Patient care Continued »
there are many patients who don’t expect health, comfort, function and longevity to be delivered at the same time. Similarly, there are few patients who would accept a functional result that did not at least look reasonable. Under s tanding and managing the patient’s expec- tations is without doubt the most fundamental part of any treatment plan. Taking the time to do this is crucial to a satisfactory result and a happy patient. We also need to remember that a patient may not share the vision we have of how their treatment may end up. There are many tools at our disposal to do this, from digital imaging and diagnostic wax ups to showing examples of completed treatments. It is also often possible to develop a treatment plan in stages, allowing a patient to stop at the point where the result is appropriate for them.
Scheduling treatment Paul wanted to improve his smile while understanding that there was signifi cant structural and biologic damage to his teeth (Fig 2). He was found to have moderate periodontal disease together with erosion, attrition and caries. He also wanted to improve his smile for a trip to America in just three weeks’ time! Based on a thorough exami-
nation and records process, together with listening carefully to the patient’s requirements, we were able to develop a suitable treatment plan that would allow us to continue
Fig 1 Cosmetic/Esthetic Biologic Complete Structural
Despite uneven gingival levels and the basic aesthetic level, the patient was delighted with the result and has continued to maintain an excellent hygiene regime. The treatment was cost effective and fulfi lled the patient’s needs and desires (Fig 6). While he understands that composite restorations may require some degree of maintenance, he is willing to accept that. This process of scheduling
Functional/Occlusal
to work on the patient’s peri- odontal needs while at the same time improving his smile and helping him to envision what could be achieved. Initial periodontal therapy
was commenced and a diag- nostic wax-up produced on mounted models. After ensuring that the patient understood the limitations of the procedures to be provided, together with the need for further treatment, single layer hybrid composite restorations were placed in accordance with a stent constructed from the diagnostic wax-up (Fig 3). We were able to meet his deadline for his journey to America and at the same time help him to see how his appearance may be improved. The patient returned a
month later delighted with the result and highly motivated to further improve the aesthetics. After his periodontal condition had been stabilised, porcelain crowns were placed 12, 11, 21, 22 and 23 to restore structure,
function and aesthetics (Fig 4). Elsewhere, composite restora- tions were left in place. The patient was totally satisfied with the treatment provided and maintains his hygiene with renewed vigour. Barry’s main concern was
that his front teeth continued to break down and he was afraid of losing them (Fig 5). He presented with erosion, decay and attrition together with mild periodontal disease. He was unconcerned about the appear- ance of his teeth at this stage. However, often such patients
desire a more aesthetic result once their initial concerns have been met. In this case, after initial periodontal therapy and tooth whitening, we were able to restore the teeth with a simple single layer composite system to achieve the patient’s structural, functional and biological requirements. Once these parameters had been met, the patient was able to reasseß∑ss his aesthetic goals with a more positive approach.
the treatment or “progressive smile design” can also be very benefi cial in helping patients spread the cost of treatment over time, particularly impor- tant at these diffi cult economic times. Employing this approach will almost always ensure a more natural result and certainly produces a solution that is appropriate to meet each patient’s individual needs and desires. In order to develop a staged treatment plan, it is very important to understand the treatment options that we have available to us together with the tools and materials that we have at our disposal.
Treatment options and timeless principles Forty years ago, Dr Peter Dawson spoke about the concept of complete dentistry. He became known for function and occlusion not because it was the only part of compre- hensive dentistry that he taught, but also because he explained those concepts so well and how they had an impact on every other aspect of dentistry. The tools and materials that we use may have
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Fig 2
Fig 3
Fig 4 Ireland’s Dental magazine 37
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