Patient's Cosmetic Concerns In Dentistry

The Teeth-ing Troubles-Cosmetic needs and patient satisfaction

Ref: American Dental Association Newsletter

http://www.quintpub.com/journals/ejed/abstract.php?article_id=14383#.U4zpqPZOWcw

Achieving patient satisfaction, step-by-step

 It’s not uncommon for cases that start out with low esthetics to be accompanied by high patient expectations. Researchers publishing in the summer 2014 issue of The International Journal of Esthetic Dentistry described how to manage such circumstances using the case of a 27-year-old woman with amelogenesis imperfecta.
Caused by protein mutations involved in enamel formation, the genetic developmental disorder causes light and dark discolorations and atypical crown shapes. The subject’s chief complaint was dark and white opaque staining. However, she was also bothered by teeth that overlapped and an asymmetrical gingival margin. Researchers hoped to sacrifice as little healthy enamel as possible, while still meeting high expectations for an improved appearance.
The initial clinical examination did not reveal the true depth of the staining, so in agreement with the patient, a step-by-step treatment plan was adopted.
The first treatment step consisted of a home bleaching process. The patient noticed a positive change and was motivated to seek further improvement.
Step two was a microabrasion technique. Only the most superficial enamel layer was etched and removed with an abrasive paste and a rubber cup. Again, in the follow-up visit, the patient noticed improvement and wanted to continue treatment. This time the goal was to correct the position and shape of her front teeth.
All conditions were ideal for step three, a plan to restore the maxillary incisors and canines with ceramic veneers. At the outset, corrections were performed digitally, and foreseen changes were transferred into a wax-up. The dentist used the resulting mock-up to serve as a communication tool and discuss the prospective outcome with the patient.
Both were satisfied with the result during a try-in session, when veneers were inserted with glycerin gel in order to improve color assessment. All involved with the treatment plan were “very satisfied with the final treatment outcome,” authors reported.
“The patient was heavily involved in the process of decision-making and, therefore, her esthetic expectations could be integrated into the final treatment,” authors commented about the success. “For the predictability of the treatment, a meticulous prediagnostics and a stepwise treatment protocol is crucial; otherwise the outcome may be compromised.”