A 65-year-old woman visited her dentist, concerned that her upper anterior teeth were less visible when she smiled. Upon examination, the dentist noted that her upper six anterior teeth had veneers that had been in place for 17 years.

Eager to improve her smile, the dentist proposed replacing the veneers with longer ones. He explained that creating sufficient inter-occlusal space and stabilizing posterior support would also require replacing her lower partial denture. Radiographs showed approximately 25% horizontal bone loss in the upper anterior teeth, though the periodontal status was stable, and the patient’s oral hygiene was good.

The patient consented, and treatment proceeded smoothly. She was initially pleased with the outcome, but within two weeks, both upper lateral veneers fractured. The dentist replaced all six veneers at the patient’s request, making them slightly longer and lighter in shade.

Although the patient was delighted with the new veneers, she returned a month later when the veneer on her upper left lateral incisor fractured, leaving the tooth slightly mobile. A periapical radiograph revealed no pathology or fracture, so the dentist replaced the veneer and recommended a night bite guard to be used when the lower denture was removed. However, before this could be fitted, the patient sought a second opinion.

At another practice, it was determined that the upper left lateral incisor had Grade 2 mobility and was likely to be lost. Additionally, all upper veneers exhibited an unfavorable crown-to-root ratio, and there were occlusal interferences during lateral and protrusive excursions. The patient filed a formal complaint, stating she would not have agreed to treatment had she been fully informed of the potential risks. She expressed regret that she hadn’t simply accepted the natural appearance of her smile, as explained by her new dentist.

How Dental Protection Assisted

The dentist reached out to Dental Protection, admitting that he had been swayed by the patient’s enthusiasm and had provided treatment that, in hindsight, was inappropriate. He acknowledged that his initial assessment and treatment planning were subpar, as he had not conducted a full occlusal assessment, created articulated study models, or used a wax-up to guide diagnosis and planning.

With Dental Protection’s guidance, the dentist covered the cost of a referral to a specialist prosthodontist for remedial treatment, which satisfied the patient. The dentist also undertook targeted professional development to address gaps in his assessment and treatment planning processes.

Learning Points

This case highlights several important lessons for managing cosmetic dental treatments:

1. Manage Patient Expectations

   • Avoid making promises or statements that cannot be substantiated. Clear, realistic communication about outcomes is essential.

2. Ensure Informed Consent

   • Provide patients with all relevant information, including risks, alternatives, and limitations, to allow for truly informed decision-making.

3. Pause When Problems Arise

   • If complications occur, take time to reassess the situation before proceeding further. As the saying goes, “When you’re in a hole, stop digging.”

4. Work Within Your Competence

   • Only perform treatments or make decisions if you are confident in your skills, training, and indemnification. When in doubt, consider seeking specialist advice or referrals.

Conclusion

This case underscores the importance of thorough assessment, planning, and communication in cosmetic dentistry. It also serves as a reminder to prioritize patient well-being and professional boundaries over the desire to meet patient demands.

These case studies are based on real events and are intended as guidance to help Dental Protection members navigate similar situations. They do not constitute legal advice but illustrate the benefits of membership, including support in challenging scenarios.

This article is sourced from: https://www.dentalprotection.org/australia/publications-resources/case-studies/case-studies-display--/cosmetic-expectations-not-met-aus