Dealing with unforeseen challenges in cases and in life.

Good morning. Today I wanted to talk just a little bit with you about a particular case that I was able to complete yesterday. This case was an interesting case. It was a patient who needed some help after having some work done by another provider. So let me kind of set up the case for you. Basically what had happened was she had gone in to another dentist. The dentist had done some work and it looked pretty good, nothing wrong with the work necessarily, but it didn't meet what the patient expected it to meet from the standpoint of aesthetics. We're talking about some front teeth work which in dentistry can be notoriously difficult, you know, especially if we're trying to design it in office with same-day crown machine processes like CEREC. So she came to me and she was very frustrated. She didn't like the way it looked. Aesthetically, cosmetically, functionally it worked just fine, but aesthetically and cosmetically didn't like it at all. So there's a commentary here that I'll touch on at the very end. Oftentimes we start a particular case and it ends up being very different from what we anticipated and what we thought. So not that this is a huge departure, but it was different to some degree than what I originally thought it would be. So she came in, we started the process. Originally the plan was to do two central crowns, these front two teeth here, so we numbed her up. We took the old crowns off, which weren't that old, you know, they were a few months, maybe more than a year old. We took those crowns off, really no decay in the teeth except one tooth, her upper front left tooth had a lot of stain, which was indicative that there may have been a bond failure issue when the crowns were cemented. So we took that stain out, we replaced what was removed with a core buildup in composite resin, and then evaluating the teeth on either side, which would be the lateral incisors, number seven and number 10. She had very, very large, very large fillings in those teeth, one of which was loose. She had mentioned that she felt like it had shifted earlier that day or earlier in the week, and so in evaluating those two teeth it was determined we ought to probably consider crowning them for her as well. So we had the appropriate discussion, discussed finances in the process, and fortunately we had time to go ahead and get things done for that day yesterday. So we went ahead and prepared those two teeth for crowns as well. Now once I prepared all four of them for crowns, removed the decay, and done the appropriate core buildups, I was evaluating her gum height. You know, the front two teeth, her gums had come much, much lower than they really should be, and this is commonly a consequence, sometimes what we call a gummy smile, and a lot of that's based on, you know, as the jaws are developing and the teeth are erupting, how does that mechanism work to allow the teeth to come fully through the gums. For some of us, the teeth never quite come completely through the gums, and there's a millimeter or two or more that is covering the enamel portion of the gums. So I had a discussion with her at that point, hey let's go ahead and remove some of this extra gum tissue while you're numb, and she was on board. You know, I kind of explained that we could get her a much better cosmetic outcome, much better aesthetic outcome if I made those teeth a little taller, and so we did it. And the process that I used, first and foremost, I measured to make sure we had extra gum tissue. Some people actually have really short teeth, but her teeth were normal length, they were just partially covered by gums. So we had to remove some of that gum tissue to allow for a taller tooth height to create a much better long-term outcome. So after the discussion with her, I went ahead and removed the gum tissue. She was, again, she was still numb, and we're just talking about the front of those teeth. She was still numb, didn't feel any pain during the process, but I just used a carbide, a high-speed finishing carbide, to gently trim the gums down. Once we got the gums trimmed to the appropriate even height, I went ahead and placed some viscostat, a material that halts the bleeding temporarily, and we imaged and designed her crowns. So we did all four crowns, four gingivectomies. It took us about three hours start to finish. We completed her crowns in lithium disilicate, a high-strength ceramic, and she left a new woman. It was great. It was really a fantastic outcome for her. You know, and as often happens, when the patient sees their new smile, and we did this on the try-in, we try on the crowns and hand her a mirror and let her look at it, and she's leaning back, you know, laying in the chair, looking up at her teeth through the mirror. They oftentimes, not often, but sometimes, patients will tear up. They'll begin to cry, as she did as well. So there were lots of tears. She was very happy, very excited. Turned out to be a great opportunity to serve, but going back to what I commented at the very beginning of the video, we oftentimes start a procedure or a process or some type of a project and get in to much more than we originally had planned. Whether it's much more difficult, whether it's much more time-consuming or requires extra steps, extra cost, extra expense, extra uncomfortable conversations like I was having to have with her about, you know, two extra crowns, gingivectomy, there's cost and time involved there and recovery. So how we deal with those extras, the additions after the fact, more than what we anticipated, says a lot about who we are. And I'm not saying I'm perfect by any stretch of the imagination, but the more circumspectly we can approach a situation like this allows us to maintain a much better outlook, a much better paradigm, and potentially create a much better long-term outcome, not only for our patients, but for whatever the project is. You know, oftentimes we'll get into a situation where there's so much more work involved that we just toss our hands up and walk away. Well, we've wasted time, we've wasted money, resources, certainly emotional energy. So what do we do at that point? Should we turn around and re-engage the project or should we cut our losses and move on? Ultimately, that's a judgment call that has to be made by the individual in the situation. But how we handle that, I believe it was John Wayne that said, you know, the true measure of a man is what he does when he knows no one is watching him. How we handle those situations can create or instill or reinforce in us the character that we need to move through more difficult circumstances in the future. So that's my wrap up for today. Thanks for watching this video again. I'm working on some new content, which will be pretty exciting and kind of fun coming along in the near future. I'm also going to be probably placing some advanced dental education courses here on YouTube and on Teachable and on Udemy, which are going to be interesting. Lots of work to do there, but lots of fun coming along. So again, thanks for watching. Feel free to comment if there's something that might be helpful for you. Questions, concerns, content you'd like me to try to work on creating, I'd be happy to help. Thanks for watching.