I wanted to share a case with you that is outside of the norm but stresses a number of themes I believe are critical to providing treatment. Recently I was treating a difficult case of a long time patientwho struggles with bulimia. Ideally the first course of action is to get the underlying condition under control. When that isn't possible some leveloftreatment can becomenecessary to protect the patient from themselves. Unfortunately that was the situation in the case I'm about toshare with you. It ischallenging cases like this that make your choice of materials and treatment protocols critical. If you aren't completely confident in your materials, work like this becomes even more challenging.
This is the pre-op photo showing the level ofdamage that had been done by the patient. Obviously,treatment was necessary to preventthe further damage and complications
In this case I proceeded withdirect restorations as I felt they provided the best cost / reward benefits. Certainly crowns could have been prescribed and may have provided a more robust / long term solution, but with the underlying condition not under control the added cost and increased reduction of tooth structure could not be justified.
I proceeded by onlyremoving the residual decay. Nothingmore than absolutely necessary.
I used the same protocol and materials I use for all of my direct restorations:
Surpass Self Etch Adhesive System
Titan Flowable Composite
Exquisite Restoration: Low Shrink,Nanofil Composite
These materials are thecornerstone for successfor each and every case I do. I feel theyprovide thebest performance that can be deliver on a consistent basis. Without these tools I don't believe we could have achieved the results below.
We continue to work with the patient and family to address the underlying cause of these issues. I'm hopeful someday we can get the patient back on track. In the meantime, I can rest assured the work performed will protect and preserve the existing tooth structure and the patient from addition complications.
The reason Isharethisis to illustratea treatment protocol that can be utilized in a case where treatment may seem futile or impossible. In these cases a cost/benefits analysis needs to be done to determine the best level of treatment for the patient. In some cases no treatment is the best protocol, in others we need to place materials into adverse conditions to help the patient while theywork throughother challenges. In those cases we have to have the utmost confidence inour materials. To date, the restorations abovestill look perfect.
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