Getting Treatment Acceptance Through Patient Education and Comprehensive Treatment Planning

CASE STUDY
Getting Treatment Acceptance Through Patient Education

and Comprehensive Treatment Planning
STACEY HALL, DDS brings her
A DAWSON ACADEMY STUDENT CASE STUDY unique outlook on dental care and
her personable optimism to the
Case Summary Williamsburg Center for Dental
Greg presented to the office for a new patient exam Health. With nine years of expertise
because it had been a number of years since having as a dentist in Williamsburg, she
dental care. He knew his teeth were getting ‘worn decided in early 2011 to branch out
and open her own local practice.
looking’, but did not really understand the cause or
long-term effects. After completing her undergraduate
degree from Virginia Tech in 1998,
Greg had many dental needs that were phased at the Dr. Hall graduated from VCU’s
beginning to just get bacteria under control. Once he MCV School of Dentistry in 2002,
saw things continuing to break down he was ready to receiving her D.D.S. She is a member of the Academy of General Dentistry,
restore his teeth to improve the function. This, in turn, the American Dental Association, and was awarded member fellowship
to the International Congress of Oral Implantology in 2008. She is a
resulted in better esthetics and less breakdown in the scholar with the internationally renowned Dawson Academy. As a Dawson
future. ambassador, Dr. Hall also assists in the training of students in the Dawson
Academy. Stacey and her husband Michael have been blessed with three
beautiful girls, Lanie, Gracie and Abbie. She is a loyal Virginia Tech Football
fan, and enjoys Bible study and missions work.
Figure 1. Radiograph prior to treatment.
800.952.2178 ▲ 390 4th Street North, Suite 200 ▲ St. Petersburg, FL 33701-2802
Phone: 727.823.7047 ▲ Fax: 727.821.0482 ▲ Email: Info@THEDAWSONACADEMY.COM
© 2017 The Dawson Academy. All rights reserved. This material may not be reproduced, displayed, modified or distributed without the express prior written permission of the copyright holder. For permission, contact info@thedawsonacademy.com. 1
Rest Position
Johnson Greg
"E" Position Tipped Down Smile Profile Smile
Full Face Profile Face Face, Lips Retracte
Right Lat. Retracted Frontal Retracted Left Lat. Retracted

(Teeth Right Lateral Smile
Apart) (Teeth Apart) Full Smile (Teeth Apart)
Left Lateral Smile
Full Face Profile Face Face, Lips Retracted
Patient Summary
Patient: Greg J.
Chief Concerns: No chief

concerns and had a good
medical history
Dental History: He had Rest

Right Position
Lat. Retracted "E" Position
Frontal Retracted Tipped
PatientPatient
Down
Left Lat.
PhotosPhotos
Smile
Retracted Pro
many teeth with large
(Teeth Together) (Teeth Together) (Teeth Together)
restorations
Right LateralcoveringSmile
than 70% of the tooth
more
Johnson
Full Smile Johnson
Greg Greg
Left Lateral Smile
structure, a history of
popping and clicking that
had gone away, and he was
aware of his grinding. He’s
a Dawson classification of Right Lat. Retracted Frontal Retracted Left Lat. Retracted Patient Photos
2A. He had a sleep apnea (Teeth
Right Lat. Retracted Apart) (Teeth
Frontal Retracted Apart) (Teeth Apart)
Left Lat. Retracted
diagnosis of mild positional (Close Up) Profile Face Profile
(Close Face
Up) Face,(Close Up)
sleep apnea a couple of Full Face
Full Face
Johnson Greg Lips Retracted
Face, Lips Retracted
Rest Position
years ago. "E" Position Tipped Down Smile Profile Smile
(Figure 1).
Complete Examination:
The patient’s examination
included an occlusal Right Lat. Retracted Frontal Retracted Left Lat. Retracted
analysis, muscular exam, (Teeth Together) (Teeth Together) (Teeth Together)
Upper
Right Lateral Smile OcclusalFull SmileLower Occlusal
Left Lateral Smile
doppler auscultation,Right
load Lateral Smile Full
Full Smile
Face Left Lateral
Profile Smile
Face Face, Lips Retracte
testing, range of motion,
diagnostic
Right Lat. casts, CR bite
Retracted Frontal Retracted Left Lat. Retracted
registration, and
(Teeth Apart) (Teeth Apart) 1 (Teeth
/2 Apart)
facebow transfer.
Right"E"
Lat. Retracted FrontalDown
Retracted LeftProfile
Lat. Retracted
Rest PositionRest Position"E" Position
Right
Position
(Close Tipped
Up)
Lateral
Tipped
Smile Down Smile
(Close
Smile
Up) Profile Smile
Full Smile Left(Close
Smile
LateralUp)
Smile

(Teeth Together) (Teeth Together) (Teeth Together)
Right Lat. Retracted Frontal Retracted
Rest Position Upper
"E" Position Left Lat. Retracted
Occlusal Lower
Tipped Occlusal
Down Smile Pro
(Teeth Apart) (Teeth Apart) (Teeth Apart)
(Teeth Apart) (Teeth Apart) (Teeth Apart)
Figure 2. Export of Dawson Diagnostic Wizard®. Photos taken prior to treatment.
800.952.2178 ▲ 390 4th Street North, Suite1

200/▲ 2 St. Petersburg, FL 33701-2802
Right Lat. Retracted Frontal Retracted Left Lat.
Right Lat. Retracted Retracted
Frontal Retracted Left Lat. Retracted
(Close Up) (CloseFrontal
Right Lat. Retracted Up)
(TeethRetracted
Apart) (Close
Left Up)Retracted
Lat.
(Teeth Apart) (Teeth Apart)
Screenshots from the Dawson Diagnostic Wizard® Software’s 2D Treatment Planning Section.
Photos taken prior to treatment.
Figure 3, 4 ,5, 6. Patient had poor occlusion with no anterior guidance. His profile was acceptable, and was perpendicular
and parallel where he should be. However, the lower occlusal plane was not appropriate and not acceptable.
Figure 7, 8, 9, 10. Patient’s upper incisal edge was not appropriate and worn. His buccal corridor was acceptable, and
while the gingival area was acceptable to smiling, upon closer examination the contours were a little off balance.
Figure 11, 12, 13, 14. Patient did not meet the golden proportion, and width-to-length ratio was not appropriate. His papillary position was acceptable, without any
black triangles. All axial inclinations would need to be addressed in restorations.
Figure 15, 16, 17. His incisal embrasures are not appropriate due to wear.
Treatment Plan
Phase 1
Phase 1 treatment began with scaling and root planing the upper and lower with prophy (which had been done
previously by my associate). As a part of re-care, I spoke with him about the problems I was seeing and when it
came to the instability what would happen if we did not address those areas over time. That is when he decided to
proceed with an advanced records exam so I could become more familiar with the breakdowns in his system.
After gathering all the records, I reviewed the findings, my treatment plan, the benefits of treatment, and the long-
term consequences of not treating his issues. We also talked about phasing treatment due to his financial concerns.
Greg wanted to wait, and as the breakdown continued due to no treatment being done, suddenly his financial
concerns dissipated. From there I started the treatment with a root canal on #11 to get the inflammation stable.
Figure 20. After Placement of Provisional Restorations.
Figure 18. Diagnostic Wax-Up.
Figure 19. Diagnostic Wax-Up.
Phase 2
I referred Greg to a specialist for gingival recontouring
of tooth #6, #12 and grafting tooth #10, but the he
denied this part of treatment. Figure 22. After Placement of Provisional Restorations.
In two back-to-back days we did cores, prepped and

temporized tooth #2-4, #12, #13, #15, #18-21, #30, #31
for full coverage crowns #2-15, #18-31.
Phase 3 the lab uses them for the wax-ups - there’s very little
adjustments to be made, and the delivery is really easy.
Greg returned several weeks later after trying out the
temporaries. We did a master impression and then Patients will say they can’t afford a lot of treatment, as is
refined the temporaries again. We did zirconia crowns what happened in this case. That’s when we treat them
for teeth #2, #3, #14, #15, #18, #19, #30, #31, and Emax for-- or you talk to them about what they really need
crowns for teeth #4-13, #20-29. After final restorations to solve the problem. You explain to them what will
were delivered, a bite guard was fabricated. happen if it’s left untreated. And when they see things
are happening like you said, they will come back. In this
Final Thoughts case, this guy first said, “None. No treatment.” Then he
wanted to break it down into sections, and he wasn’t
Greg was a patient who claimed he wasn’t worried happy with that because of how much time it would
about his esthetics, but he’s now smiling a lot more. take. And then, all the sudden he had the money to take
Once the treatment plan was accepted, the entire case care of all of it at one time.
flowed perfectly, especially considering I was dealing
with a patient who was easy to work with. I am glad
that I took the impressions after the patient wore his
temps for a few weeks, while I worked on some rough
models of the original preps. This allowed me to review
the preps, and make adjustments where necessary. It
allowed for the fabrication and the delivery of the finals
to proceed flawlessly. Using the Dawson Wizard has
just proven by far to be a highlight and key to these
cases in my practice. When I follow the checklists - and
Figure 24. Pre-Op. Figure 26. Final Restorations
Figure 25. Pre-Op. Figure 27. Final Restorations
The Dawson Academy teaches dentists how to improve patient satisfaction by confidently
diagnosing and treating every case by following our easy-to-follow records and treatment
planning protocols.
You can learn this time-proven method through our live courses, study clubs or online
courses. Visit https://thedawsonacademy.com for details.
Live Courses.
In The Dawson Academy live courses, you will develop the knowledge and skills
to confidently and accurately tackle any case - simple to complex, allowing you
to increase your patients’ satisfaction and your overall enjoyment of practicing
dentistry.
Study Clubs.
Dawson Study Clubs are the ultimate local learning experience. Not only will
you experience camaraderie learning from the provided Dawson Academy
content during meetings, you also have untlimited access to all
online resources.
Online Courses.
Learn from the comfort of your home (or office) with our online courses, videos
and webinars. Dawson All Access gives you unlimited access to 40+ hours of
CE courses, the Dawson Diagnostic Wizard® treatment planning software, and
more!

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CASE STUDY

Getting Treatment Acceptance Through Patient Education

Figure 1. Radiograph prior to treatment.

Right Lat. Retracted Frontal Retracted Left Lat. Retracted

Chief Concerns: No chief

Dental History: He had Rest

Right Lat. Retracted Frontal Retracted Left Lat. Retracted

800.952.2178 ▲ 390 4th Street North, Suite1

Figure 21. After Placement of Provisional Restorations.

Figure 19. Diagnostic Wax-Up.

In two back-to-back days we did cores, prepped and

Figure 23. After Placement of Provisional Restorations.

Figure 24. Pre-Op. Figure 26. Final Restorations

Figure 25. Pre-Op. Figure 27. Final Restorations

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