CASE 3 “I never smile”

Age: 53

Sex: Female

Chief complaint: “I haven’t smiled since my wedding day”

Medical history: History of breast cancer, occasional consumption of anti-inflammatory medications

Periodontal assessment: AAP type III, Grade A with minimal inflammation, furcation involvement, and minimum plaque

Function/TMJ: No clicks, no joint pain, no functional limitations, good range of motion

Tooth structure: Restorative procedures were performed on many of her posterior teeth

Esthetics: Crowding, misaligned teeth, reverse smile line (Figs. 1.15–1.18)

Clinical scenario: Crowding and missing teeth

Problem list:

1. Unattractive smile

2. Severe crowding

3. Uneven gingival zeniths

4. Discolored teeth

5. Peg laterals

6. Dark teeth due to amalgam show-through

7. Occlusal plane asymmetry

Treatment plan: Porcelain veneers on teeth 6 and 11 and individual crowns on teeth 7 to 10

Summary of treatment performed: Porcelain veneers placed on teeth 6 and 11 and individual crowns placed on teeth 7 to 10 [25]. The treatment instantly changed her appearance and made her very happy (Figs. 1.20-1.22)

Treatment analysis: Based on the problem list and the patient’s facial esthetics, orthodontic treatment would have been very beneficial for improving her smile [22, 23]. It would have helped conserve tooth structure and correct the reverse smile line, occlusion, and teeth alignment [22]. It would have allowed for staging treatment and replacing older alloy materials at a pace the patient would be comfortable with. The maxillary anterior teeth were vital and healthy. To accomplish the restorative treatment, a large amount of their tooth structure was removed (Fig. 1.23). The final smile shows an improvement in the esthetics and proportions of the teeth, but there are still enhancements that could make the smile better. The arch is still narrow on both sides, which could be improved by orthodontics or additional restorative procedures (Fig. 1.24)

The treatments rendered in all three cases were perfect examples of unidisciplinary dentistry [21]. Their features included non-integrated diagnosis and treatment planning, no use of other disciplines, and no collaboration among dental practitioners. Patients with misaligned teeth, missing teeth, and esthetic concerns are seen very frequently in a dental practice. Most dental practitioners quickly choose a restorative option for treating these conditions, thereby overlooking other issues that may need attention [15]. However, it is important to consider other treatment options, including orthodontics, as they might contribute favorably to the outcome. It is important to perform a comprehensive diagnosis and formulate an optimal integrated treatment plan with more than one option for every patient [1, 15, 21]. It is critical to point out conditions that could negatively impact a patient in the future if they are not addressed. Dental practitioners should not only address missing teeth, misaligned teeth, and unesthetic smiles but also try to improve the overall oral health of their patients [28]