Digital smile makeovers
This page features two digital smile makeovers that can give you an idea of the comparative advantages and disadvantages of two different dental approaches.
One is having your teeth just look like they’ve been straightened by placing dental crowns (or possibly veneers). The other is actually realigning teeth via the use of orthodontic treatment (braces).
Digital smile makeover #1: Advantages and disadvantages of straightening teeth with braces.
Dental history and concerns:
When we look at this person’s “before” picture, these are the cosmetic problems that we see.
1) Her teeth are crooked. There’s tooth crowding on the top and tooth spacing on the bottom.
A smile with misaligned teeth.
3) The gum line across the upper front teeth is irregular. Her right center tooth (central incisor) is positioned relatively too high and the lateral incisor next to it somewhat too low. (Compare the level of the gum line on the teeth on the right and left sides and you’ll see the imbalance.)
Braces vs. cosmetic dentistry: Which approach is best?
Treating this case orthodontically. – In a nutshell, a braces approach would simply involve realigning the teeth. Then, after that’s done, straightening their biting edges either by placing dental bonding, or just trimming them with a dental drill. (This is what we’ve illustrated in our “after” picture.)
As a side benefit (and a pretty important one in terms of creating the “perfect” smile), having orthodontic treatment would also resolve the gum line discrepancy across the upper front teeth. (See the makeover below if you need more help understanding our point about this issue.)
a) Treatment time. – As a disadvantage of this approach, it would probably take between one and two years to complete this case. And it’s easy to see why someone might have objections to having to endure braces for that amount of time. But considering all of the different types of orthodontic techniques and options (including Invisalign invisible braces) that are available nowadays, this argument seems to carry less and less weight. In comparison, placing crowns and veneers would be the “instant gratification” approach, although it usually does take a few weeks to have them made and placed.
b) Cost comparisons. – The cost of the orthodontic treatment could be a concern. But getting results even approaching what we’ve illustrated in our “after” picture by placing some combination of crowns would involve at least eight teeth. That means that the cost of both treatments would be at least somewhat similar (many thousands of dollars).
We should point out that a braces approach would only involve substantial costs now. Long-term maintenance could be expected to be simple and cheap (wearing a retainer, possibly somewhat infrequently, and repairing any bonding that had been placed on an as-needed basis).
In comparison, a “cosmetic dentistry” approach involving crowns and veneers would involve placement costs now, and then again some years later, and then probably yet again… You have to realize that no “permanent” dental restorations really last forever. Especially when their cosmetic appearance is a major consideration.
c) Other disadvantages of a crown-placement approach. – Anyone considering having their teeth “straightened” by placing crowns needs to understand that doing so probably involves trimming away healthy tooth structure. And doing so does have the potential to cause unexpected consequences.
There is also the issue that placing restorations on teeth can make it more difficult over the long term to maintain the health of the gum tissue around them. This should be a major consideration for people who are lax in their brushing and flossing habits.
Digital dental makeover #2: Making teeth look straight by placing crowns.
This smile has misaligned and chipped teeth.
Dental history and concerns:
1) The “ideal” treatment plan. – We don’t think any dentist would dispute that the best treatment plan for this case would involve the use of orthodontic treatment (“braces” of some sort).
Doing so would take care of all of this person’s misalignment problems. The two chips could then repaired by placing dental bonding. (A more durable solution might be to place porcelain veneers instead.)
How placing crowns on the center two upper teeth would improve this smile.
b) Treating the lower teeth. – Creating a perfect result by way of “straightening” the lower teeth via the placement of restorations would be very difficult, if not impossible.
At a minimum, six teeth would need to be treated. The cost-reward ratio associated with doing so seems questionable.
c) Disadvantages of placing crowns. – With this case, the tradeoff of correcting the misalignment with crowns as compared to orthodontic treatment would be:
- The front teeth will now look narrower (that’s the only way to get two new “straight” teeth to fit in the old “crooked-teeth” space).
- When placing crowns, the dentist has no ability to change the current gum level on the teeth (we discuss this issue below).
- The lower teeth still remain untreated.
b) Correcting the gum-line discrepancy. – If the gum-line irregularity that exists with this case is a concern (in our “after” picture you can see how the gum line is higher on one center tooth than the other), as a separate procedure, “gum sculpting” could be performed.
This is a minor surgical procedure that, in this case, would be used to position the gum tissue around the patient’s left tooth up higher (so to reveal more of the tooth).
This procedure would need to be completed before the process of making the crowns is begun. (In comparison, if a braces approach were used to treat this case, this issue would resolve on its own during the treatment process.)