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Composites and composition: the art of cosmetic dentistry

Dr. Zainab Al-Mukhtar offers her view on approaching cosmetic work as an artform.

Enlighten Smiles
10 August, 2021
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Zainab pursued an early interest in cosmetic dentistry, especially in the art of direct sculpting composite veneers and now holds a postgraduate certificate in aesthetic dentistry. She runs a very sucessful practice, Harrow on the Hill. In this interview she talks about composite work, how she does it and the importance of practicing.

Payman L: Tell me about your composite work. You’re here because you’ve come up on our radar, on the Mini Smile Makeover course with really beautiful composite work.

Zainab: Thank you.

Payman L: It really is. Do you feel like that can be taught? Do you feel like there’s a talent there?

Zainab: Yeah. I’m sure it can be taught.

Payman L: Because we grapple with this a lot. We teach 30 dentists a month on this subject.

Zainab: Really?

Payman L: Some people are always scared that: “I don’t have the talent.” We’re always saying that if you follow the simple steps you can get there. What was your journey from the composite perspective?

When it comes to composites is just practice, practice, practice

Zainab: I’ve always had a background where my mum draws paintings and she used to encourage us. Art was always something we just found really fascinating. We’d love drawing and we were quite particular about things.

Payman L: Actually, some of your first Instagram posts were drawings.

Zainab: Yeah, were actually drawings.

Payman L: I saw that.

Zainab: I’m quite particular about how things are done in my hands. They need to be a certain way. When it came to composites, I think that it was literally just practise, practise, practise. Then I’d look at pictures, look at what’s this beautiful smile, what’s desirable. I shadowed a dentist in Beverly Hills, Doctor Dorfman. He had wall pictures, like you’ve got smiles here. He had lots of these. I’d look and just really absorb what was a beautiful smile, and then just try and recreate it.

I had a slightly, well, you could say OCD approach towards a composite. If I was doing a tooth, I wouldn’t let the patient leave until I was really happy with it. I’d seat them up, have a look, check with the lips, check with everything. “Sorry. Can I just sit you back down? Can I just polish that bit a bit?” That was how I was doing it. Then the rewarding feeling of their reaction…, and it’s addictive when patients are that happy about something.

Then I just wanted to build on it. It was taught, at the same time, of course. This was 2012.

I’d take photos and I’d go home, I’d look and I just wouldn’t like something. Then I’d know what I want to change next time. It was just building on all of that. It’s definitely a process, and I still have lots to learn, I’m sure, constantly. And capturing the line angles, and, yeah, definitely lots more to learn.

Payman L: What are your plans going forward?

Zainab: I want to continue doing what I’m doing, but just continue taking it to the next level each time. I am where I am, really happy doing what I’m doing now. I just want to do more of it.

(…)

In my opinion staining is the pitfall of composite. Although what I love about composite, what really drew me is I could transform someone’s smile in a completely additive way without drilling their teeth. Always felt ethical. Could sleep at night. Happy. Everyone’s happy. The staining over time for some patients who aren’t good with their diets is a limitation.

Prav Solanki: What’s the replacement time for composite veneers? I’ve had numerous conversations with either people who teach composite veneers or other dentists who do them. They say a big worry is that after three years or however long it is that they’re probably going to need redoing. I just want to get an idea in terms of how easy is it to redo a composite veneer or is that the time where porcelain kicks in?

Zainab: I would then just have to put it to a patient. I tell patients that it will last somewhere between three to seven years, and that it’s very dependent on your diet, your maintenance, how often you come in, eating habits. Do you grind your teeth? All the colourful things in their diet, but also how hard the foods are that they’re eating. I have that discussion and I think what I’ve found is it’s really variable and really does depend on all those things. I can never really truly predict when a composite’s going to need replacement.

Polishing and the composite you use are a big factor in how composite ages

Payman L: You also haven’t been around long enough to see your composites seven years.

Zainab: Yeah. Exactly. I’ve seen that over the last five years my rate of chips, fractures is not high but the staining is something I see a lot.

Payman L: Staining’s definitely the primary concern.

Zainab: That’s the primary thing. Yeah.

Payman L: Then obviously polishing is a big factor. The composite you use is a big factor, by the way.

Zainab: Yeah. This is something I’m learning and want to go into a bit more actually. At that point when it fails, it’s having that conversation again. I always warm them. There’s always we’ve got a consent form. I’m always warning them this is something that requires maintenance. When it chips, you’ll need to have it either replaced or repaired or look at plan B. That’s instilled into all consultations.

Payman L: When you say you want to do more of what you’re doing now, I mean that could be you want to open six more practises, or it could mean you want to…

Zainab: It’s the nature of my work. No. Just the clinical.

Payman L: You want to only do minimally invasive cosmetic dentistry yourself and let other people do other. Is that what you mean?

Zainab: Yeah. I want to continue doing minimally invasive dentistry, but really, really get a bit more transformative in my smiles. Apply more disciplines to my smile makeovers and expand on my facial aesthetics. I now do mainly facial aesthetics injectables and skin care. I’d like to expand a bit more. There’s so much more out there, but it’s a real …

Payman L: What, the lasers and things?

Zainab: There’s loads. Yeah. There’s loads. I’m not one to just try and do everything. Like I said, I want to master one thing before I go onto the next, which means I take my time. I don’t jump into things too quickly. My vision is to just become more of an expert in what I’m doing clinically. In terms of business and buying more practises, I don’t visualise it. I don’t visualise me buying many. I want this one to be really, really, really successful, fruitful, have the reputation it deserves and represent us really well.

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