Personalised Learning

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

Case summary 

Sarah 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 div 2 presentation (relapse) with proclined lateral incisors, retroclined central incisors and deep skeletal bite. The decision was made to accept the overbite and focus on alignment of the anterior 6 teeth. My plan was to complete treatment with some whitening and composite edge bonding. 

Service: PRO
Stages: 16
Extra aligners? No
Duration: 6 months

My Approach 

Approach and considerations 

Lateral incisors can be prone to tracking issues and so gingivally bevelled horizontal rectangular attachments were used to facilitate palatal root torque and improve control. The plan was 16 stages, and no refinements were needed.  

Key considerations were the patient’s profession - as an oboist she was very worried that the aligners would impact her playing. To help her make a decision before starting I made a single passive retainer for her to see whether she could still play.  

I added this to her consent form in case compliance was an issue and affected the outcome. The Specialist had also advised that black triangles were likely to occur in the aesthetic zone  but suggested that IPR should be used to minimise this. The patient was consented for this.  

During Treatment 

How did you monitor? 

Sarah was motivated and so agreed to visit every 6 weeks. I did want to keep closer tabs on her in case there were issues by using the remote monitoring tool. She wasn’t confident at first so we submitted a treatment check in together, and I explained what I’d be looking for. After that she diligently submitted check ins every 10 days.  

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

Completing Treatment

How did you achieve the final result?

She didn’t want a Hollywood smile, she was so grateful that her lateral incisor was no longer digging into her upper lip that she would have been happy with that. She 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. We 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 her package. 

Lessons Learnt 

What lessons did you learn which would be useful for a colleague? 

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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