• Dr Levy (BDS)

Two Complex Cases

Today was a very especially busy day at the emergency dental clinic. Two specific cases however shown out for the complexity involved. One Lovely lady came in complaining of a shattered tooth, this was within her smile line. The upper premolar was root canal-ed and the dentist rightfully warned the patient she requires a crown. As can sometimes be the case, the patient seeing from the outside that everything seemed to be ok, postponed this treatment. As a result the tooth which was very hollow inside broke away. Only half of the crown of the tooth was left and even this was mobile. After an x ray was taken, the decay in the tooth was visualised well below the gum line. This transformed the case into a very poor prognosis tooth. It will be impossible to create a seal within the tooth to prevent infection. I therefore suggested that the patient undergo an extraction followed by an Implant, bridge or denture. The patient was reluctant to undergo the extraction as she had a wedding to attend to in a few days. Alternative options were explained, all with the emphasis on a very poor prognosis. The patient finally settled on placing a fibre post within the tooth, and bonding composite around it to enable somewhat aesthetical façade. The patient was astounded at what could be made ‘’from nothing’’. I however reinforced the fact that the treatment was far from ideal and that the tooth will not last long. A long term restorative option should be implemented as soon as possible. The patient understood this and promised to visit her local GDP asap.

In another case, a woman attended after loosing one of her recently bonded emax crown. The tooth however was cut down significantly leading to a severe lack of retention. The patient was complaining that the ‘smile makeover’ was only completed a year ago and already three of the teeth have de-cemented. On examination the tooth was very small relative to the crown, and I advised that the patient have the tooth re-cemented at her local dentist who prepared the crown. The patient however having work tomorrow could not accept this as a possibility. After warning the patient that the chances of de-cementation are very high and that we could not guarantee the crown remain, I re-cemented the crown and checked the occlusion. The patient seemed to be content with the feel and aesthetical outlook, but distressed about the expensive job not working out as planned. I advised her to visit the Dentist who prepared the teeth, to discuss her feelings and come up with a solution that will make her feel more secure and comfortable. It is important to understand the risks of cutting down teeth for the sake of aesthetical ‘smile makeovers’ and that there many risks involved. Once an invasive treatment is implemented, unfortunately there is no going back. In our practice we will rarely advice patients to go for such invasive procedures that are irreversible. Minimally invasive is always the best way to go if the circumstances permit. This we hope guides all our dentists’ treatment options and suggestions for our patients. We wish everyone a great month ahead and look forward to serving the public to our best abilities. With blessings and good tidings to all.

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