But what would they look like? How much bigger would we make the teeth? Would bigger teeth suit his face and smile? These are questions that both the patient and I were asking, so the decision was made to take impressions so a diagnostic wax-up could be constructed. An intra-oral mock-up of the diagnostic wax-up was then produced using a putty key and temporary crown material.
While looking at the extra-oral photographs with our patient, we discussed whether the midline of his teeth not being coincident with his facial midline was a concern. In this case it wasn’t, but again, best to find this out now instead of finding out after treatment that the patient thought this would be corrected as part of their treatment! The patient was also able to see how his ‘bigger teeth’ would look in relation to the rest of his face. In this instance the patient thought they looked natural and if anything that they could be a bit longer.
Looking at the intra-oral photographs with the patient, we were able to discuss the discrepancy in gingival heights around the upper lateral incisors. This was a concern to the patient and so it was decided to increase the gingival margin height around tooth 22 to better match the gingival margin around tooth 12.
The intra-oral mock-up only involved the upper anterior 6 teeth, which was what the patient had originally considered doing after our initial discussions. On reviewing the photos of the intra-oral mock-up, he noticed the first premolars looked dark and not very visible. We therefore discussed placing composite resin veneers on these teeth as well, along with the extra cost that this would incur.
Our patient therefore had a very clear understanding of what they could expect from the visual aspect of their treatment prior to any definitive treatment starting, thanks to the use of photographs, a diagnostic wax-up and an intra-oral mock-up.
Yet there are other aspects that also need to be addressed prior to starting treatment. Does the patient expect their composite resin veneers to last forever? Do they think the composite resin veneers will be as strong as their natural teeth? What happens if one of the composite resin veneers chips? Is our patient aware of what might happen if they don’t wear a protective appliance while sleeping?
It is imperative that all these aspects are discussed prior to treatment commencing so that our patients’ expectations are aligned with ours. It also goes without saying that all of these discussions should be documented in our records, including informed financial consent. Then even if complications do occur, the patient has been well informed of this possibility and the way in which they can be managed. We are all well aware that despite our very best efforts it is unrealistic to expect our restorative treatment to last forever. It is important that our patients understand this too.
Meeting our patients’ expectations is something that we all strive to achieve on every patient, however our patients’ expectations will not always align with our own. Identifying these situations before any definitive treatment is started will go a long way to preventing negative outcomes in not just aesthetic cases, but all of the treatment that we offer.