Form and Function

Sep 02, 2015 No Comments by

THE BENEFITS OF USING AN AESTHETIC RELEASE.

Whether in digital or print, all dentists are required to keep a certain amount of paperwork. As a dentist, you already know the various requirements for mandatory dental records, including a dental history, a medical history, treatment records, a notice/acknowledgement of privacy practices (HIPAA), informed consent forms, financial records, and more.

But consider adding an additional form to the pile. A specific type of informed consent form that you may not be familiar with (but you likely should) is called an aesthetic release form. The aesthetic release is a document that patients sign prior to delivery or bonding of any cosmetic or prosthetic dental work.

Basically, patients acknowledge that the dentist will deliver an aesthetic look that meets their expectations as defined in the form. In my document, I designate the specific color and the shape of the restoration as well as any additional restorations that will be completed.

It helps my office meet and exceed patient expectations.

The document states that the patient releases us (the dental office) from any extra changes the patient may want after bonding. It helps my office meet and exceed patient expectations.

My dental office takes every effort to ensure that we give patients the smile that they want. The aesthetic release helps me and my dental team meet that goal, while at the same time, protecting us from poorly defined or unarticulated patient expectations.

Key Elements
The aesthetic release is a fairly straightforward document (for an example, see www.AdentMag.com/AestheticRelease)—the one I use is one page and includes the following information:

• Description of the Procedure. The form includes a place to describe which procedure is being done, anything the patient a specifically requests (including tooth color, shape, and size), and a place for notes.
• Any Changes. During the treatment, if anything changes (either on the temporary or the wax-up), it is noted.
• Name and Date. The document is dated and the patient’s name is listed.
• Statement of Acceptance. In the document, the patient agrees that they accept the dental work and that we’ve met their expectations with respect to color, shape, arrangement, etc.
• Statement of Release. The document releases the dental office from any cosmetic changes in the future.
• Provision for Maintenance. The patient agrees to maintain their dental health (they agree to come in regularly for cleanings).
• Warranty for Dental Work. The aesthetic release also includes a provision that if I prescribe an appliance, such as an orthotic or night guard, to help protect the dental work, the work is guaranteed for three years.

I put the document in layman’s terms and try to keep it as simple as possible, because it’s easier for the patient to understand and accept. Similarly, I try to use the patient’s words and I put notations in quotation marks to identify them. Using the patient’s words means that the statements are theirs, rather than a summary or interpretation from the dentist.

In general, many of the procedures in aesthetic dentistry are subjective in nature. Sometimes what I think looks great (versus what the patient thinks looks great) is completely different. The aesthetic release helps ensure that dentist and patient are on the same page.

The release helps because some patients are very vocal about what they want, while other patients are either timid or they’re not as detailed as perhaps they should be. Occasionally, a patient returns home and changes his or her mind. The patient sometimes says, “I want them more white,” or, “Now, I think I want a different shape.”

Once patients have determined what they want, we write down their expectations and ask them to sign the release. After the patient signs the release, I sign it and then we also have a witness sign it (it can be the patient’s spouse, a significant other, or a member of my staff).

When to Introduce It
I introduce the idea of the aesthetic release early in the treatment-planning process. I learned to bring the release up at the beginning of the procedure, so the patient has input and control over the design of their teeth. We bring up the aesthetic release right from the get-go, so that it’s not a surprise at the seat appointment.

Initially, when I meet with a patient, I just mention the aesthetic release. I don’t personally show the physical document to the patient at this time, but it isn’t a bad idea to do so. I just talk about it as part of the process. I mention that I will detail everything that the patient wants done in a written document

To show the patient how the treatment will proceed, I use a wax-up and photos. I assure the patient, “We’re not going to deliver anything until you’re happy with the results.”

At the seat appointment, I give the patient time to evaluate the shape and color and to carefully consider their choices. I usually ask patients to bring a spouse or significant other with them to the appointment, so that we can get their input, too.

Sometimes what I think looks great (versus what the patient thinks looks great) is completely different.The aesthetic release helps ensure that dentist and patient are on the same page.

I don’t recommend sedating patients for this procedure, if at all possible, because I want patients to say whether they like the final work and to be competent to make that determination.

During the final try-in process, we use a try-in paste that gives a bit of stick to the teeth. We clean it out afterwards—before we do the actual bonding. It gives enough retention so the patient can sit up and look at the teeth in place.

I make sure the dental assistant stays with the patient and that he or she is careful to watch for anything that might come loose while the patient is trying it out. We don’t want anything falling out on the floor or being swallowed!

I tell patients that we want them to be happy with their teeth and let them know we will work with them and the lab to ensure that all expectations are met and that the patient is satisfied. If they’re not satisfied, we’ll continue to work with the lab.

When the final restorations are in place with the try-in paste, I ask patients to sit up and I let them sit in the room for a little while with the mirror, so they can look at their smile privately (preferably with their spouse or significant other). After giving patients some time to discuss their teeth with a significant other, I ask my assistant to bring up the cosmetic release. The assistant asks, “Is there anything you want to change?”

I recommend having a third party (an assistant) ask that question rather than the dentist. My patients trust my team and sometimes they are more forthcoming with my team than with me. If there’s an issue, the assistant brings me back in. If not, everyone signs the release and we proceed to permanent cementation.

In the event that final expectations are not met by me or the patient, I take very detailed photos and write down (again, in the patient’s words) any changes that he or she desires to make so that I can communicate that information to the lab. We make sure that patients approve of their temporaries before we resend anything back to the lab for any changes. I add notes regarding all of this information to the aesthetic release, which becomes part of the patient record.

Trial and Error
I got the idea for an aesthetic release early on in my career, when I worked with a dentist who implemented it into the practice. Unfortunately, I had to learn the value of the aesthetic release the hard way. At the time, I had a patient with a fairly large diastema. When we proceeded with the work, we closed the diastema and the patient said, “Actually I really love that space between my front teeth and I still want that.”

As a result, I learned to ask patients very specific questions and to put that information directly into the release. Your expectations as dental provider may be very different from the patient’s. Through careful treatment planning and using a wax-up to design the temporaries, we get as close as we possibly can to meeting each patient’s expectations.

Since using the release for the past nine years, the number of patients requesting changes has dramatically decreased. Only once has a patient returned after a procedure to request additional changes.

In that instance, the patient said, “I understand that I signed this [aesthetic release], so I know I’m going to have some extra costs.” The patient insisted on changing a few things despite the cost.

I ended up not charging the patient full price for the revisions and the patient was responsible for the lab fee only. Ultimately, I wanted the patient to be satisfied and it was worth the extra expense. In general, the aesthetic release is more of a preventive measure and it’s highly effective.

Ultimately, all dentists have to balance the customer experience and customer satisfaction with the demands of the release and then decide what they are comfortable asking the patient to do.

Why It’s Important
The value of the aesthetic release is great because at some point, every patient needs to make a decision so that the dentist can finalize treatment without worrying about additional changes.

As you know, there are limits to what we can do for our patients. I can only move a midline so much with restorative work, or I can only close a gap that is so wide. The aesthetic release enhances the patient’s involvement in the overall treatment because the release requires them to articulate what they want as a final outcome.

The release helps me become more aware of how I’m setting expectations for the patients, so that I can clearly communicate with them.

The release is also about generating patient satisfaction. With the signed form, I am assured that the customer will be satisfied with my work. It brings peace of mind when I have the patient sign an aesthetic release.

The aesthetic release has helped me better communicate what I can actually do versus what the patient expects. And in return, I think it has helped patients become more accepting of their treatment and has led to an increase in overall patient satisfaction. I wouldn’t consider large case treatments without it!

Editor’s Note: Do you currently use an aesthetic release in your practice? If not, will you use one in the future? Please let us know at info@adentmag.com.

For Dr. Gearin’s aesthetic release, click this link. (www.AdentMag.com/AestheticRelease)

Best Practices, Fall 2015

About the author

In 2005, Dr. Amy Gearin earned a Doctor of Dental Medicine degree at the University of Louisville School of Dentistry in Louisville, KY. After graduating from dental school, Dr. Gearin moved to Las Vegas, NV, where she runs her own practice. Dr. Gearin has received additional training in cosmetic dentistry, occlusion, dental implant placement and restoration, full-arch dental reconstruction, snoring and sleep apnea treatment, TMJ disorder treatment, and more. Dr. Gearin’s goal is to help patients achieve healthy, disease-free smiles.
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