Here's one for you all to debate. This 20-year-old is a new patient in my practice and I have not yet worked up the case. She had 10 upper and eight lower veneers placed at the age of 16. She was advised that the optimal treatment for her situation would be orthodontics and orthognathic surgery. Although her parents were in favor of the process, she refused. The alternative she was offered was the veneers. They were done to correct tooth positions and to give the illusion of closing her open bite. While I don't have the complete history, my understanding is that there were significant rotations which were corrected by preparation design. The resultant preps were very aggressive. Today, she has had two endos and is facing at least two more. She has poor periodontal health, partly from her neglect and partly from inconsistent marginal integrity of the restorations.
Here is the discussion:
- Would you have proceeded with the veneers if the patient refused orthognatics/orthodontics?
- Would you do this kind of significant dentistry for a 16-year-old?
- What are my responsibilities as a clinician to my patient in this circumstance?
I do not presume to have a correct answer. I was not part of the original conversations, nor do I understand the family dynamic that was present when the decisions were made.