Hello All,

I recently saw this patient for a New Patient appointment. His CC was that he has noticed his teeth are becomming more stained recently and he inquired about porcelain veneers.

I will post xrays and some photos I took with my Digidoc camera. I realize its not the best photos, but it will let you visualize his teeth. I also took a Trios Digital impression scan and I am having diagnostic models printed. In my initial interview with the patient, he indicated that it had been a year since his last cleaning. We cleaned his teeth on his first appointment and discussed briefly some possible options for him. I made some simple recommendations from my initial assessment such as:

-Pxs, increase the pxs to 3 month intervals, Diamond Clean Sonicare Toothbrush,

I am a bit hesitant to whiten his teeth due to the excessive wear on lower anterior teeth. I asked him if the crossibte #6,7 was something that he would ever consider correcting. He said he never really thought about it, but would not like to entertain the idea of braces at this point in his life.

What your thoughts on Invisalign for this patient? Perhaps pre-restoratively? I am concerned about porcelain veneers with his crossbite. He has some old composite bonding that has been done several years ago on the anterior teeth.

I am having him return later this week to review treatment plan options with him. Would you all recommend just replacing some of the older composites with some "slower whitening" then seeing how he does with the 3 month prophy then evaluate the possibility of more extensive treatment? I would like to present Invisalign treatment to improve the position of the anterior teeth. I am limited with the Invisalign due to the recent crown and bridgework on the lower posterior areas.

What are your thoughts on the facial gingiva with Invisalign? Should I have him see Perio for a consult first?

These are the cases that really challenge us.

Your input is always appreciated.

Thank you!

Kimet[image:X03242_1.jpg][image:X03242_2.jpg][image:X03242.jpg][image:X03242_3.jpg][image:X03242_2.jpg][image:X03242_2.jpg]