Tooth wear frequently seen with deep vertical overbites.
This page explains how dental crowns can be used to rebuild and restore the appearance of worn front teeth.
Each case discussed is similar by way of the fact that the type of damage that’s occurred is characteristic for people who have a deep vertical overbite (see below for an explanation).
In cases like these where an extensive amount of wear has taken place, dental crowns typically make the best choice for the repair due to the great strength characteristics that they can offer.
In this first picture, you can see how the person’s front teeth, especially their center two, have substantial wear.
One reason for the extent of this damage is related to the fact that they have a deep vertical overbite.
Case #1. (View this makeover’s full-size animation.)
Note the extensive wear of the center two upper teeth.
A rough estimate of the amount involved can be gauged from the picture. With their back teeth fully closed, this person’s upper teeth probably overlap about 1/2 the height of their lowers. With cases involving a more “normal” occlusion, this amount would be much less.
Why wear facets form.
That’s because due to the overbite the upper and lower teeth are in frequent contact. And when they are, wear takes place on the front side of the lower teeth and the backside of the uppers. (These flat surfaces are called “wear facets.”)
Wear facets form on teeth that oppose each other.
The wear on the backside of upper teeth is much more obvious (and extensive) and has resulted in the loss of massive portions of tooth structure. (Quite possibly parts the tooth had worn quite thin and then fractured off.)
Note the missing upper back teeth.
An additional issue.
In this case’s “before” photo, you can see that there appear to be some missing back teeth. This isn’t just a side issue.
Their loss means that more chewing function must be shifted to the front, thus causing additional wear and tear on the teeth there.
Replacing the back missing teeth will help to ensure the longevity of the repair made in the front by allowing more chewing activities to be returned to the rear of the mouth where they belong.
Cross-section of a tooth with a dental crown.
A crown completely encases that part of a tooth above the gum line.
Rebuilding the teeth using crowns.
In comparison, porcelain veneers, while capable of creating a similar cosmetic end result, are just bonded on to the front side of teeth. They are much more fragile in nature and do little to strengthen a tooth. (This page compares applications for veneers vs. crowns.)
Even with the teeth repaired, the fact that this person’s vertical overbite still exists means that continued wear and tear will tend to occur. Having new dental work placed doesn’t mean that it (or the teeth that oppose it) will be immune to future damage.
The “ideal” treatment plan for Case #1 would also include the use of orthodontic treatment to correct the overbite situation. Doing so might make placing crowns a one-time affair, or at least a process that’s needed less frequently.
Of course, including this type of work adds a lot of time and expense to a treatment plan. And for some patients, especially comparatively older ones, it may not be something that they’re willing to opt for.
It’s simply the dentist’s obligation to explain the long-term benefits of using this approach, and then letting the patient decide what course of treatment is taken.
This second case shows the same type of wear pattern as Case #1.
- On the bottom, you can see the beveling of the top portion of the incisors.
- The ragged biting edges of the upper central incisors suggest that they have worn thin from the backside and, finally, a point has been reached where fragile bits have chipped away.
Case #2. (View this makeover’s full-size animation.)
Note the extensive wear of the upper and lower front teeth.
As mentioned above, this is termed having a deep vertical overbite. And in this case, the upper teeth probably overlap 50% or more of the height of the lowers. With an ideal occlusion, the amount would be significantly less.
An additional issue.
Something that’s different about this case, as compared to Case #1, is that the alignment of the upper front teeth isn’t as perfect.
The center two teeth (the central incisors) are crooked. The two teeth that lie to each side (the lateral incisors) seem to set back just slightly.
We’ll discuss these issues in the treatment section below.
Rebuilding the front teeth using crowns.
Our “after” picture for this case illustrates how dental crowns might be used to make a repair for this smile.
Why crowns make the best choice.
Instead of crowns, a treatment alternative for this case might be to place porcelain veneers. But as discussed above, doing so probably wouldn’t provide as lasting a repair.
Just like crowns, veneers can give an excellent cosmetic result. But when they are exposed to excessive forces (like those that have worn down these teeth) they frequently chip or break.
In comparison, dental crowns are the strongest type of dental restoration that can be placed. (Use the link up above for more details about the uses of crowns vs. veneers.)
Improving the apparent alignment of the teeth.
When a crown is placed, the dentist has a chance to make significant changes with the shape of the tooth.
With this case, the crowns for the lateral incisors could be made in a fashion where their front surface is slightly fuller, thus creating the illusion of more perfect tooth alignment.
In a similar fashion, crowns could be used to change (straighten) the apparent angulation of the center two teeth.
FYI – It’s important to understand that for the most part these alignment changes would just be cosmetic in nature. They would accomplish little toward correcting the vertical overbite (one main underlying source of this person’s problems).
And since the overbite still exists, even after the patient’s repairs have been made wear and tear (both on the natural teeth and new restorations) will continue to take place.
For this reason, the “ideal” treatment plan for this patient would involve correcting the overbite first (via orthodontic treatment) and then rebuilding the teeth.