Personalised Learning

Patient case: "I just want to stop my lip bleeding"

Sara is a professional oboist and a painfully protruding incisor was causing cuts to her lip every time she played.

The case was a classic Class II division 2 incisor presentation with proclined lateral incisors, retroclined central incisors and a deep bite. Sara had the main focus of correcting her laterals, so we made the decision to accept the overbite and focus on alignment of the anterior 6 teeth. 

After her teeth were aligned, I planned whitening and composite edge bonding to complete her new smile!

Case Details

Service: PRO
‍Stages: 16
Extra aligners: None
Total Duration: 6 months

Approach and Treatment Considerations

Given the patient’s profession as an oboist, she was very worried that the aligners would impact her playing. To help her make a decision and ease her concerns I had a single passive retainer made to see whether she could still play during her aligner treatment. This really helped to reassure her.

A note from the Specialist

Lateral incisors can be prone to tracking issues given their shape, small crown and position within the arch. To help combat potential tracking issues and increase predictability of movements, rectangular attachments were used. Our goal was to introduce palatal root torque to the lateral incisors and buccal crown torque to the central incisors.

Despite the GDP outlining clear goals for the case there were a few flags that if discussed sooner and consented for, could prevent hiccups down the road:

1) Knowing that Sara was already worried about her ability to wear the aligners and given aligner therapy is reliant on patient compliance, I suggested adding a clause regarding the importance of aligner wear to her consent form. This ensures that in the event of any compliance issues, it had already been discussed.
2) Black triangles were likely to occur in the aesthetic zone. IPR was suggested to minimise this, but it was another important issue for the GDP to address during consent. Ideally, patients are never surprised by any treatment side effects.

During Treatment 

Sara was motivated and agreed to visit me every 6 weeks. In between visits, we agreed to keep up to speed by utilising the treatment check-in tool. At first, she wasn’t confident so my advice is to do this WITH your patient for the first check-in together and explain what you’d be looking for. 

After that she diligently submitted check-ins every 14 days.  

I was able to schedule her finishing appointment once she confirmed after 16 stages that she was happy.  

Completing Treatment

She didn’t want a Hollywood smile, she was so grateful that her lateral incisor was no longer digging into her upper lip and she would have been happy with that! Sara admitted that she didn’t feel like she deserved a nicer smile- she felt too old! After some discussion she admitted that she was actually excited about some natural cosmetic improvements, she just never thought it would be achievable. 

I started with some simple whitening, and a composite mock up to fix the chipped tooth. I used a cervical matrix for a naturally aesthetic finish. She loved the result. I finished off by fixing a bonded retainer and providing a multi-year guarantee for her removable retainer as part of the package.

Lessons Learnt

At first the case looked tricky, but the treatment proposal was clear and I felt confident in taking it on. I was pleased they highlighted the risk of black triangles; I think this would have bothered the patient had she not been warned. 

I was wary that she might have thought I was ‘selling’ too much, but I could sense that she wanted to improve her smile but didn’t want to broach the subject herself. I’m happy we took the time to help her make the decision which was right for her, it was a great outcome for both of us!

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