Digital smile makeovers
- Using dental crowns to repair wear caused by tooth clenching and grinding (bruxism).
The smiles of people who clench and grind their teeth typically have a characteristic wear pattern.
The digital makeovers on this page provide examples of this look. They also explain how dental crowns can be used to repair this type of damage and restore the smile back to a more normal, youthful appearance.
Case #1: Making a smile look youthful again.
a) Dental history and concerns:
When looking at this "before" picture, any dentist would quickly conclude that this person has a bruxing habit.
The term "bruxing" means that this person clenches and grinds their teeth. This may be something they do subconsciously during their waking hours or else while they sleep, or both.
The usual wear pattern.
People who have this habit frequently have similar looking smiles:
a) The look of normal smiles.
When looking at a person's 6 upper front teeth:
- Their central incisors (center teeth) are usually about the same length as their cuspids (eyeteeth).
- Their lateral incisors (the teeth in between the centrals and cuspids) are just a little bit shorter.
- This is the look we've illustrated in this case's "after" picture below.
b) The smiles of bruxers.
When teeth are worn from clenching and grinding:
- All of the upper front teeth frequently have the exact same length.
- Instead of having gently rounded contours, their biting edges are usually straight across.
- It's often easy to imagine how the very straight biting edges of the lower teeth match up exactly with the straight edges of the upper ones. (This is the position the teeth are held in when the person grinds.)
- Both of the "before" pictures on this page show this characteristic pattern.
b) Treatment solutions:
1) Restoring the relative lengths of the teeth.
Our "after" picture shows how a dentist might rebuild this person's teeth by way of placing dental crowns.
The goal would be to return the teeth to relative lengths that give this smile a more normal and youthful appearance. (Central incisors and canines close to the same length with the lateral incisors just a little bit shorter.)
2) Dental crowns would probably make the best choice.
In situations where a patient's tooth wear has been caused by bruxism, the dentist may be limited as to what type of restorations they should place. That's because those chosen need to be able to withstand the extreme forces caused by tooth clenching and grinding.
With this case, dental crowns would probably make the most durable, longest-lasting choice (as opposed to porcelain veneers or dental bonding).
3) This patient's bruxing must be controlled.
It's important for a patient to understand that whether or not they have repair work performed, if their tooth grinding continues some type of tooth or restoration wear and damage will continue to occur. The habit needs to be controlled.
It's possible that by bringing their problem to their attention, this person might be able to control their bruxing during their waking hours. More likely, and especially for use when they sleep, they should probably have a nightguard appliance made.
Case #2: A second bruxism case.
a) Dental history and concerns:
Just as with the case above, any dentist looking at this "before" picture would immediately come to the conclusion that this person has a serious tooth-grinding habit.
You can literally see how the flat, worn biting edges of the lower teeth match the flat, worn surfaces of the upper teeth. (When this person does their grinding, they hold their jaw just slightly to their left.)
It's a simple equation; prolonged tooth-to-tooth contact = tooth wear. With this case, it looks like five of the six upper teeth have simply been ground off. In effect, they have been.
No doubt you've also noticed that the "before" picture shows that one of the front teeth is noticeably darker than the others.
This is probably an indication that the tooth has had (or needs) root canal treatment. For our discussion here, this is simply a side issue.
b) Treatment solutions:
Restoring the teeth with crowns.
Because of the great strength that they can offer, dental crowns (like porcelain-fused-to-metal ones) would probably make the most durable, lasting choice for treating this case.
Just like with the case above, the crowns would be used to restore the relative lengths of the teeth back to a more normal configuration (one where the central incisors and canines have a similar length and the lateral incisors are just a little bit shorter).
And also just like above, the extent to which the teeth can changed will be dictated (and possibly limited) by this person's bite.
The tooth grinding must be controlled.
Just as with the case above, the key to the long-term success of this case is simply controlling, or at least minimizing, this person's bruxing habit.
If it's not, while the nature of the future problems may change, some type of damage (either tooth or restoration) will continue to occur.
Other treatment considerations.
Dental bonding would probably make a suitable choice for closing the spaces between the lower teeth. It's not as strong and lasting as other types of dental restorations (like crowns). But most of the wear and tear associated with this mouth is on the biting and chewing surfaces of the teeth, not in between.
We're assuming that the dark tooth has had the root canal therapy it requires. Placing a dental crown (possibly in conjunction with a dental post and core) will complete its treatment.
View more makeovers -