The nationally syndicated television show The Doctors has made it possible for countless people, often in desperate situations, to find hope and a new beginning through various treatments and opportunities. When you work in dentistry on television, you find many people who are in need of help. I am grateful to be included as an expert on The Doctors for the past few years. I’ve served as a guest expert for dental reconstructions, smile makeovers, and dental advice. It has been a true pleasure to be part of their team. Recently, instead of us looking for a patient for a future episode, the patient found us.
Samantha Diane was in desperate need of a smile makeover. After reaching out and telling me her story, I evaluated Samantha’s case with my public relations consultant and the producers at The Doctors to determine if her case would be a good fit for the show. Together, we decided that Samantha was a good candidate for an upcoming, heartwarming episode.
Samantha has a career as a model, and has unfortunately made a few regrettable decisions in the past—but she has since turned her life around. That was a main reason why The Doctors decided to take on her case; she’d come from a bad situation and was doing her best to get a second chance.
A Unique Challenge
An early challenge with Samantha’s case was that she does not live in the city (or even the state) where my dental practice, True Dentistry, is located (Las Vegas, NV). For all her dental appointments, Samantha had to travel back and forth between southern California and Las Vegas.
On Samantha’s first visit to the office, we did the initial exam. Unfortunately, after years of neglect and bulimia, her mouth was in poor shape. She wasn’t taking care of her teeth. We found a lot of periodontal disease, enamel erosion, and infection, and many broken-down, non-restorable teeth. Because of the extent of the damage, we had to postpone our original tape date for The Doctors because there was just too much healing that needed to be done.
The next step was to get Samantha’s periodontal disease under control. We needed to extract the infected, damaged teeth (two on the upper left, two on the lower left, and two on the lower right), and it was necessary to do extensive bone grafting as well.
One of the biggest issues that we encountered was that a missing central tooth had been gone for so long, and no bone grafting had been done when the tooth was lost, so Samantha’s whole buccal plate had collapsed in the anterior area. This large defect in the bone was a challenge to restore. When that happens, it’s difficult because you get a large shadow near the coronal portion of the restoration in the bone. Getting the correct shape, contour, and color is a difficult challenge for any restoring dentist.
Because I was using Arrowhead Dental Laboratory for the restorations, I knew the capabilities of the technicians. After extensive photos, preliminary impressions, and case planning, I discussed Samantha’s case with the technicians. To solve our major aesthetic problems, we ultimately decided to use pink porcelain to correct the void and fill the tissue out. We discussed possibly doing an implant in that area, but the bone was extremely thin and the patient didn’t want to undergo extensive grafting procedures.
Because of the patient’s unique situation and her cosmetic desires, we decided to use some advanced techniques and new materials in pink porcelain and composites. Being able to use the pink materials helped solve a very difficult restorative problem for Samantha, especially in the anterior area. The biggest difficulty with pink porcelain is matching the tissue color, because when the tissues are inflamed, they turn red, but the pink porcelain doesn’t ever change color. It can be a challenge to match shades.
To compensate for that challenge, we used the pink composite bonded to the porcelain so we could get an exact match to the client’s tissue. That way, when we needed to, we could adjust the color to the final healed soft tissue.
It was first necessary to clean off multiple layers of stains and remove years of accumulated plaque. Controlling her periodontal problems was a major factor in her upper and lower arch. As the periodontal condition healed, it was necessary to contour the lower anteriors, and the teeth were bleached with the Smile 365 bleaching system. The Smile 365 system was a perfect fit for Samantha, as her treatment and dentition were changing.
For the treatment materials on the uppers, IPS e.max® with the pink porcelain was used. In addition to the pink porcelain, Gradia® pink composite was used. The restorations were bonded with Kuraray Panavia™ V5 cement. We used Alleman-Deliperi biomimetic techniques in repairing and bonding the tooth, including Ribbond® fiber mesh, Kuraray Clearfil SE Protect bond, Kuraray Majesty Flow, and Kuraray Clearfil AP-X composite. Because it was an e.max® (porcelain) bridge, it was important to use the Kuraray Panavia™ V5 composite in combination with an immediate dentin seal technique to ensure the highest bond strength possible.
Because of the infection in her teeth, Samantha was in quite a bit of pain for the early treatments. The pain from her periodontal disease was very bad, too. We decided to use sedation—oral sedation and nitrous—to help Samantha and manage the pain during the procedures.
It took about four months to complete the entire process for Samantha. The uppers were prepped and the lowers were treated on separate visits. Completing her implant work will finish her case.
The biggest transformation for Samantha was when the temporaries were placed and she could see her new smile take shape. The temporary placement is really the first time patients are able to envision what their permanent smile will look like. For Samantha, it was a dramatic transformation. She cried a lot and thanked us profusely. Samantha said, “This is a new start for me. I haven’t smiled in years.” And that’s the fun part for the dentist—seeing such a change in the lives of your patients.
With the work we finished on Samantha’s mouth, we were able to tape the episode for The Doctors last fall (the show originally aired on September 23, 2015). It was great to showcase Samantha’s new smile and see how it gave her a new outlook on life.
As Samantha smiled throughout the show, she seemed genuinely happy with her new makeover. Hopefully, from Samantha’s example, others will learn what treatments are available through reconstructive dentistry. No matter how “bad” a smile is, it’s never too late, and it isn’t always as hopeless as you might think. Often, the future can be bright—just like it was for Samantha.
For more information about The Doctors, please visit www.thedoctorstv.com.