Digital smile makeovers

- Straightening teeth with braces vs. by placing crowns. - A comparison of two cases.

This page features two digital smile makeovers that can give you an idea of the comparative advantages and disadvantages of having your teeth just look like they've been straightened by placing dental crowns (or possibly veneers), or really realigned using 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.

2) There are some chips and wear showing on the biting edges of the teeth. It's quite likely that this damage is directly related to her malocclusion (the way her teeth come together).

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.)

Treatment solutions:

While each of the above concerns is cosmetic in nature, collectively they're not really issues that are best corrected by "cosmetic dentistry" techniques (placing dental crowns, etc...). Instead, the ideal approach for treating this case would be orthodontic treatment (braces). Here's why.

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 crowns 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.

Dental history and concerns:

1) This person's upper teeth are crowded, to the point that the center two teeth are overlapped. It also seems that the biting edges of these teeth are chipped. The lower teeth display tooth crowding too.

Treatment solutions:

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.)

2) An alternative approach - Straightening the teeth with dental crowns. - Our "after" simulation shows the types of difficulties that are often encountered if placing crowns is used as an alternative to having braces.

a) Treating the upper teeth. - With this case, crowns could be used to change the width and apparent alignment of the center two upper teeth, thus creating a more even and regular appearance. The changes for the tooth off to the side could most likely be made just by trimming it a little with a dental drill.

b) Treating the lower teeth. - Creating a perfect result by way of "straightening" the lower teeth by placing restorations would be very difficult, if not impossible. At 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: 1) 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). 2) When placing crowns, the dentist has no ability to change the current gum level on the teeth (we discuss this issue below). 3) 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. (If a braces approach were used to treat this case, this issue would resolve on its own during treatment.)

Smile makeover cases illustrating how dental crowns can be used to straighten teeth.

Improving the apparent alignment of teeth with dental crowns.

If a person wants to make an improvement with their misaligned teeth, they really only have two...

Click image.

Straightening teeth with dental crowns - This case shows what type of changes can be possible. And explains why perfection might not be possible.

Using crowns and veneers to adjust the comparative lengths of front teeth.

This digital smile makeover provides an example of how dental crowns (or possibly even...

Click image.

a) Creating smile symmetry. - This smile has an abnormal look. This makeover shows how restoring the relative lengths of the teeth can return this smile to a customary appearance. b) Dental crowns and veneers. - We discuss how these types of restorations can be used to make changes, as well as the potential complication associated with placing them.

Straightening teeth with crowns vs. orthodontic treatment.

Here's a case submitted for a digital smile makeover where the treating dentist seems to have two...

Click image.

Straightening teeth by placing dental crowns. - This case illustrates the degree to which crowns can be used to make alignment changes for a smile. And explains some of the challenges and aesthetic deficiencies that must be dealt with when doing so.



View more makeovers -


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