CASE 3
Diagnosis and Treatment Planning
An adult patient who had not received dental care for more than 15 years presented to our office. In our initial consultation appointment, he had indicated that he was embarrassed of his teeth, but that he had recently committed to improving his overall health and was determined to do the same with his mouth.
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Figure 15. Preoperative photo (Case 3) shows discolored teeth with heavy calculus buildup. The patient’s smile was guarded due to appearance of his teeth. |
Visible in his initial smile photo, taken at the triage consultation appointment, was a lower orthodontic retainer (Figure 15) that was fixated with bands typically used for orthodontic retention prior to the use of adhesive bonded retainers. The facial surfaces of the anterior teeth had previous restorations and defects that he wanted to replace and resurface. Additionally, his teeth showed tetracycline staining and were coated with severe calculus buildup throughout his mouth.
His guarded smile, as seen in the preoperative photo, revealed emotionally what he had indicated verbally in our consultation: that he was not comfortable smiling. Although he was committed to optimizing his overall health, his mouth did not look healthy.
Financial concerns limited treatment possibilities for the final restorations. Nanohybrid direct bonding was chosen to improve the surface defects and tooth coloration on the upper anterior teeth. This allowed for minimal tooth alterations, which was important to this health-aware patient.
Restorative Treatment
Our initial treatment phase included removal and replacement of the banded orthodontic retainer, appropriate procedures to clean the teeth and gums, and tooth bleaching to improve coloration. With the gums returning to normal health and the teeth looking cleaner, the patient was excited about the changes that had already been accomplished (Figure 16) and was ready to begin the restorative treatment phase.
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Figure 16. A professional prophylaxis and bleaching created a healthier smile, laying the foundation for final restorative enhancements. |
Figure 17. Postoperative photo shows the teeth after resurfacing with a nanohybrid composite resin (Herculite Ultra XL [Kerr]) to maximize whitening affect to fulfill patient desires. The patient’s smile was then unguarded and relaxed due to improved self esteem. |
At the restorative appointment, we meticulously performed the preparation, etching, and application of bonding as described in the previous cases. Since the patient wanted to maximize lightening the color of the teeth, we chose Herculite Ultra (Kerr) (shade XL), a durable nanohybrid composite that has been shown to maintain a natural polish and appearance over time. The procedure was completed in one appointment.
Until that final appointment the patient displayed a pursed lip, guarded appearance when he smiled. Although the teeth were improved in color and health with the prerestorative work prior to the bonding appointment, he was not emotionally comfortable enough yet to let go when he smiled. That all changed once the composite resin restorations were completed. The photo we took immediately (Figure 17) after his first glance in a mirror reveals a wide, “let go” smile that shows all of his teeth with a comfort that he had not previously experienced. The improvements that we accomplished with cleaning, whitening, and bonding were life changing to him and he verbally expressed this at his final consultation appointment.