The Black Pen
Another trap for the unwary is the patient who arrives at your surgery wanting to have teeth reshaped or crowns shortened and they will not return to the care of the dentist who made the restorations.
The vital question to ask is therefore ‘by how much would you like your crowns shortened?’
If the reply is along the lines of just do want you think, then I would be even more wary. This is the case where if you go ahead and do what you think, the inevitable will happen and you will be told you have taken too much, so you can remake the crowns at your expense. And yes, that has happened!
Sometimes this may be the request of one of your own patients for whom you have carried out for example a smile makeover, and despite mock ups and prior agreement a minor adjustment at a future time may be indicated.
I would never, ever, reshape a tooth unless I had a predetermined and agreed mark and a photograph for my records. Thank goodness for clinical cameras!
The method is very simple. First visit your local stationer and purchase a fine tip black marker pen with an ink in an alcohol solution, ie not water based. When these cases arise, as they do from time to time, you are prepared. Dry the teeth then using the black pen place a mark on the labial surface where to the limit of where you think the refinement is required (Fig 1). Then let your patient look at their teeth in a hand mirror. The black mark will be ‘lost’ against the background of their open mouth and your patient can then see what will be the result. If at first you don’t succeed, then remove the black mark with an alcohol wipe and start again.
Once the position is agreed, then photograph, and only now is it time for you to remove either tooth or porcelain. I always left just a hint of the line in situ and never went beyond. At this stage you can show your patient the result in a hand mirror again (Fig 2).
The final stage is polishing the prepared surfaces down to the line.
The method can be used when planning a smile makeover (Fig 3). This patient has periodontal disease that needs treating first and bulky, inaesthetic crowns. You have given them an idea about where a result could be placed before commencing work on makeover models.
In summary, for an outlay of about £2.00 you have a new item of equipment for occasional use. It may save your bottom line many times its cost.
Copyright Dr C Turner, 2016.