Remember the video about the choice of bleaching versus restoration given to a young patient with a history of trauma to teeth no. 9–11 which then led to darkening of the adjacent teeth and the need for endo on no. 10? The patient was given the following options:
- End of nos. 9–11 with internal bleaching
- End of no. 10 (initial reason for consultation with the endodontist) and crowns on nos. 9–11 (with possible ending required later)
The approaches in this case are multiple, but the overall theme can be summed up in a generalized, unique, conservative approach.
First, it’s internal whitening for the win, because once you get a cast on a tooth, you can’t go back. The patient is young and if bleaching doesn’t work, then veneers are the next best thing…followed by full coverage crowns.
Most of you would complete the end at no. 10 and monitors the vitality of nos. 9 and 11, which we can probably assume will need endodontic treatment at some point due to the onset of rust on presentation. Until then, external bleaching can keep things at bay, provided the patient agrees to this approach. Internal bleaching can then begin on all three teeth, but the patient may or may not be satisfied with this as it should occur on the left half of the midline. Veneers may then do the trick, but cosmetic combinations with no. 6-8 can be difficult.
Many make a good point when they say that crowns really hectare the best choice since the endo is done on the tooth and standard care dictates this. Others argue that keeping as many teeth as possible—since these teeth are essentially virgin—is the most realistic course.
Here’s what to keep in mind: there is no single answer. Variables include symptoms, patient perspective, inputs, financial resources, home care habits, etc. If you start conservatively, having an alternative option is not a bad thing to consider. However, there are disadvantages in that it is more expensive cumulatively if you have to keep “falling back” on these options.
Having a frank, honest discussion with the patient will drive the final decision. We can do many things to teeth in our profession, but the question we so often forget is: What does the patient want? It seems simple, but how many times do we have patients come to us because “the other dentist down the road didn’t listen”?
Listening to different options, weighing them all, and being fluid in our decision-making process will get us far and we keep our patients happy. I’ll take it – all day, any day!
Well done my friends! Dr. Stacey
Editor’s Note: This article first appeared on Through the Loupes newsletter, a publication of Endeavor Business Media Dental Group. Read more articles and subscribe to Through the Loupes.
Stacey L. Gividen, DDS, graduate of Marquette University School of Dentistry, practices in private practice in Hamilton, Montana. She is a visiting lecturer at the University of Montana in the department of anatomy and physiology. Dr Gividen is its co-editor Through the Loupes and contributing writer for DentistryIQ, Implant consultationand Dental Economics. Serves in Dental Economics editorial advisory board. You can contact her at [email protected].
