Sometimes it Just All Works

By Rhys Spoor, DDS, FAGD

Every once in a while you get the pleasure of doing an aesthetic case where everything comes together and the synergy of the parts creates a whole which exceeds yours and the patient’s expectations. Here is an example of one such case, and how this truly changed the patient’s life for the better.

This patient had a high fear of dental visits. Because of her fear, she had neglected taking care of some of her posterior teeth—they had significant caries and were causing chronic pain. The patient is the sibling of my long-time dental assistant. With her sister’s love, coaxing, good caring technique and supportive pharmacology, we got her through those initial treatments comfortably and her trust and confidence in dentistry blossomed.

She had always wanted a beautiful smile, and now she wanted to know how that could happen for her. We developed a plan that fit her desires; it involved some limited straight-wire orthodontics (Figure 1), gingival augmentation (Figures 2, 3, and 4), and bleaching. Because of improving the arch form, only four veneers on the maxillary incisors were needed to get us to a very acceptable aesthetic result. From the diagnostic wax-up, a 3-dimensional minimal reduction matrix was fabricated and used to place a Luxatemp shell prior to preparation of the teeth (Figures 5, 6, and 7). The preparations were done through the shell, thereby minimizing the amount of tooth structure removed. This same matrix was used for directly-made provisional restorations (Figure 8).

The final clinical result was good and the restorations were nearly invisible; a combination of effective clinical technique and superb ceramic artistry (Figures 9, 10, 11, and 12). The best part of this case was how this type of dentistry became the spark for overall improvement for the rest of this patient’s life. During the time she was going through treatment, our patient decided that it was time to take care of herself. She started running on a routine basis and took better care of her physical health. She has now lost over 60 lbs and is as fit as she was in her youth. She has a noticeable radiance that just makes you smile (Figures 13 and 14). Sometimes it just all works.

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