63 year old male came in for a limited to re-cement #9 crown that came off. Last dental visit was 3 months ago. Let him know the re-cementation wouldn't last, but he had a big family reunion the next day and said he just wanted to have a tooth there for esthetics. I reduced the lingual of #9 and let him know there is no retention and this is for esthetics ONLY. No significant Med Hx or Social Hx. Had him come back following his family reunion for a comp exam.

He's on my schedule Monday morning to re-cement #9 (it lasted a month) and to discuss possible treatment. I brought him back for a second appt for a comp exam and to go over photos/xrays. Let him know the cost of tx and that it would be the "price of a car." He's in the middle of a lawsuit as well as a divorce and broke down crying saying his teeth weren't always like this

I always struggle coming up with "the next best thing." If ortho is not an option (due to finances), what is the next best thing?

When I think of "ideal" treatment, I go back to the EFSB from the Spear Online videos. In this case, this patient has severe wear in the anterior and posterior resulting in a collapsed vertical and secondary eruption. Incisal length seems fine with lips at rest (sorry, no photo attached). There's a deep overbite with severe pathway wear and appears there was a significant amount of secondary eruption on the mandible as well as the UL quadrant.

My first thought would be that since there is severe wear on all teeth, I will be increasing the vertical dimension to some extent with my final restorations. Before that, I'd like to even the lower incisors to create more restorative space. I'd also like to intrude the UL quadrant to correct the reverse smile and also because any further reduction would result in endo on the premolars. The lower premolars would either need crown lengthening and endo/post core to gain adequate ferrule or they'd need ext/implants. Can restore anteriors in composite once vertical is established.

He is definitely no where near interested in comprehensive treatment and started asking about extractions and partials/complete dentures. Honestly, that was probably the one question I wasn't ready for. What is the "next" thing I can recommend him and does he have any other options because his main focus is only #9. He's coming in Monday to get the crown re-cemented again, but he also wants to talk about his options if he can't afford comprehensive dentistry.

Help! [image:Screen_Shot_2018_09_15_at_8_36_15_PM.jpg][image:Screen_Shot_2018_09_15_at_8_37_38_PM.jpg][image:Screen_Shot_2018_09_15_at_8_35_41_PM.jpg][image:Screen_Shot_2018_09_15_at_8_37_57_PM.jpg][image:Screen_Shot_2018_09_15_at_8_38_10_PM.jpg][image:Screen_Shot_2018_09_15_at_8_38_19_PM.jpg][image:Screen_Shot_2018_09_15_at_8_39_02_PM.jpg][image:Screen_Shot_2018_09_15_at_8_38_48_PM.jpg]

Thank you