Scott W. Finlay DDS, FAGD, FAACD graduated with honors from University of Maryland, Baltimore College of Dental Surgery and a GPR program at a Washington DC Area Trauma Hospital. He was accredited by the American Academy of Cosmetic Dentistry in 2007 and received his fellowship in 2010. He currently serves as an examiner and was elected to a seat on the American Board of Cosmetic Dentistry for accreditation and is a contributing editor for the Journal of Cosmetic Dentistry presenting the examiner’s perspective. He is also the author of the recent revision of Contemporary Concepts in Smile Design, which is the criteria guide that serves as a basis for Accreditation in the AACD. Dr Finlay is a senior faculty member for the Dawson Academy. He teaches contemporary functional concepts related to aesthetics and restoring anterior teeth in a hands-on format. He has contributed articles that have appeared in professional journals such as the Journal of Cosmetic Dentistry, Dentistry Today, Dentistry (UK) and Vistas. He began his practice in Annapolis, Maryland in 1987 with a special emphasis on aesthetic and restorative dentistry. Dr Finlay is a fellow in the Academy of General Dentistry and has been awarded four gold metals in the AACD annual Smile Gallery. He has appeared on Baltimore Fox 45 Morning News and two other health television programs as an expert in dental aesthetics.
The baby boomers are coming of age. They are cumulatively beginning to experience the signs and symptoms of dental deterioration. They represent a significant demographic with very special dental needs. They enter our offices asking to improve their oral health and their smiles1. Many have done their online research and are requesting veneers, whitening and Invisalign. The restorative dentist’s challenge becomes the reconstruction of these smiles with plastic and glass, with predictability and durability. Adding pressure to this demand, the media and economy have influenced the mindset of the consumer, resulting in more educated shoppers who put great value on having it done right the first time.
Although the ability to provide tooth-coloured restorative materials and techniques has been available for the past century, in the earliest form as silicate cements, the predictability and aesthetic results were disappointing. Great progress was made in dental materials over the ensuing decades, but the missing link was the relationship of these aesthetic goals and the proper management of the engineering of the system within which these teeth functioned. These wonderful advancements in materials have allowed us to be even more conservative and effective in providing dental treatment4. However, relying on technology alone can be a double edge sword as it can also have the effect of getting us into to trouble faster. Dr Dawson tells us that 90% of failures are not attributed to the materials or techniques, but our failure to plan. As restorative dentists, we need to be comprehensive in our evaluation of our success or failures. Our vision of failure is often narrowed to the fracture of the restoration, when in truth we need to also appreciate failure to represent all of the signs and symptoms of occlusal disease including tooth mobility or migration, gingival recession and sensitivity.
As our understanding of the design of the stomatognathic system has evolved, we began to identify and address the two primary etiologies of dental deterioration: bacteria and force. By creating restorations that mimic natural tooth contours and with proper positioning, we provide an environment that is sterile and maintainable for our patients, and promote the best opportunity to obtain optimal biological health. With the application of the functional matrix presented Dr Dawson, we can begin to manage the risk factors related to force. The functional matrix is a sophisticated system that is composed of three primary elements: teeth, muscles and a joint. A compromise in any one of these components will inescapably influence the other two. This matrix, when appropriately functioning, allows the muscles to respond in a non-antagonistic way, providing comfort and efficiency.
The design of this system allows the temporomandibular joints, when they are in their hinge axis position, to facilitate balanced simultaneous contacts on all teeth, with an anterior guidance that is in harmony with the envelope of function and a peaceful neuromusculature. This helps to insure an orthopedically stable position. The starting point of this functional matrix begins with a balance distribution of forces with muscles that are comfortable and coordinated due to the non-conflicting proprioceptive feedback from the sequentially loaded teeth. We begin with the assessment of the joint, because we are focused on predictability. Predictability that provides us with a reproducible, specific reference point we refer to as centric relation that is based upon our scientific understanding of the physiology in this orthopedically stable relationship.