When this patient first presented to me, she just turned sixteen. The mom says she has been having bondings on her teeth to mask the yellow discoloration resulting from a genetic condition that led to an abnormal development of the dentinal structure. She understands that many of her teeth will need crowns and at the time she was too young to consider such treatment.
I have discussed the different strategies to address her aesthetic concerns as well as protecting the remaining dentition from the further wear and breakdown. Part of me is trying to delay the inevitable of a reconstruction, knowing that everything I do comes with a cost. To me I was thinking of a biologic cost to have to prepare these teeth at such a young age and to go through the dentistry it takes for the reconstruction. There is also a financial cost. For this case, luckily there is government funding to provide some financial support. But also to me an opportunity cost she may have lost….the time she spends in my dental chair could be time for her to spend enjoying herself as a teenage girl, or to be in school.
We talked about just doing the six anterior and to replace the unaesthetic stainless steel crowns. We talked about phasing the treatment so it does not disrupt her busy school schedule. It also takes the patient at least one to two hours of travel time to see me….so you can understand the commitment she needs to have to have this reconstruction.
At the end, we have decided to start with the maxillary reconstruction. She did some teeth whitening first. She also needed some periodontal treatment to improve the gingival contour as well as to provide me more tooth structure to work with. At the end, I am glad to have done this reconstruction. I realized by delaying this reconstruction, the patient may not have the confidence to go out there to be the best version of herself. In the end, her attitude helped convinced me that this is indeed the right treatment.
For now, she is very happy with the maxillary teeth. We have discussed to address the mandibular teeth when she is ready. At the moment, there is no rush to do that yet.
I have posted the pictures here to highlight the steps I took to complete this case. Many thanks to my colleague and classmate Dr. Vinay Bhide for such a wonderful job…and to Gordana Dental Studios who helped me refined this case to another level I didn’t think was possible.
Thanks for reading!
