When we talk about solving complex dental problems, it is very important to know the patient’s side of the story, and what they expect to achieve from our treatment. As professionals, we have to be able to predict how far we can go with a patient’s treatment, and for this reason we must have sufficient data available (occlusal analysis, study models, X-rays, photos, etc.)
Once we have studied the case, if our goals do not coincide with those of the patient, we have to know when to say "no", especially if what we are proposed does not coincide with reality. There is nearly always a solution, but it is not always the ideal one.
False expectations are the worst enemy of any relationship. Obviously, if a person has very advanced periodontal disease, however much we build on top of their teeth, it will be a failure in the medium term, as the "foundations" will fail.
If a person has lost teeth with major reabsorption of the maxillary bone, despite having had grafts, we cannot create an ideal volume so that the fixed teeth over dental implants emerge in the right place. In this case it is better to create overdentures held in place by implants than a completely fixed prosthesis, as the appearance will be better.
In the case of orthodontic treatments, each patient is completely different, and in many situations it is not possible to achieve a perfect mouth. There are many variables to be taken into account, and this is why we carry out previous studies, to make a correct diagnosis. Overlapping teeth are not the same problem as bone differences between the two maxillaries. There will be cases where in order to achieve a good occlusion, orthognatic surgery will be required, combined with orthodontic work.
Even when carrying out tooth whitening it is essential to make a diagnosis in order to explain the specific case to the patient. Severe staining caused by tetracycline is not the same as a colour change caused by aging of the dentine.