European Journal of Prosthodontics and Restorative Dentistry

Book Review

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Cover Date

December 2011

Print ISSN

0965-7452

Vol

19

Issue

4

Abstract

Book Reviews

Esthetic Clinical Case Studies – Dilemmas and Solutions. Irfan Ahmad. Published by Quintessence. 130 pages 383 mostly colour illustrations. ISBN 978-1-85097-172-6. Hardback £96.00

Ifran Ahmad offers the philosophy he follows to support his decision making during the very real and difficult task of managing cases with a significant aesthetic component. This is a good looking book that is easy to work through in a short time, either dipping in and out or consuming all at once. In his preface the author offers sensible advice on the need for reflection of one’s own delivery of dental care and the need to support it with an evidence based approach. Unfortunately I feel this is exactly where this book fails in that he insists that the reader finds the evidence, the essential ingredient to evidence based dentistry, to support his management of these cases. If there is good scientific support to what we do, then I would suggest that it is made as easy for colleagues to find it so they may use it whenever possible. Without some form of evidence base this book sits within level 5 of the Centre for Evidence Based Medicine levels of evidence. This is termed ‘Expert Opinion’ and is considered the lowest level available (if you are interested in an evidence based approach look around www.cebm.net and www.cebd.org). The book is structured over eight chapters. The first focuses on evidence-based treatment planning. The sentiment surrounding the concept is sound, in that the balance of patients’ wishes, their clinical needs and the scientific support of treatments must be maintained. This idea is then extended by surrounding it with the ethical principles that govern working as a dental professional. There is outline discussion of the requirement to work within your personal knowledge, skills and experience, along with consideration of the financial constraints upon patients and their ability to tolerate different treatments. The fact that this text is written by someone who is undertaking dental treatment on a regular basis comes through well. There is a background of pragmatic realism and you feel as if you are listening to an experienced practitioner with many years of dental practice. Chapter 2 through to 8 consider the patient pathways followed in 7 case reports. The cases focus predominantly upon the upper anterior dentition, the majority of them stemming from trauma to the teeth at some point in their history. One case is associated with tooth wear and another related to the provision of long term piecemeal dental treatment and the impact this had upon aesthetics. Each case follows a similar structure in that a background history is summarised, options for management are suggested with a critique of each leading to the option chosen by patient and practitioner. The ‘Scientific Credence for Treatment Options’ discusses the author’s opinions of the upsides and short-falls of each option but has no evidence to justify his decisions. There are good quality clinical photographs of many of the stages for each patient and they support the reader well in understanding what treatment he has undertaken. In some cases the photographs are supplemented further with some excellent graphics to simulate planned restorations. They are also used to good effect in explaining some difficult concepts in restoration planning and design. Finally there is a summary discussion of the case with a critique of the techniques used and outcome achieved. This has been a useful text to review and has helped me reflect upon the way decisions are made with patients who have a significant aesthetic component to their management. It has reminded me of potential options and I will be reviewing my evidence base to support my treatment plans. And in that I will be seeking other contemporary texts that integrate the available options and the evidence base that support them. Dr Giles McCracken School of Dental Sciences Newcastle University