CASE 1 “How about a quick fix?”

Age: 29

Sex: Female

Chief complaint: “I don’t like my smile, but I don’t want braces”

Medical history: No significant medical history

Periodontal assessment: AAP type II, Grade A with some infl ammation and plaque. Gingival recession associated with lower anteriors

Function/TMJ: No clicks, no joint pain, no functional limitations, good range of motion. 2 mm overbite, 7 mm overjet, 44 mm maximum opening

Tooth structure: No restored teeth

Esthetics: Severe crowding, uneven smile

Clinical scenario: The patient was not happy with her teeth and her smile (Figs. 1.5a, 1.5b).

She wanted a conservative and quick treatment. She had declined an orthodontic consultation

Problem list:

1. Unattractive smile

2. Severe crowding

3. Excess overjet

4. Uneven gingival zeniths

5. Dark buccal corridors

6. Occlusal plane asymmetry

7. Gingival inflammation

8. Gingival recession on lower anteriors

Treatment plan: Direct composite veneers on teeth

7, 8, 9 and 10

Summary of treatment performed: A unidisciplinary treatment with four direct composite veneers was provided to correct the shape and alignment of the four maxillary anterior teeth (Figs. 1.6a, 1.6b, 1.7a, 1.7b)

This was primarily additive to preserve the remaining tooth structure. This fulfilled the patient’s desire to improve her smile and avoid orthodontic treatment.

There was minimal discussion of the benefi ts of orthodontics, but not soft tissue grafting, and other restorative procedures

Treatment analysis: The patient’s problem list indicated that many issues needed to be addressed, not just one. Not all the problems were of concern to her, and some were not even evident. However, it is important to address all the conditions on the problem list and explain the implications of not correcting them to the patient. Patient education through consultations with specialists would have facilitated understanding the risks and benefits of treatment choices.

Since the patient’s main concerns were esthetics, it would be prudent to draw her attention to the way overall function, facial esthetics, and occlusion could be improved by straightening the teeth. She could be educated regarding the benefits of orthodontic treatment [22, 23]. It could also be explained that periodontal maintenance would be easier with well-aligned teeth. A periodontal consult would help address the gingival recession and the benefits of grafting [24]