Generally speaking patients are not dentally educated. While it is true they may sometimes know what they want (thanks to consumer marketing and the internet) – they don’t truly understand the nuances of ideal treatment.
The following case study showcases a patient who has come to the office for ‘smile work’ using porcelain veneers. She knew that she wanted veneers and wanted a quick result.
During her consultation we gathered photographs and put them up on our big screen patient viewing monitor in the operatory. For smile consults it is imperative that you do this. Typically I will then ask the patient to look at the picture on the monitor and walk me through exactly what it is about their smile they are unhappy with. I listen intently and make notes.
In this case the patient never mentioned to me the apparent gingival discrepencies. I was quite shocked. When a patient doesn’t bring up something that I feel is critically important, I go ahead and make them aware of this.
The last thing I want is to do beautiful work and suddenly the patient points out the discrepency. I believe it is my duty to make the patient aware and properly inform them of their options.
In this case the patient wasn’t that interested in fixing it. She said if the fix was easy she would consider it, but wasn’t particularly interested in the ‘gum surgery’ I advised her it would need. Instead of giving in, I asked her permission to use digital imaging (Adobe Photoshop Elements is what i typically use) to show her the difference the gum work would make. I just wasn’t convinced she really understood the value and the long term benefits.
Here is the digital imaging we quickly did…
Once she was able to preview the results she was on board and ready for perio surgery. This also meant treatment would be more costly and take more time than previously discussed. All things considered this was the right choice.
She was referred to our preferred periodontist for consultation. My periodontist and I have an understanding that elective treatment will never begin until we have collaborated on treatment. I want him to be aware of my restorative plan and I want to discuss the case so I can become more educated on his process and reasoning for various treatments.
Here is a collage of the perio surgery.
After allowing about 2 to 3 months for tissue maturation, the case was ready for minimal prepartion for 10 porcelain veneers.
The provisionals were created to communicate shape, shade, and characterization. This step is critical to ensure the patient is happy and to assist in laboratory communication. I prefer to know in the ‘plastic phase’ if any changes are necessary.
This patient did request that her final teeth be made brighter. Her case was completed at the laboratory and then bonded in place.
The final result is a tremendous improvement and thanks to digital imaging I was able to visually explain to her the benefit of perioplastic surgery prior to her veneers. Communication is critically important – verbal is the minimum and visual is ideal.
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