Hollywood smiles at Absolute Dental Kingsbridge

As a treatment co-ordinator at Absolute Dental, it was my pleasure to work recently on this quite quite a high profile one; the patient involved was a new patient to us who works as a high profile psychic, has her own website and psychic reading site and also appears regularly on daytime television in this country. The patient was hoping to move her career forward by conquering the American market also, but was aware of the “Hollywood Smile” look and felt that her teeth would be a barrier from achieving her goal (picture 1)

Her main concerns were the shade of her teeth, the gaps between her lower anterior teeth, a central incisor that appeared longer than the other and the upper left lateral incisor that was slightly in standing, and therefore looked darker due to shadows cast on it. The patient is 44 years of age, a smoker with Type 2 diabetes. From our first consultation with this patient it was clear that we were going to have to be realistic and honest about what we could hope to achieve for her, and managing her expectations has always been a challenge. The patient was keen to achieve all of her changes as soon as possible, but there was a more urgent problem that we needed to address before any of the cosmetic changes could begin. The patient had chronic adult periodontitis, which would involve numerous visits to our hygiene team for periodontal treatment, plus enormous changes in the patients homecare routine before we could begin to think of achieving the cosmetic changes requested. It was clear that many of her concerns over the appearance of her teeth were due to the effects of the periodontal disease in the past. The patient’s medical history and smoking habits were against us, but our hygiene team worked hard to treat the periodontal disease and educate the patient in how crucial her input was to driving the improvements forward; all the time using the cosmetic changes requested as the motivation for improvement.

Eventually, after several months of periodontal treatment, we felt that the health of the gums had stabilised sufficiently for us to begin the cosmetic treatment. This began with a course of tooth whitening; both an in-surgery treatment, followed by a home whitening kit. Over a course of 3 weeks the patients shade improved from C3 to B1, and once again, we had to manage the patients expectations that this was the best shade achievable in her circumstances. And so we began the process of addressing the shape of the teeth with which she was unhappy.
Firstly we adjusted the upper left central incisor – a tooth that had over erupted due to the bone support lost by the effects of the periodontal disease – then using composite material, we built the left lateral incisor out slightly so that it was no longer in shadow (picture 2).

The patient is extremely apprehensive of all dental treatment, and it was a testament to Rhodri John, that this was all achieved without local anaesthetic, just calm reassurance and confidence built up between the patient and the dental team. The patient understood exactly what treatment was to be carried out, and understood that by adding composite rather than aggressively changing the shape of the natural tooth, if the appearance did not please her, the procedure was 100% reversible.
At a longer appointment the following day, the patient returned for treatment to improve the appearance of her lower incisors. Once again, without adjusting any natural tooth, composite was added to the lower canines, lateral and central incisors; mesially, distally and buccally to improve the appearance and shape of the teeth, closing the diastemas between each one that the patient felt were so noticeable on camera. The finished result was again breathtaking (picture 3).

The patient was amazed at how natural the restorations looked, and despite initial reservations over how they might affect her speech, she was utterly delighted. Only time and the bright lights of the television studio will tell if the restorations have achieved the flawless smile she was hoping for, but the changes achieved have been dramatic, and can be altered still further if the patient requests this.

This is one of those cases that a dental nurse loves to be involved with, a patient who presents with specific “wants”; “wants” that need to be managed carefully and balanced against what the patient actually “needs” and then working with all aspects of the dental team to achieve a goal that we are all proud of.

Written by Diane Cox