A Simple Trick You’re Likely Not Using to Make Anterior Restorations More Predictable

The hardest thing in dentistry is the anterior porcelain restoration.  There are literally so many things you have to get right.

  1. shade
  2. value
  3. characterization
  4. length
  5. surface texture
  6. contour
  7. and so much more

So how can we make some of these things easier?  To me the answer is always technology.

Here’s a great example of how I use PowerPoint or Keynote to help evaluate and determine symmetry.

Meredith came to our office unhappy with tooth #9.  As you can see it is quite dark from endodontic therapy due to trauma.


Experience has shown me that while the patient is mainly focused on the discoloration, when the discoloration is addressed they will often then turn to symmetry.  This symmetry typically exists before we start but has been masked by the more prominent discoloration.

Here I use tracing of tooth #8 (in the solid line) and then simply duplicate and mirror the tracing and overlay it on #9 (the dotted line).


Now you can better see and communicate with the patient where the discrepencies exist.


So why go to all this trouble?  Two main reasons in my mind.

  1.  Avoid unhappy patients.  Anything that you deal with after the fact is an excuse.
  2. Build value.  As a PPO dentist I have limitations in fees.  Quite honestly, I can’t provide this level of expertise for PPO fees.  I give patients a choice.  You can have a PPO restoration or you can have a ‘cosmetic’ restoration.  The cosmetic restoration costs more.  The patient then chooses which they want.  That’s another discussion.  If you would like for me to go into more detail on this just leave a comment below.

This same concept is then applied to the provisional for evaluation.

Here is our provisional.  In cases like this I utilize a CEREC ceramic provisional.  This is EmpressCAD Multi B1 stained and glazed.  This is not nearly good enough.  But the amount of information it provides my ceramist is crucial to being able to achieve a great result.

  1. It shares the value and shade.
  2. It shares the facial anatomy.
  3. It helps evaluate characterizations.
  4. It conveys the contours.
  5. It conveys the opacity.  How well does this mask and do we need to use something more translucent or more opaque for the final restoration.


The natural #8 is then overlaid onto the provisional #9.


The patient kept saying the tooth was longer.  When shown this picture it was clear it wasn’t longer, but the disto-incisal contour was incorrect.  The arrows show areas where contouring is needed.


Do you ever look at a restoration and just know it isn’t quite right, but can’t figure out where to adjust.  Just use the simple trick above and you’ll be surprised at how well it shows itself!

Do you hope to reduce your patients dependence on insurance?  Using photography and communication can help your patients see the value.  It has worked extremely well for me, our practice, and our patients.

Your thoughts would be greatly appreciated in the comments below.

About the Author Tarun Agarwal

Dr. Tarun Agarwal represents the next generation of leadership for the dental profession. As a respected speaker, author and opinion leader, he is changing the way general dentists and their teams practice.

follow me on:
  • Chin Patel says:

    How do you communicate “cosmetic” restoration to patients? Do you charge a “lab fee” for this type of procedure? How does this affect a provider being “in network” with the ppo insurance?

    • T-Bone says:

      I am in network… i simply give patients a choice… they can have a nice PPO restoration or they can opt for a master ceramist restorations for a greater fee.

  • matt mcmasters says:

    T, One question: In terms of asking the patient “do you want a PPO restoration or a cosmetic restoration?”, how does that work? If you are a PPO provider, then the insurance company will pay one fee, regardless of which lab that you use. We both know they don’t care. If you just charge the pt the difference, and they were to contact the insurance company, it could be a problem. I will usually just do that, and thankfully, have had no issues. However, i am just curious if there is a better way to handle this.

    • T-Bone says:

      matt… i am doing much like you in that i charge an aesthetic upgrade fee. it is a separate “made up” code that isn’t submitted to insurance. the standard PPO fee goes to insurance and the upgrade is it’s own line item

  • Terry Box says:

    I’m interested in hearing more details on this , if there is more. I don’t do this but I certainly need to at times.

  • Chetan says:

    Do you have patient sign something that they want cosmetic restoration vs PPO crown?

    • T-Bone says:

      Nothing specific… Our plan clearly spells out this to be an upgrade above and beyond insurance…

      Generally it’s a non-issue….

      It’s more an issue in OUR minds

      • Totally agree. Many “issues” are merely us assuming the worst, usually from dealing with a few patients that made life more challenging. Sorta like 2 people making it hard for 1000 others.

        Plenty will state “PPO only” but some will gladly pay extra. As long as they perceive value (and who WOULDN’T after a presentation like this?). Even non-PPO dentists still need people to understand, as patients still want the fees pretty similar to in network (can’t charge double…. well… unless the plan is HORRIBLE….).

  • Abraham says:

    What program are you “simply drawing a line and duplicating it” with?

  • >