PA to schedule a consultation and learn more about what treatments, including dental implants, are right for you.