Tooth wear frequently seen with deep vertical overbites. -
Pictures of tooth damage. / Virtual makeover (before-and-after) examples showing how repairs can be made using dental crowns.
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.
Example #1
In this first picture you can see how the person's front teeth, especially their center two, have substantial wear.
Note the extensive wear of the center two upper teeth.
One reason for the extent of this damage is related to the fact that they have a deep vertical overbite.
Vertical overbites.
What we're referring to here is that when fully closed, this person's top and bottom front teeth overlap significantly.
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 a "normal" occlusion, this amount would be much less.
Wear facets.
If a photo could somehow be taken from the side, it would show that both the upper and lower teeth have beveled biting edges (see graphic).
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 back side of the uppers. (These flat surfaces are called "wear facets.")
Wear facets form on teeth that oppose each other.
Example A
Here's a close-up of two teeth that display a classic overbite-related wear pattern.
The beveled surface of the lower tooth matches up with a wear facet on the back side of the upper one. In this instance, both teeth have undergone a fair amount of damage.
Example B
When looking at the full-sized makeover pictures for Case #1 (the first photo we showed up above), you can just make out the wear facets on the lower teeth.
The wear on the back side 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.)
Takeaways from this section.
Note the missing upper back teeth.
An additional issue.
In this case's "before" photo, you can see that there appears 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 insure the longevity of the repair made up front by allowing more chewing activities to be returned to the rear of the mouth where they belong.
Cross section of tooth with a dental crown.
A crown completely encases that part of a tooth above the gum line.
Rebuilding the teeth using crowns.
With teeth worn as extensively as the upper front incisors are in Case #1, dental crown placement makes the best (and possibly only) choice. (Here's our illustration of how this repair would turn out.)
The idea is that a crown cups over and encases its tooth as a whole, thus providing a way to both rebuild and strengthen it.
Vs. veneers.
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.)
Additional solutions.
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.
Example #2
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 back side and, finally, a point has been reached where fragile bits have chipped away.
Note the extensive wear of the upper and lower front teeth.
Vertical overbites.
Just as with Case #1, a prime factor in the fashion in which the wear has occurred has to do with the way the teeth come together. When closed, the upper and lower front teeth overlap significantly.
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.
Takeaways from this section.
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 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 similar fashion, crowns could be used to change (straighten) the apparent angulation of the center two teeth.
Takeaways from this section.
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.
Rebuilding front teeth that have worn excessively.
This digital smile makeover gives an example of how dental crowns might be used to rebuild and restore the...
a) Worn teeth - The upper teeth of this smile show wear, likely due to a habit of tooth grinding. b) Crowns - As this makeover explains, the extensive nature of this wear and resulting fragile status of the teeth means that dental crowns (and the strength characteristics they offer) would make the best choice.
Using dental crowns and veneers to realign and repair worn teeth.
Here's a case where a smile has both tooth wear and alignment issues. The "after" portion of...
a) Vertical overbite. - This case involves the situation where the person's front teeth overlap significantly. As a result, tooth wear has occurred. b) Dental crowns. - We illustrate the placement of dental crowns with this makeover because they offer great strength characteristics and can be used to improve the apparent alignment of teeth.
Realigning and repairing worn teeth with dental crowns.
This person's front teeth, both top and bottom, show a great deal of wear. Most likely it's the result of...
a )Tooth wear - A person's malocclusion (in this case a deep vertical overbite ) can place them at greater risk for tooth wear. b ) Dental crowns - As this makeover illustrates, crowns can be used to both rebuild damaged teeth and improve their apparent alignment.
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