• Regular dental checkups – By visiting the dentist at least on a bi-annual basis, many issues that cause the deterioration of your smile can be intercepted by a trained, tenured and experienced comprehensive care dental team.

• Orthodontics is just not for children – Alignment and position of your teeth have a lot to do with their appearance and reflection of light.  A broad smile, absent of rotations or overlapping teeth, is not only esthetic, but also easier to clean and the teeth receive forces in a way that they were designed to be the most durable.

• Professional Dental Whitening – Yes, over the counter whitening can be very effective, but if you truly want a white smile, seek the advice of your dentist.  Whether it is accomplished with an in office technique or with custom fabricated trays in a take home technique, your smile can appear whiter and cleaner with professional whitening.  At home maintenance with whitening toothpastes can help to maintenance that white smile between dental visits.

• Avoid staining agents – We can’t always avoid those dietary and beverage agents that stain the teeth, but it will help to insure a whiter smile.

• Proper home care – The importance of routine dental home care is essential not only to the appearance and health of your smile, but also your body as well.

• Smile Makeovers – If significant defects do exist in your smile, don’t worry, modern dentistry has potential solutions.  Many shortcomings can be restored with implants, veneers, crowns and bonding to rehabilitate a beautiful appearance.  Proper care can often require a significant investment, but is always worth the effort in hindsight.  The key element is to achieve these results in the most conservative way possible, while respecting the essential criteria related to healthy functional and biological design.  Treatment solely for esthetic reasons without consideration of these critical criteria can only result in unpredictable durability and require additional treatment due to the eventual failure of a short sited goal.  It is always best to have proper treatment completed the first time then it is to rescue treatment that was inappropriate.
Choosing a Cosmetic/Restorative Dentist –

-Search for a cosmetic dentist in your area that has the talent and training who can accomplish your smile enhancement predictably.

-Visit their facility; does their décor and technology reflect the level of commitment to cosmetic dentistry that is appropriate for the treatment you want?

-Talk to the staff.  Are they courteous and polite?  Will they make you comfortable for the procedures you will have completed?

-Talk to the doctor.  Does he have the level of passion and enthusiasm to stay committed to your treatment goals?  Will he listen and understand what you want to accomplish?  What has he done to dedicate himself to continuing education in this field?

-Finally look at his work.  Does he have before and after photos of treatment he has actually completed that is similar to the treatment you are seeking?

There are a handful of organizations dedicated to advancing cosmetic dentistry and recognizing dentists who meet their lofty standards. The American Academy of Cosmetic Dentistry (AACD), was founded in 1984 by Dr. Jack Kammer and Dr. Jeff Morley. What started out as a small group of dedicated individuals, has blossomed into the world’s largest and foremost organization for cosmetic dentists and cosmetic dental professionals.

Today, there are more than 6,000 members including cosmetic dentists, laboratory technicians, educators, and researchers from around the world.

The AACD Cosmetic Dentist
The American Academy of Cosmetic Dentistry offers education and training on the latest techniques, procedures, and advancements in cosmetic dentistry. In addition, the AACD has an accreditation program for cosmetic dentists who are dedicated to going the extra mile.

There are many steps in the accreditation process. Candidates begin by passing a written examination. Next, they must submit a series of clinical cases that demonstrate their ability to treat a wide range of situations and complexities. Finally, accreditation is achieved by passing an oral examination. This process takes years to complete – but an AACD Accredited Cosmetic Dentist is special, there are fewer than 325 Accredited members worldwide.

Dr. Scott Finlay Annapolis Cosmetic Dentist
Annapolis cosmetic dentist, Dr. Scott Finlay has achieved the highest achievement in the AACD by becoming an Accredited Fellow. In addition to his rigorous accreditation process, Dr. Finlay has met the AACD’s high standards for an extended body of work representing excellence as judged by a jury of his peers.

This incredible number of cases demonstrates the level of expertise Dr. Finlay has treating complex cosmetic dentistry cases.  There are fewer than 50 dentists nationwide that have achieved this level of excellence and recognition by the dental profession.

More than that, Dr. Finlay is an active member of the AACD and holds a position on the American Board of Cosmetic Dentistry, where he is responsible for testing, analyzing, and evaluating the services of dentist and laboratory technicians for the purpose of AACD Accreditation in cosmetic dentistry.

He contributes regularly to AACD publications as well as other cosmetic dentistry journals. He has recently finished revisions to the AACD’s Criteria Guide: Contemporary Concepts in Smile Design, which will be released in mid to late 2012. This guide, which saw its last update in 2001 will set the new, universally accepted parameters for smile design.

Dr. Finlay is committed to continuing education and is a senior faculty for the Dawson Academy which is a leading post graduate center for advanced dental training.  He presents programs to dentists from California to Florida, to Virginia and Chicago – even in the United Kingdom – on topics related to cosmetic dentistry, often in a hands on format.

Expert Care
Cosmetic dentistry is more than just creating pretty smiles. A cosmetic dentist should be a highly trained and skilled professional who strives to treat not just the cosmetic concerns, but the underlying functional problems that cause wear and damage in the first place.

According to Dr. Finlay, “Dental Aesthetics are only a mirror of the relative health of the smile. If something doesn’t look quite right, there is usually a biological or functional reason why the deterioration exists.”

A cosmetic dentist should also take into consideration the patient as a whole to create a smile that will look natural, fit comfortably in their mouth, and be best suited for their lifestyle.

Don’t trust your smile to any cosmetic dentist. Contact Annapolis cosmetic dentist, Dr. Scott Finlay for a consultation and learn more about improving your life and smile with cosmetic dentistry.

The edentulous space must be documented pre-operatively with a radiograph. The examiner’s focus is limited by definition to the replacement tooth and any areas that that candidate has treated. It is not necessarily a case type in which comprehensive smile design criteria are heavily weighed, unless the treatment rendered encompasses a broader field in the smile zone.  The candidate must keep in mind that if a limited scope of treatment is elected, the balance of the smile zone should not be visually distracting to a reasonable extent that may otherwise indicate the need for additional management. A common modifier in this case type is underestimating the time required in establishing ideal tissue architecture.

The candidate’s case selection and abilities to treatment plan are particularly magnified in this case type. It is in the candidate’s best interest to find a patient with reasonable periodontal architecture that presents the optimal environment to create excellence. Our goal is to achieve a result that challenges the observer’s eye in discerning that a natural tooth does not otherwise occupy the edentulous space.  Working with a mentor, who has been calibrated as an examiner, is strongly recommended with every Accreditation case.

Successful management and treatment planning demands a mastery of not only prosthetic concepts, but also the parameters of health imposed by the periodontal architecture. Although some restorative dentists may provide advanced surgical procedures to their patients, in many cases effective treatment involves an interdisciplinary team.  This team would typically consist of the restorative dentist and the surgeon who may be involved in site development or the placement of the implant. Regardless of who performs the surgery if it is indicated, the key responsibility remains the orchestration of the treatment planning by the restorative dentist with a protocol that will hopefully provide predictable, durable and esthetic results.

A predictable protocol begins with a complete understanding of the options to restore the health and function for the patient. This protocol starts with a visualization of the desired solution that is then studied and modulated in 3 dimensions through the use of diagnostic models and a wax up of the intended result.  From this dental blue print, stents can be fabricated and utilized in both the surgical and restorative phases to effectively reproduce the designed anticipated results.  The restorative dentist will find great value in methodically and patiently manipulating the prototype restorations to help establish the best possible periodontal architecture.

Dr. Chan should be commended in his fine demonstration of each of these elements of case management and the final result. His conservative approach in limiting his treatment to the edentulous areas #6/11 was well within the parameters of this case type. His model analysis and diagnostic wax up allowed him to make key decisions in managing the spaces and develop the appropriate stents to be used during treatment.  His understanding of the biology of the system facilitated his planning in the ideal placement of the implant in 3 dimensions.  His attention to detail in managing the prototype insured the predictability of the tissue architecture and what appears to be a healthy and sustaining result.  His keen eye identified those elements of macro and micro esthetics that allows the restorations to invisibly disappear into the surrounding dentition.

The examiners as a group identified very limited criteria that were at fault. Most examiners awarded the case a plus one because of the excellence that it demonstrated.  The case passed unanimously.  Those criteria that accounted for minor deductions included:

Criteria 53- The opacity is slightly high in the cervical 1/3 of the cuspids
Criteria 87- Minor dissymmetry’s are noticed in the contra lateral teeth #6 & 11

The Accreditation Process represents the ultimate challenge in your growth in the mastery of dental esthetics.  Achievement of this gold standard of excellence will provide immeasurable rewards for you and your patients.

Accreditation Examination Criteria, American Academy of Cosmetic Dentistry, Madison, Wisconsin, March 2009.

Garg AK, Finley J, Dorado LS., Single-tooth implant-supported restorations in the anterior maxilla.   Pract Periodontics Aesthet Dent. 1997 Oct;9(8):903-10.

Hu XL, Li H, Luo J, Qiu LX, Lin y;  Multidisciplinary management of congenitally missing teeth with osseointegrated dental implants: a long-term report. Chin J Dent Res. 2011;14(1):29-36.

Simeone P, De Paoli C, De Paoli S, Leofreddi G, Sgrò S.; Interdisciplinary treatment planning for single-tooth restorations in the esthetic zone.  J Esthet Restor Dent., 2007;19(2):79-88.
Dawson PE. Functional Occlusion: From TMJ to Smile Design.  2007, St. Louis, Mosby, Chapter 31, pp366-377.

Jansen CE., Guided soft tissue healing in implant dentistry. J Calif Dent Assoc., 1995 Mar;23(3):57-8, 60, 62 passim.
Lewis S, Parel S, Faulkner R., Provisional implant-supported fixed restorations.,  Int J Oral Maxillofac Implants. 1995 May-Jun;10(3):319-25.

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!

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.

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.