Forever Changing the Life of a Teenage Patient
by Ashley Spooner, DDS
A true story from Smile Generation® Serve Day: Dr. Ashley Spooner of PDS®-supported Falcon Park Dental Group in Highlands Ranch, Colo. recounts the story of how she and her office staff helped to change the life of a once non-compliant teenage patient with honesty, a whole lot of patience and an amazing, once-in-a-lifetime chance to receive complimentary dental work.
We all have had days where there is difficult news that we’ve had to deliver to a patient. It is never easy to tell someone something that they are not prepared to hear. This past April, I had one of these days. My patient, a 17-year-old female who is getting ready to start her senior year in high school, entered my office with her parents. They came to me looking for a second opinion because they wanted their daughter to have a camera-ready smile for her senior pictures. Her prior dentist treatment-planned veneers for the upper anterior teeth, and the family was very concerned about the cost of this treatment, but remained hopeful that something similar could be done. At this point, I knew that our conversation was going to be much different, and I had to quickly determine how to discuss my thoughts with the family.
I reviewed the radiographs prior to entering the exam room and realized that this was a full-mouth rehabilitation case with the possibility of multiple root canals and maybe an extraction or two. Once I spoke with the family, I knew that something to that extent would not be attainable. Furthermore, the patient’s oral hygiene was so inconsistent, I could not consider restoring her teeth before we had that under control. I informed the patient and parents that it was crucial to get the gums healthy prior to any restoring, and that veneers were not going to restore her teeth. I expressed the severity of the situation and stressed that we needed a healthy foundation prior to any other treatment. At that time, the patient was not in pain, so no emergency caries control was necessary. I prescribed custom fluoride trays and SRP with irrigation and laser with strict three-month recall periodontal maintenance visits.
Following the patient’s SRP visit, I re-examined the teeth to determine what restorative treatment would be necessary. At that time, I informed the patient and her family that I had chosen her as my yearly We Serve patient and that I would do all of her dental work for free. The emotions quickly came as the mother asked, “Is this real?” I happily responded, “Yes indeed!” We established the “deal” that I would do all of this dental treatment, so long as the patient continued to show good oral hygiene and maintain healthy gums and no plaque build-up. She agreed.
This journey did not come without some roadblocks. The patient needed to have some yearbook pictures taken, and she would not have her full-mouth treatment in time. I started to do my research, and we found Glidewell’s Smile Transitions. These are purely what I like to call “party teeth”. They fit directly over an individual’s existing dentition and are intended for pictures, smiling and talking, but not for function. They served their purpose for pictures, but the patient was happy when we had the opportunity to move into something more definitive.
The next roadblock came after the first periodontal maintenance. My hygienist reported that the patient was not doing well with hygiene. I completed an exam shortly after and came to the same conclusion. The patient had a high plaque index, severe inflammation, and looked like she hadn’t seen the fuzzy end of a toothbrush in weeks. At this point, I had to have another crucial conversation regarding hygiene. I informed the patient that I would not complete her dental treatment if this is how she was taking care of her teeth because all of her crowns will fail. It was another emotional visit, but the patient and her mother understood. We then set a plan, and the patient continued to come in for oral hygiene checks every week until her treatment day on August 24. The patient quickly improved.
The morning of August 24th came very quickly! I had two staff members volunteer with me, and we established a plan for how this day would go. I chose the right side first and numbed upper and lower. The plan was to treat all of the posterior teeth, then to move to the anterior teeth. We took the bite images on the CEREC® machine in order to make sure VDO was maintained. I prepared all right-side posterior teeth at once, crossing my fingers that we did not encounter any pulp horns. Although we came close, we did not end up with any endodontic concerns. I did place Vitrebond on any teeth that were within 1-2mm from the pulp as indirect pulp caps in an effort to avoid the need for future root canals. My assistant imaged the right side of the arch, and we designed all of the crowns. I prepared and cemented the upper left, then proceeded to the lower left where I also completed a root canal on #21. It worked out well because we had to mill so many crowns already. I completed the root canal while everything was milling. All crowns were Vita Mark II Shade B1 and cemented using Hemaseal and Variolink. We were approximately 12 hours in, and the posterior was finished! We checked in with the patient, and she wanted to continue, so we went for the anterior.
I have restored many anterior cases with CEREC, and I continue to learn each time. I had a backup wax-up available in case we needed to biogeneric copy, but decided to see what CEREC would design first. I did end up having to complete a root canal on #10 which surprised me with two roots!
I am sure I have seen that in a text book before, but never thought I would do one in real life. (I had to show my endodontist, Dr. Thomas Helvey, after the fact, and he said he hadn’t seen one in his 20+ years of practicing.) I have found that the secret to designing the anterior teeth in CEREC 4.3 is making sure you utilize all axis settings when establishing the bite relation. This will provide better contours and a better overbite and overjet for anterior crowns. I completed just this for the upper anterior teeth, and they turned out great. I made minor contouring adjustments in the mouth, but for the most part, the crowns were perfect out of the mill. Things were really coming together; only one sextant to go!
I chose not to crown the lower anterior teeth due to where the caries were located. I wanted to leave as much tooth structure as I could, so if anything were to happen in the future, we would have something to work with. I prepared all teeth for composite veneers and removed all caries. I restored the teeth using both flowable and packable composite and contoured using discs. The overbite and overjet were maintained, and the patient now had correct occlusion and chewing function. After 15 hours, 22 crowns, six veneers, and two root canals (around $35,000 worth of work), we were complete! The patient and staff were exhausted, but what we did to this 17-year-old girl’s smile will change her life forever.
The patient returned one week later for a post op and final contouring, polishing and bite adjustments. She was a celebrity in the office! Everyone came to see her, and she was smiling from ear to ear. She and her mom were so grateful for what we did, and I can already see changes in the patient’s demeanor, confidence and personality. It has been an amazing experience to help someone in a way that will last forever and to have the opportunity to utilize our CEREC technology for full-mouth rehabilitation. We will follow her very closely with routine recall examinations and make certain she stays on her prevention protocol.
I encourage everyone to commit to finding at least one patient a year to nominate for an opportunity to serve. It is an experience you will never forget, and you will motivate others to pay it forward as well.
Dr. Ashley Spooner is a PDS-supported owner dentist at Falcon Park Dental Group: 9579 S University Blvd, Ste 400 A, Highlands Ranch, CO 80126. 303-683-5091.
About Pacific Dental Services (PDS)
Founded in 1994, PDS is one of the country’s leading dental support organizations, providing Supported Autonomy that allows dentists to concentrate on Clinical Excellence and the highest levels of cost-effective comprehensive patient care. PDS originated the PRIVATE PRACTICE +® model to allow dentists to focus on their passion: serving patients. PDS also pioneered the concept of modern dentistry, enabling dentists to combine advances in technology with the best operational practices and procedures, highly skilled support staff and a commitment to ongoing training and education. PDS has grown to over 400 supported dental offices across the western, central and southeastern United States.