Dentistry is demanding in many ways. It’s physically demanding. It’s mentally demanding. Dentists have to wear a lot of hats. We are the primary producer in a business. We are the doctor. We are the manager. We are the CEO, and we change light bulbs.
Never perfect!
When it comes to the actual dentistry, many of us can be perfectionists and our own worst critics. I think that stems from the “beatings” we took in dental school. I remember being told to change the pulpal floor of my first Class 1 prep by a QUARTER-MILLIMETER. I thought the instructor was full of shit (well… most of them WERE!). But, now a quarter-millimeter is a “mile” in my eyes.
Restoring anterior teeth is probably the most demanding procedure we do. There is a LOT riding on the result… whether it’s one tooth or all of them. The anterior teeth “enter the room first,” so to speak. If something isn’t right, it stands out… big time. The anterior teeth are important socially and psychologically for the patient. They’re important, functionally, with occlusion and eating. They’re even important in speech.
Here’s an example of an anterior restoration gone wrong (at another office). I presented this case (a new patient consultation) in my blog about “Putting Out Fires.” You can click on the image to see that article.
Mission Critical!
So, when a patient comes in with a broken upper central or lateral incisor, it’s a BIG deal. When that patient is an 8 year old girl, it’s critical! It’s critical to her AND her parents.
Last Friday, I got a text from a local colleague. A friend’s 8 y.o. daughter fell face-first on a tile floor and fractured both upper central incisors. My colleague is an extraordinarily-gifted dentist, but he doesn’t see children. So, he referred the family to me. There was no pulpal exposure (by her dad’s estimation), so we scheduled her for Monday.
This is the photo, Dad sent by text.
On Monday morning, Dad and 8 y.o. daughter came to the office. She started by presenting me with a homemade greeting card, thanking me for seeing her. What a sweetie!
We took a PA radiograph and ruled out any root fractures or displacement. Teeth #s 8 and 9 were fractured, as you can see below.
Before and after. I didn’t take any intra-operative technique photos, due to time constraints and a fidgety 8 y.o. 🙂
I used three shades of Filtek Supreme Ultra and a bit of white Tetric Color (composite stain, now marketed as Empress Direct Color). It was a tricky shade match, as her teeth were a bit mottled with opaque white spots.
Normally, I’d lay down a big “wavy bevel” (aka “dazzle camouflage”) to hide the margin of a big Class IV direct composite. With a mottled surface, hiding the margin is even tougher. But, since she is only 8 years old, I really didn’t want to prep the tooth, taking away enamel. So, I just lightly buffed the enamel and dentin with a diamond. No real prep. I wanted this to be a purely additive (rather than subtractive) restoration.
Mission Accomplished!
The patient and Dad were very happy with the result. Upon studying the photo afterward, there are things I’d work on to make it even better… especially #9. But, it’s a good result. After 1-1/2+ hours, the 8 y.o. patient had enough, and I admit to the same!
I texted Dad that evening to check on the patient. He wrote back, “She’s on top of the world! Telling stories to everyone about your loupes, the alien and bee drills.” (I referred to the handpiece as “Mr. Whistle” and joked that it sounds like an “angry bee” in the mouth. She said it sounds like an “alien.”)
Mission accomplished! I think we were ALL relieved at the end and with the result. A lot riding on those two restorations!
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Great job, Mike! One of my missions in life now is identifying dental students with unrealistic expectations. My opener is usually, “Strive for EXCELLENCE, not perfection. All it takes is someone with bigger loupes to find the flaws in your work.”
I’m still amazed at how many students are OCD-shackled introverts! I can see their demeanor change the instant they hear that excellence doesn’t equate to perfection.
Well… when my instructor told me to take another 1/4-mm from the pulpal floor of my prep, I went back to my bench and made some noise with the handpiece. I didn’t even touch the prep. Took it back to the instructor… “Much better.” Uh-huh. 🙂
My instructors didn’t suggest we strive for excellence or perfection or anything. They just harassed us relentlessly without really telling / teaching us what the goal was.
I like the quip about “someone with bigger loupes.” 😀 Your students are LUCKY to have you!
Awesome result. It looks perfect from here!
Really, really cool. Must be especially gratifying to receive a handwritten note from an 8 yo patient.
How she was able to sit relatively still for 90 minutes is in itself, quite an astonishing achievement.
Great work; honestly can’t see any flaws from here.
Thanks!