Yesterday, I saw a patient for a 2nd opinion. She had a full mouth rehab with implants and was reportedly not happy with the result. I didn’t take any photos. This will be a short and sweet blog post. But, I hope it’s a story that resonates.
I met the patient and chatted with her. I engage in conversation with a patient like this for a couple of reasons. First, I want to get to know her (and her demeanor). Secondly, I’m also evaluating the cosmetics and phonetics of her dental treatment.
Eventually, we got to her complaint. She explained that she has implants on the upper and lower arches. The upper arch is a bar-retained denture. The lower is all fixed in three segments. She felt that the teeth are “too far forward.” Based on our initial conversation, I did not observe them to be proclined or protrusive. Her ability to speak was good. I did not notice any lisp or difficulty enunciating.
I asked what she had before.
Ten years, but I hardly ever wore them… just for smiling and pictures.
How long have you had your new teeth?
I did a cursory clinical examination. She told me the treating dentist was working on the lower front “temporary.” She had bridges in the posterior segments (that looked great) and a bridge in the anterior (canine to canine) that was PFM (porcelain fused to metal) and obviously significantly adjusted on the facial (through to metal on #27. She told me that she felt the lower front teeth were “still too far forward,” and the dentist had been adjusting them. She complained that she couldn’t bite off food. The adjustments had created an overjet / anterior open bite.
I observed lip support… from the front and in profile. It looked pretty good. But, if anything, there was a slight LACK of support rather than too much.
Overall, the work was quite nice. And, I told her so.
“Not only is this nice work, but I think you’re going in the wrong direction. If anything, your teeth are too far BACK.”
That’s what my dentist said!
“I agree with your dentist. I understand that you FEEL they stick out too much. But, I’ve looked at your facial and lip support. I’ve listened to your speech. It’s all pretty good. Your smile looks great! It looks very natural (my assistant nods and voices her agreement). But, I’d go the opposite direction. Bringing your lower teeth back to where they should be will give you a bite in the front. You told me you hardly ever wore your dentures. So, you’re used to not having teeth. You’ve had these teeth only two months. So, it feels strange to you. But, I can tell you with CONFIDENCE, and in my professional opinion, they are not sticking out too far. If anything, they’re not out far ENOUGH. That’s my story, and I’m sticking to it. (Yeah, I said that.)
My opinion is that you should work with your dentist, trust him, and give yourself TIME to adjust.”
And, that was that. I hope it works out! It’s not the first time I’ve pulled a dentist out from under the bus. Nor is it the second time. But, I think it is good for the profession. I don’t know who her dentist is, and he or she will never know about my visit with the patient. Sadly, I think there are some dentists out there who would see this as an opportunity to redo a case. I’ve been thrown under the bus by a colleague. To them I say, “Be very careful what you wish for!”