Compromise is usually the enemy when dealing with esthetic dental outcomes. The danger for patients is that their ability to clearly visualize the difference created by the compromise is not within their experience, and that once completed, the treatment will not have achieved the expectation created by the mental image of the outcome they pictured.
Unfortunately, for some patients, the things we doctors see as necessary to achieve ideal results may be roadblocks patients are unable or unwilling to climb in pursuit of the result. My resolve to “hold out for the best” should be tempered with this reality, and both the patient and I need to be crystal clear on what we CAN accomplish together.
When this patient was submitted to me as a potential case for the Live Patient: Anterior Esthetic Restorations course, I was concerned that the patient may have unrealistic expectations regarding the outcome that could be created by only treating the six anterior maxillary teeth restoratively. There are gingival issues, buccal corridor things with tooth angulation, and a lower arch that would require considerable reshaping to accommodate the new incisal edge position. Did I mention the occlusal plane cant?
This doctor and patient were very clear on what the limits of accomplishment were given the constraints. The outcome suggests that there are times when those discussions are warranted when compromise presents the only way to proceed.
I’m at a loss as to what the patient’s expectations were – what the DR. expected and was this considered a success. Are these photos immediately post op – are there any photos of 3-4 weeks after.
Brad
The patient was VERY clear on what she wanted and it primarily involved the crown on tooth #9 and the wear on tooth #8. When orthodontics is indicated I am concerned that what patients “see” as the final outcome cannot be attained restoratively. Looking at models and photographs gives me the dentist’s view, I need to “see” the patient’s view. For this patient mocking up what was possible before beginning treatment and getting patient approval put everyone on the same expectation level. The patient did NOT see the things I saw as compromises to an optimal outcome and was ecstatic with both the mock-up and the final restorations. The photos are immediately post-cementation. At this point I do not have any later photographs.