I special _ smile design treatments are conducted in order to establish the proper health and function of the oral tissues. Owing to the complexity of the treatment, a multidisciplinary approach may be necessary for a good result. Once the case is stable in terms of health (controlled disease) and function (balanced force elements) with good oral habits, the patient is requested to re-evaluate his or her smile in terms of aesthetics with the help of the MICD self smile re-evaluation form. This is important, because in some cases the patient is fully satisfied with the results of the establishment step alone and may modify his or her idea of further aesthetic enhancement. In MICD TP it is considered unethical should the practitioner not collect self smile re-evaluation information from the patient. The enhancement step of MICD is focused on the fulfilment of the patient’s aesthetic desires, which can be grouped into two categories based on the patient’s needs and wants. Even though it is sometimes difficult to draw a clear line between the two and their related treatment, in MICD they are categorised as follows: _needs: objective restorative needs of the patient in harmony with the SRA factors and due emphasis on health and function of oral tissues (naturo-mimetic smile enhancement) _wants: subjective desires of the patient, which may not be in harmony with the SRA factors (cosmetic smile enhancement) During any want-based aesthetic treatment, where healthy oral tissue is treated with no direct benefit to health or function, the treatment modalities should be within the scope of non-invasive (NI) or MI procedures.19 The patient’s desires alone should not be the rational for the treatment.20 Do no harm! should always be the credo pertinent to all dental treatment procedures. Phase III: Keep in touch Regular maintenance, compliance and timely repair play a crucial role in the long-term success of aesthetic enhancement procedures. Hence, MICD emphasises the keep-in-touch concept and encourages patients to go for regular follow-up visits. Responsibility for maintenance is grouped into two categories: _Self-care: Patients are advised to continue their normal oral hygiene procedures. If necessary, special care and precautionary methods are given, as well as protective devices. Selfcare should focus on regular tooth brushing, flossing, the use of prescribed protective devices and other pertinent professional advice for maintaining general health. _Professional care: The oral habits, health of the oral tissues, and the functional and aesthetic status of the work preformed are well documented during each follow-up visit, and necessary maintenance repair jobs are carried out. Evaluation is the final step of MICD TP. Any ‘completed’ treatment without a proper evaluation is considered incomplete in MICD protocol. The following components need to be evaluated: _Global patient satisfaction: After receiving aesthetic dental treatment, the patient is requested to complete the MICD exit form, in which the patient evaluates his or her new smile, gives a second perceived smile aesthetic score (b-score), and indicates his or her global satisfaction score. The b-score is compared with the previous a-score. This process helps determine the patient’s actual satisfaction status. In MICD, this is the main parameter for evaluating a patient’s aesthetic satisfaction. _Clinical success: Clinical success is a multifactorial issue. Selection of proper cases (the patient), restorative materials, TPs and their correct and skilful application are the key factors for clinical success. Therefore, MICD TP suggests self-evaluation of the following four factors (4Ps) using the MICD clinical evaluation form: _Patient factors: regular maintenance status, compliance issues and attitude of the patient towards aesthetic treatment; _Product factors: bio-compatibility, mechanical and aesthetic quality of the products used for the treatment; _Protocol factors: TP used in terms of its simplicity, predictability and its evidence-based nature; _Professional factors: existing knowledge and skills, and attitude towards developing these. Detailed clinical documentation of the case during maintenance and evaluation can provide Fig. 4a Fig. 4b Fig. 4a_Gummy smile with lack of upper central dominance. Fig. 4b_Harmonised smile with proper central dominance. Treated with MI approach. 32 I cosmetic dentistry 4_ 2009