Orthodontics + Porcelain = Life Changing!

I’ve been blessed with the opportunity of doing quite a few smile cases in my career to this point. However, very few have been as dramatic and as life changing as the case shown below. Not only was this case rewarding, it was an opportunity to really test all my dental skills. Too often we think of our dental skills as just our clinical abilities. What we often forget and/or neglect is our use of verbal skills and planning skills to convey to the patient the long term plan, the time involved, the final costs of this vision, and how to fit this vision into the patient’s life.

Len walked into my office in August 2006 after responding to one of my advertising pieces. He wanted to improve his appearance and was unhappy with his smile. I didn’t learn until recently, while talking with his wife of 30 years, how disabling his smile was. Before I had even looked in his mouth he said “Doc, I don’t expect miracles and no idea what it takes or how much it costs”. The first thought that popped into my head was “what the hell could be growing in there and why am i wasting my time – he probably can’t afford this.” But having been taught the lesson of never judging a book by it’s cover, I went through the entire consultation just as I do on everyone.

Melinda (my treatment coordinator) and I gathered as much “fit” and “life” issues we could from Len and then took a few photos of his mouth to share with him. What I found was a case of tetracycline and malocclusion. The prescription was easy – orthodontics and porcelain! The difficulty comes in letting the patient know and not get discouraged by the time and money involved. This is very important in cases like this, because the real goal isn’t accomplished until the very end.

The final plan looked something like this…..

Phase 1 – Invisalign to straighten teeth – 12 months $5,000

Phase 2 – Upper 8 Anterior Porcelain – 6 weeks $9,600

Phase 3 – Lower 6 Anterior Porcelain – 6 weeks $7,200

Phase 4 – Upper Posterior – TBD (implant vs bridge)

Phase 5 – Lower Posterior – TBD (implant vs bridge)

Looking back, I really had to fight myself to resist on skipping the ortho and just prepping down the teeth. I am convinced now that Invisalign was not the best choice in cases like this as it ended up taking 18 months with 2 corrections and didn’t get the teeth where I really wanted them. We gave up and decided that prepping the canines a bit more wasn’t terrible. I should have gone with traditional brackets and wire ortho ala STO.

In the end, the patient wanted whiter and whiter teeth. At the beginning it was “one consistent color and i’d be happy” to “can we make the finals whiter”. That’s why I am glad I work out the color and shape with the temps.

Photos at Consultation

Photos after Orthodontics with Invisalign

Photos after Porcelain Veneers