Case presentation of the large/full-mouth rehabilitation

By now, most of us feel relatively comfortable presenting smaller treatment plans to our patients; however, we tend to have a disconnect with larger treatment plans ($7,500 to $40,000).

By Daniel Rairigh, DDS

By now, most of us feel relatively comfortable presenting smaller treatment plans to our patients; however, we tend to have a disconnect with larger treatment plans ($7,500 to $40,000). I have been blessed with the opportunity to treat many larger cases and drastically improve the lives of my patients. I would like to share with you the presentation methods I follow that allow me to engage patients and help them make the decision to go forward with the treatment for which they have come to me.

Seating the new patient

It is important to have an area on the new-patient forms that allows patients to write in the reason they have come to see you. When my dental team seats new patients, they make them feel comfortable by engaging them in conversation about their concerns. I feel patients are more at ease when the staff initially hears their concerns. Frequently, patients will disclose that an upcoming event has initiated their consultation appointment. After a relaxed discussion with the patient, my staff takes a series of clinical photographs as recommended by the AACD protocol. The dental team then uploads the patient smile photo on the monitor and gives the patient the smile album that best matches the patient's treatment goals. These smile albums are a collection of before-and-after smiles of similar cases I personally have treated. The patient will have a good chance to really look at his or her smile and compare it to the ones in the smile book.

Preliminary planning

The team and I then examine the photographs on the computer outside the operatory and discuss what outcomes the patient desires. It is very helpful to get a preliminary idea of what the patient will require to meet his or her goals prior to entering the room. I often will run through three treatment options in my mind. The first is an ideal treatment that is complete for maxillary and mandibular to achieve the most predictable desired outcome. The second is a phased plan that accomplishes the same ideal treatment over months to years of treatment when the patient is ready. The third is a treatment that will give pleasing results for the patient now, but allow him or her to move forward with more ideal treatment over time. For example, whitening and porcelain veneers on 7 to 10 with facial bonding on the premolars to fill a negative buccal corridor. At a later time, the patient can replace the cosmetic bonding on the premolars with porcelain veneers. Patients want to know that you can help them and that you can offer them solutions that fit in their budget at that time.

Greeting the patient

If you have a sincere heart to serve patients when you meet them, they will appreciate it and begin to build a foundation of trust. I enter the room and greet the patient by introducing myself and confirming what his or her concerns are. Have the discussion while you are seated in front of the patient looking eye to eye (not down at them). I like to focus on the event that the patient has identified for his or her "reveal."

The conversation might follow a script something like this: "Mrs. Jones, I understand your daughter's wedding is coming up in a couple months, and I know we can have you smiling for her big day. We have to work together to find the plan that is going to best fit your goals and budget."

At this point, patients will usually give me an idea of what they were thinking of investing in their smiles. The attitude must be one of "investing" not "spending." When our mindset is correct, our patients see the value for long-term life change rather than a one-time purchase. The greatest challenge is breaking the ice with patients so that they lower their guard and become vulnerable with their concerns. Your patients are considering investing a sizeable amount of money into their smiles, and they need to feel lasting satisfaction from their decisions. The way I do that is by …

Being compassionate. Many patients can honestly have a smile that is crippling. Approach the patient from a place of empathy. Direct your conversation to show the changes for the better in their life due to their new smile and relate that to their reveal when possible. These interactions stay with the patient after the appointment much better than the technical aspects of what you will be doing. This will create an emotional connection with the treatment.

Being confident. Many patients want to do the work, and they can afford it if it is a "want." By focusing on their reveal date, the want stays in view. But with any large investment, there are concerns other than financial. Most of my patients know their "cousin's friend" who had veneers and they look "just awful." Be the dentist for the patient in front of you! Have a vision of what you can do for your patient and confidently engage him or her to capture the same vision of what his or her changed smile will look like and how it will change his or her life. Show your patient before pictures of patient smiles that YOU treated that are very similar to his or her case. Seeing this encourages your patient to imagine a new smile personally.

Be excited. Enthusiasm is contagious. Be genuinely excited for your patient and the results that you know you can deliver. When patients catch hold of this enthusiasm, they are excited, too, and want to get the work completed. "Mrs. Jones, I am so excited for you. When you are getting photos with your daughter on her wedding day, you can smile without reservation."

Be flexible. Work with your patients by offering financing to allow them to get the treatment they want. If you know your patient has only budgeted for six porcelain veneers, but their smile would be amazing with eight, work with your patient!

"Mrs. Jones, I know this is quite an investment for you and you were considering six veneers, but I am so certain that eight will make your smile amazing that I'll cover the eighth if you cover the seventh."

If she still can't afford it, then do composite bonding on 5 and 12 and give her the option to restore with porcelain veneers when she is able. In the end, either way you look like a hero! Patients connect with you and know you really care when you meet them halfway.

For the purpose of this article we are assuming Mrs. Jones has no parafunctional habits, good periodontal health, and is seeking treatment to replace chipped/stained large anterior composites and improve the overall fullness of her smile. Prior to beginning any restorative treatment, patients are scheduled for a second appointment to review diagnostic models, have a full-mouth series of radiographs, and comprehensive exam including complete periodontal exam. A diagnostic wax-up and diagnostic stent are fabricated when warranted. To best serve our patients, we must provide a "complete dentistry" approach and gather all appropriate information prior to beginning dental work. Without a proper evaluation, even a seemingly straightforward veneer case can become problematic in patients with conditions such as occlusal disease.

I hope this has provided some insights on how to present extensive treatment plans to patients. And remember your confidence with presentation really only comes when you have confidence in your abilities to repeatedly provide predictable results for your patients. First and foremost, I encourage you to seek education that allows you to truly serve your patients with proper clinical techniques that offer predictable successful outcomes. Preparing up to 28 units can be quite complex, and you don't want to put yourself in a pinch. Have a dental laboratory relationship that provides consistent results and open communication, and get the training to allow you to confidently treat these cases. That confidence will transfer to your patients when presenting large treatment plans.

Dan Rairigh, DDS, is a general practitioner at Advanced Dental Solutions of Pittsburgh in Pittsburgh, Pa. He is a graduate of WVU School of Dentistry and had implant training at Midwest Implant Institute. You may reach him by email at rairigh@gmail.com.

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