If you are like me (and most other dentists), nothing is ever exactly what I want. The second molars in the picture above have occlusal milled composite restorations, the first molar crowns are milled lithium disilicate, the three pre-molar crowns are pressed lithium disilicate cut back and built up, the remaining teeth, all veneers, one premolar and the anterior six, are pressed leucite reinforced porcelain cut back and built up.

It is a very pleasing result, but it's not exactly what I had in mind. I pictured a mouth in which no one could tell I had done any dentistry in spite of the fact that whiter and brighter was the goal and the result is in fact quite different from the natural teeth. When this patient's cheeks are released and she goes to the mirror, even the really close-up mirror and even opened really wide, she doesn't see the buccal surfaces of those first molars, she sees the occlusals of teeth shadowed by the mouth – and they look GOOD.

I look in and see only the blinding reflection of snow white brilliance on molars gone wild. I've had many experiences in which patients told me I was nuts when I told them why I thought we needed to change this or that. From where they sat (and saw), the results had exceeded their wildest expectations and they couldn't understand why I wouldn't celebrate with them. “They DO fit as well as any restorations I've ever put in, and we didn't have to adjust the bite hardly at all, BUT...I just know you wouldn't be happy with them someday.”

This is not my patient, and I didn't do this work. It was done by a very dear friend who is an excellent clinician. I saw all those emotions noted above in his face when he looked at this picture, and I felt every one of them again myself. It hurt to have him feel that way when he had created something that was good. I've learned that I will never be 100% pleased, that “THE 10” is probably something I can think about but won't experience until I gain my heavenly reward – hey, I can keep trying and hoping, can't I?

Today I'd wait to see the patient's response to these. I'd listen carefully, I'd ask appropriate questions like “How do feel the color blends from front to back?” rather than “Don't you think those second ones from the back are just too dang white?” By the way – that's not really a question.

I'm good. My stuff is good too, when I and the patient say it's good. Sometimes I just have to get out of my own way to know it. And by the way, I'm not giving up on that 10.


Commenter's Profile Image Jeff Cooper
October 4th, 2009
When at the end of the day, every thing that walks out of our offices is representative of our skills and desire to make it "perfect" can be difficult to cope with. The biggest reward comes when the patient gets up and says, thank you so much, no one has EVER treated me in such a fine manner before! Those crowns would never have been placed with a marginal or cclusal discrepancy.