Cosmetic dentistry looks nothing like it did 30 years ago, so on this episode of Digital Dentistry Decoded I put a simple question to a dentist who has practised through the entire shift. What has actually changed, and what has not?
My guest is Dr. Jameel Gardee, a cosmetic dentist and Smile Design educator with Avant Garde in the UK. Jameel trained under Christian Coachman, the founder of Digital Smile Design, and he has spent well over a decade working fully digitally. He is also one of the faculty behind the course we built together, Aesthetic Smile Design Excellence.
This keeps us on the cosmetic theme after my last episode with Dr. Brian Harris, and Jameel's answer was not the one I expected. For all the technology, he kept pulling the conversation back to the fundamentals that have not changed at all. Listen to the episode below or continue reading to find out more.
TLDR - The Episode in 30 Seconds
- Jameel has practised for 31 years and moved to digital smile design after the Digital Smile Design world tour in 2014.
- The biggest change is predictability. Film cameras and hand wax-ups meant flying blind. Digital lets you copy a shape reliably from mock-up to final.
- The fundamentals have not changed. You still start with the face, and facially guided dentistry was described by Kois, Dawson, and Spear long before software existed.
- Jameel scans every patient who walks in the door, and leans on trained support staff so dentists can focus on diagnosis and treatment.
- His most pointed moment is on dental tourism, patients arriving with treatment plans for 26 crowns on otherwise healthy mouths.
- On 3D printed restoratives, his take is measured. They sit as a middle-ground material between composite and zirconia, not a replacement for e.max.
Who Is Jameel Gardee
Jameel graduated from Glasgow University, then trained at Boston University's Goldman School of Dental Medicine in advanced restorative and aesthetic dentistry. He came home to Glasgow, bought into a practice, and built it into an aesthetic-focused clinic. He is a past president of the Digital Dentistry Society UK.
His turning point was digital. As he put it, "I really understood that digital was here to stay. So since about 2014, now 12 years, I've just really been focused on digital dentistry."
That is the perspective that makes this conversation useful. Jameel saw the pre-digital era up close, so he can tell you what genuinely improved rather than repeating a sales pitch.
What Has Actually Changed in Cosmetic Dentistry
When Jameel started, you shot photographs on an SLR with film, sent handwritten instructions to a technician, and hoped the wax-up came back close to what you pictured. The gap between the temporaries and the final restorations was the real problem.
He described a pain a lot of us recognise. "It was soul-destroying really to hear a patient, many times, saying after the restorations were put in, that I preferred your prototypes. I preferred the shape of your prototypes. It was that predictability that I wanted to change."
That is the honest answer to what changed. Digital did not make dentistry easy, but it made it repeatable. If a patient approves the mock-up, the mill or printer can reproduce that shape, and changing a design is quick instead of a per-tooth argument with the lab.
Start With the Face
The tools changed, the principles did not. Jameel's biggest pearl for any dentist getting into this work is simple.
"The important thing about smile design is really to start with the face. The teeth don't just sit on a technician's desk in the form of models. They're part of somebody, and the face tells us where the teeth should be."
He is also honest that none of this is new. Facially guided dentistry was talked about by John Kois, Peter Dawson, and Frank Spear well before any app existed. What digital did was make it easy to see, so you can flip through options with a patient the way you would flip through pages of a book, using software like Smilecloud or SmileFy.
Why AI Won't Earn a Patient's Trust
We spent time on AI because patients now arrive having run their treatment plan through ChatGPT, and the visualisation tools are genuinely useful. But Jameel drew a clear line.
"AI will give us a lot of things. Smile visualisations, treatment plans, suggestions. But one thing it won't do is earn the patient's trust. The patient still has to choose us based on something."
His answer is to demonstrate rather than tell, which is why his team scans every single patient who comes in the door, regardless of what they came in for. He also reframes the uncomfortable part of the job. "Selling is a dirty word, but what we really prefer to describe it is educating and motivating our patients." I think that is the right way to look at it.
The Scan-First Patient Journey
His practice runs on a scan-first system that starts before the patient arrives. Patients make contact through a form with photos, then trained support staff handles the scanning, the photos, and the X-rays, so the dentist walks in already informed and can focus on diagnosis and building rapport.
Jameel is blunt about why this matters. "As a profession, dentists are guilty of trying to do too much. At some point we have to realise we're most effective when we're actually in the chair, seeing patients and treating patients."
He also made the case for planning the whole workflow up front, not just owning a scanner. His analogy stuck with me. "It's like getting a Lego box. You've got the instructions, and if you follow them, you end up with a car, or a castle. It's the same with digital. If we plan the ortho and the restorative beforehand, execution is already easier." That is the difference between having tools and having a workflow.
Dental Tourism and the Case for Staying Local
Jameel is seeing the downstream damage of dental tourism every week, and he did not sugarcoat it.
"Young people are coming into my office weekly saying, ' Does this treatment plan look okay to you? And it's like 26 zirconia crowns on an otherwise healthy mouth. There's a lot of over-treatment going on around the world."
His argument is that efficient digital workflows, minimally invasive or zero-prep where possible, are how you give patients a reason to stay local and get ethical care. It is a strong point, and it ties the technology back to something that actually matters.
Scanners, Zirconia and Where 3D Printing Fits
Jameel's view on scanners is refreshingly relaxed. "Today it doesn't really matter which scanner you use, because they all work." He runs 3Shape, iTero, and Sirona, with a soft spot for his 3Shape.
I will add one asterisk to that, which I made on the episode. All scanners work, but if you are in a high-spending market doing high-end work like implants and All-on-X, I would not buy the cheapest on the block. The budget units tend to struggle more with edentulous scanning and scan bodies, and you see more stitching errors.
On materials, Jameel is a zirconia fan and singled out Ivoclar's range for its aesthetic gradient. And on the topic everyone wants an answer to, 3D-printed restoratives, his take matched what Brian Harris told me. "It's basically a middle ground. It's like a hybrid material. Not as good as e.max or zirconia right now, but better than plain composite bonding. It sits as its own category." He teaches printed inlays, onlays, and crowns as a genuine in-between option, while still reaching for milled e.max or zirconia when a patient needs maximum longevity.
His advice for navigating materials that change every year was practical too. With limited long-term literature, you infer from what you do have and from similar hybrid materials, and you decide how much of a risk taker you are, always with proper consent and an honest conversation about the pros and cons.
Where This Leaves Us
The theme running through the whole conversation is that digital has not replaced good dentistry; it has made good dentistry repeatable. The face still leads, the patient still has to trust you, and the material still has to suit the case. What has changed is that a well-planned workflow now lets a motivated dentist deliver predictable aesthetic results without years of specialist training.
3D printing is clearly the direction of travel, with cartridge-based systems like SprintRay's Midas pushing chairside restoratives further, and the messaging around it is finally becoming more honest. It is another tool in the box, not a replacement for everything.
If you want to go deeper, Jameel and the Avant Garde team teach all of this in Aesthetic Smile Design Excellence, the course we built together. Have a listen to the full episode above.
If you have any questions, please leave them below.
Thank you to SprintRay for sponsoring this Digital Dentistry Decoded Podcast. To learn more about their 3D Printers and to Book a Demo Click Here info.sprintray.com/digital-dentistry-decoded-podcast
