Witnessing my Own Failures
As a prostho resident, you never get to see your own follow up. So all those beautiful cases you did during your training will tell you nothing about long term follow up. One of my instructors in Grad Pros residency says if you want to have 100% success in your treatment, you have to move your practice every few years….it is called “geographic success”
This is one of my first cases that I got to do when I first moved back to Toronto; a case that I get to follow up and see how my own work fails over time. A patient who had severe anterior attrition that had resulted in very unaesthetic anterior teeth. Although the patient told me she had many dental consultations in the past, she knew her teeth were problematic and need treatment even years before seeing me. So at the time, I treatment planned her for six anterior crowns and a full mandibular reconstruction involving multiple crowns and a cast RPD. I did restore her vertical dimension in a way to facilitate restorative space and to optimize occlusal plane as much as I can.
When I first finished it, I was very proud of the work and felt good about it. The patient loved her smile and was really stable for many years. Until few years ago, I start to witness the break down of everything I worked so hard for. It was heart breaking. I asked myself what went wrong. Was I too conservative in my treatment? Should I be less heroic at saving teeth? I didn’t manage the occlusal forces adequately?
Honestly, at the time when I intervene, it was a heavily restored dentition. I did what I thought was sensible treatment at the time. But recently I watched a beautiful presentation by Drs. Lane Ochi and Michael Melkers, who reminded us all that “our responsibility is to help our patient get worse…at the slowest rate possible” and that management of occlusal forces will help decrease the rate of this inevitable break down. It is now that I am starting to appreciate the meaning of these powerful statements
Thanks for reading.
