special _ smile design I _Grade A: The established parameters of oral health, function and aesthetics are within normal limits and aesthetic enhancement is required only to fulfil the patient’s cosmetic desires. _Grade B: The established parameters of oral health and function are within normal limits; however, the aesthetic parameters are below the accepted level. Aesthetic enhancement can further improve the aesthetic parameters. _Grade C: The established parameters of oral health or function or both are below the normal limits. An establishment treatment is mandatory prior to aesthetic enhancement. From the above, the practitioner will obtain a smile aesthetic grading in terms of the patient’s health, function and aesthetics, as well as a complete overview over the smile aesthetic problems and the macro-, mini- and micro-smile defects. The patient’s PHFA factors are the four fundamental components of aesthetic dentistry18 and must be respected to achieve healthy, harmonious and beautiful smiles. The design step depends on the information obtained from exploration and analysis. The information on psychology is subjective in nature; however, health, function and aesthetic analysis provides the objective information that will guide the design with the various established and basic principles of smile aesthetics and also the feasible and practical extent of the aesthetic desires of the patient. The aesthetic mock-up, manual tracing, digital makeover and smile catalogues are some of the popular tools used in this step. A new smile, alternative designs, types of treatments involved, complexity, possible risk factors and complications, treatment limitation, and tentative costs should be established during this step. For easy application, the aesthetic treatments in MICD are categorised as follows: _Type I: Micro-aesthetic components; _Type II: Mini-aesthetic components; and _Type III: Macro-aesthetic components: facial and dental midline relation, facial profile, symmetry of facial thirds and hemi-faces. As the treatment modality depends on the professional capability and experience of the practitioner, simple and practical methods are used to categorise the MICD treatment complexity: _Grade I: Treatment that may require consultation with a specialist (preventive, simple oral surgery/endodontics/periodontics/implants, short orthodontics); _Grade II: Treatment that requires the procedural involvement of other dental specialists (complex endodontics/periodontics/orthodontics) but not oral and maxillofacial surgery or plastic surgery; and _Grade III: Treatment that requires the procedural involvement of oral and maxillofacial surgery or plastic surgery. With the aid of this simple grading system, any practitioner can determine the complexity of the treatment involved for the accomplishment of a new smile design for an individual patient and can plan for the necessary multidisciplinary support. The last step of this phase is the most important in MICD TP because in this step the patient is presented with an image of his or her future smile. Visual aids, such as a smile catalogue, aesthetic mock-ups, manual sketches, modified digital pictures, computer-designed makeovers or animations can be used as presentation tools. The results of the design step are systematically presented to the patient with professional honesty and ethics. All pertinent queries of the patient related to the proposed smile need to be addressed during presentation. The treatment complexity, its limitations, the risks involved, possible complications, treatment cost estimation and maintenance responsibility must properly be explained to the patient. The patient is thus involved in finalising the treatment plan and will sign the written informed consent form before proceeding to Phase II. Phase II: Achieve As per the TP, which is finalised during the presentation step, all necessary preventive interceptive and restorative (curative) dental Fig. 3 cosmetic dentistry 4 _ 2009 I 31