So I have this case and the patient refuses ortho, how should I treat it?
In the last two days, I've been sent a lot of messages asking for help treatment planning cases. Sometimes I can answer them. Sometimes I can't.
Now, I'm not squeamish about de-enamelising a tooth if I have a good reason. However, decapitating the dentine and the pulp is a bit too far, even for me.
So when I get sent pictures of lateral incisors in complete crossbite, and asked how to restore it, I say ortho. When I get told that the patient doesn't want ortho, and what else can we do, I suggest saying no.
But there is an art to saying no
You have to have conviction. You have to have intense eye contact (culture permitting). And preferably, you have to have the pain of a procedure that you've done, and always regretted, to give you gravitas.
So the patient that wants you to chop half their incisor off, do root canal therapy, and a wonky-looking crown that corrects massive ortho problems and will be a disaster hygienically, mechanically and aesthetically will say "but I don't want braces".
And here is what you say
No. I won't do a veneer/crown/slaughter here. It is a bad idea. It is such a bad idea, that even if you pay me double, I will not do it. However, if you go to enough dentists, you will probably find someone who will.
Then print out a picture and show them how much of the tooth you have to cut off to make it work.
Then the pièce de résistance
You are 35 now. But probably when you are 45, you will still want a front tooth. If I chop it off like this now, you'll end up losing the tooth and at some point I'll do an implant and I won't be able to fit the implant in unless.....you get orthodontics. Besides, implants wear out too.
Lastly, when you say it, don't pussy foot
Don't use weasily academic language.
No saying, "Well, the biologic cost of this procedure is quite high and jefferson 2008 showed a lovely study that you are more likely to have significant negative sequelae with reduced survival rates. " Or other academic waffle.
Just look 'em in the eye, and tell 'em straight. And mean it in your heart as you say it.
