Case Study

This is a discussion around the treatment of a patient who came in concerned about the colour of her teeth in general and the black line around her upper anterior crowns. She was a new patient to the practice and had been recommended to us through her sister who was already a patient. Medical history was taken together with the patient’s social history. The patient’s concerns were carefully noted in all respects and dental history was also noted. The examination included a thorough extra-oral examination of any facial abnormalities, lymph nodes and temporomandibular exam. The intraoral exam included an examination of the soft tissues, a periodontal check and charting of the hard tissues. Dr Muzzafar Zaman carefully recorded the patient’s exact concerns which revealed that colour was not her only concern but also the shape and teeth position including a crossbite between UR2 and LR2. Her anterior crowns had been in place for 7 years and for the last 3 years she has become conscious with the gum line which appears black and the “black triangle” space in the midline between the 2 anterior crowns where the gum has receded. The anterior porcelain fused to metal crowns looks opaque presumably due to insufficient space for both metal and porcelain. The history revealed that the patient had carried out her own online research however she was not aware that tooth whitening would not have addressed all her concerns. |Other treatment options included clear orthodontics, in-surgery whitening and all-ceramic crowns to replace her existing crowns which had a “black line” around the margins and had poor aesthetics. The patient was grateful that Dr Zaman took into account all of the patient’s concerns and no one treatment would have solved her issues. The patient was given an opportunity for referral for a second opinion however she said that she would get back in touch if she was still keen to go ahead due to time and financial constraints. She did contact us again after a few days and proceeded with an agreed treatment which included advanced in-surgery teeth whitening, a short course of orthodontic re-alignment and replacement of her crowns with all-ceramic aesthetically superior crowns.