This young boy came to us several years ago. He didn’t like his smile, and wanted to have braces to close the spaces between his front teeth. He had seen an orthodontist and wanted to start treatment. But fortunately for him, the orthodontist referred him to us for a consult.

I began this blog series by making an analogy of teeth shape and actors and length-to-width ratio. In his case, the patient's maxillary incisors are long and narrow (“Kramer teeth”). I knew instantly that it wasn’t a matter of orthodontics, but rather restorative treatment necessary to close the spaces. I wanted to communicate that with the patient and his father, who had brought him in for the consult.

There are many tools we have at our disposal to facilitate communicating our diagnosis and treatment plan with the patient.

1. Verbal Communication

The good old-fashioned way; whereby the clinician makes an instant diagnosis and visualizes the necessary treatment, then tries to communicate that treatment to the patient.

It can be hard for the patient to visualize the same outcome. The clinician may need other means of communication to discuss the desired treatment plan. 

2. Digital Smile Design


3. Chu's Esthetic Gauge

orthodontic treatment chu esthetic gauge
chu esthetic gauge

This tool allows the clinician to evaluate the width-to-length ratio of each tooth, basically giving average ratios, that if a tooth falls in a red band width, it should be in red length zone, similarly for black.

4. Direct Composite Mock-up


As they say, a picture is worth a thousand words to help facilitate communication. For me personally, the direct composite mock-up works best.

Finally, making the correct diagnosis is the key to successful treatment outcomes. If the orthodontic treatment was carried out, for sure the spaces would have been closed, but it would have caused an esthetic compromise and a functional compromise by potentially losing canine guidance.

The patient was ultimately very happy with composite restorations, which were very conservative in nature and restored his confidence in his smile.


Arezoo Bahar, D.D.S., Visiting Faculty and Contributing Author