Over the years I've had my share of patients who came in with destroyed dentitions that I had no idea how to treat. Worn, missing, broken and/or eroded teeth that seemed to make restoration impossible made those patients very frustrating for me.
We teach a system that Frank Spear has developed over the past 30 years called Facially Generated Treatment Planning. It is a linear and specific way to unravel even the most challenging cases. The truth is every dentist learned much of this system in their first year of dental school when we set denture teeth in our removable pros lab. We set the maxillary central incisors so they were correctly positioned in the face and then set the rest of the upper teeth based on the position of the two centrals. Then we set the lower teeth to work effectively against the upper teeth. That really is the way we answer all of the esthetic and functional issues of creating a treatment plan.
Of course, doing the case isn't that simple and we need to gather the right people around us, usually those specialists who can help us put the teeth, gums and bone in the right position so that we can then restore then. That is really the whole premise of Spear Study Clubs—to create small learning groups of motivated dentists who want to get better, learn more and do it in a safe, collegial atmosphere.
Take the case pictured here: A 69 year old man who wants his mouth restored.
This is a challenging case no matter who is treating it. There is wear from attrition and erosion, tooth sizes are compromised, he has an impacted upper left canine and posterior teeth with periodontal compromise. Where the heck do I start?
Really, we just need to understand where the upper front teeth fit in his face. If we can determine where the incisors should be to look right in his face, then we can figure out the rest. Our system has simple PowerPoint tools to use that can create a visual of where we want the teeth. This visual can help the patient see themselves differently, and most importantly, can help the dentist and specialist colleagues come to a common understanding of what the preferred outcome can be.
Of course, it isn't as simple as drawing teeth on a slide, but it is simple in that we always know where to start with difficult cases. Stay tuned to the digital suite for the new courses coming this summer: The Art of Treatment Planning and Case Presentation.
In this case we can speculate that the teeth need to be longer both incisally and cervically and that the occlusal plane needs to be corrected by shortening the posterior teeth in the final result. The lower front teeth need to be lengthened but at the same time moved cervically to change the occlusal plane. The next step is to figure out how to get the teeth in the correct position: move them orthodontically, lengthen them surgically, remove some back teeth and replace them and does the bite need to be opened? All questions that don't have simple answers but when we sit in the room with the right people, it is much easier to figure it out and than if we sit alone wondering.