Dr. Carlos A. Alonso, DDS
Dr. Alonso is a top-rated cosmetic dentist that has a passion for improving smiles.
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HG Case Study: Veneers/ DSD
A great passion of mine is cosmetic dentistry. I’ve spent years and countless hours perfecting my craft and this is especially true of cosmetic dentistry. Learning never stops and dentistry is constantly evolving as we are in the middle of a technological revolution in dentistry. You would think that never quite being able to “know it all” would be frustrating but it is quite the opposite. The constantly changing world of dentistry, and specifically cosmetic dentistry, is what energizes me and keeps me passionate about my career.
I want to share a case with you that embodies much of what keeps me so excited about dentistry. Before I get started, I want to thank my patient for allowing me to share. She is always a joy to have in the office and I feel great that we were able to meet her expectations. When performing a comprehensive or cosmetic case, I believe that by far the most important things are planning and communication. This case required a bit of planning as there were multiple options for the patient.
Before planning, we need to discover what the patient’s desires are. Understanding expectations are crucial to success and taking the time to listen to our patients helps us considerably. Our patient came in because she did not like the color of her teeth. While the simple answer was just to say, “sure, let’s just put some veneers on the teeth to get the color you desire”, proper planning unveiled that the key to long-term success might require a different path.
I started her case by taking pictures and studying models of her bite. I soon discovered that her bite would not allow us to just “make them white”. Her teeth were in a position that would leave veneers susceptible to fracture. If the position of the teeth were left untreated, I could expect to have a patient that would likely be coming back for many repairs and replacements. Another factor that was considered was the evidence of the smile showing a significant amount of the gums. This may or not be important to a patient but I believe it is important to at least discuss all of my findings in order to ensure that the patient knows all of the possibilities.
I’ve attached pictures of the planning process. Traditionally, I will show patients a PowerPoint presentation to show them where we would ideally position teeth relative to their face. I always tailor the treatment plan to the individual so no two cases are the same. I also incorporated the Digital Smile Design App. This revolutionary technology gives the patients a look at what their final case may look like before doing any treatment. This preview can be very important in setting expectations and ensuring that the patient is comfortable with what will be the end result.
After a long conversation with the patient and a discussion of her options, the patient chose to visit the orthodontist to place the teeth in the correct position so that we could get a more stable bite and longer-lasting veneers. The patient was not at all concerned with the amount of gums that showed in her smile so we decided against any treatment addressing this. Had she been concerned with the gummy smile, there would have been the possibility of surgery to help achieve the desired results. I felt good knowing that I was able to thoroughly explain all options and have the patient informed enough to make the best decision for her. In the end, we chose to do orthodontics followed by veneers. The patient also had the option to do lower veneers but considering that her lower teeth do not show as much in her smile, she decided against lower veneers.
First, we improved the positioning of the teeth. From there, we were able to bring her in for pictures to complete the planning. Once planned, I was able to give her a preview of her teeth in person. It took about 5 minutes to go from where her teeth were to a mock-up with temporary material to give her a preview of her future smile. This is one of my favorite tools to help patients grasp the transformation they will receive. It is a great way for a patient to get a sneak peek without ever doing treatment. Once we got the thumbs up, we moved forward with treatment. The first appointment involved preparing the teeth, making temporaries, and getting digital records for the lab to make the final veneers. Typically, a patient is in temporaries approximately 3 weeks but these temporaries were put to the test as the COVID-19 crisis hit us in the middle of completing treatment. She had to be in the temporaries quite a bit longer. In the end, we were able to achieve her desires and we ended up with a happy patient, and with a result that we know will last a long time. Being able to incorporate photography, digital technology, and spending the time with the patient to explain and educate the patient on her options are what led to our happy and smiling patient. These cases just get me more and more excited to continue my journey to be the very best I can be for each and every patient.
Carlos Alonso, DDS
Alonso Family Dental