Closing in multiple tooth gaps by placing dental crowns.

This digital smile makeover illustrates a situation where dental crowns, as opposed to porcelain veneers, make the best choice for closing in the spaces between a person's teeth.

While both approaches can provide a similar cosmetic end result, dental crowns possess greater strength than veneers. In this case, the tooth wear that's visible confirms that these teeth are exposed to significant forces.

Case issues and concerns:

  • The center six upper teeth have gaps between them.
  • The center two show a lot of wear, probably due to tooth grinding. (The worn edges of the lower teeth opposite them support this theory.)
  • The lateral incisors, the teeth that flank the center teeth, seem very small (suggesting that their crown portion has been affected by some type of developmental abnormality).
  • Lightening the color of the teeth might be considered.

On a positive note:

  • The lower teeth have a reasonable appearance.
  • This smile displays multiple tooth gaps.
    This smile displays multiple tooth gaps. This smile displays multiple tooth gaps.
  • Dental crowns have closed the spaces.
    Dental crowns have closed the spaces. Dental crowns have closed the spaces.
 

Photo submitted by website visitor.

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Treatment solutions:

1) Closing the spaces using dental crowns. -

Our "after" picture shows how this person's smile could be improved upon by making shape changes with his center six upper teeth.

Crowns would make the best choice for creating these changes (as compared to porcelain veneers). This is because, as you can see in the "before" picture, the biting edges of all of these teeth are chipped and worn.

This wear suggests that this person clenches and grinds their teeth. (Dentists refer to this activity as "bruxing.") And due to these conditions, dental crowns, because they have greater strength and can better withstand these types of excessive forces, offer a more lasting treatment solution than veneers.

2) Teeth whitening treatments could be an option. -

We didn't really address the issue of tooth color in our "after" picture. If one is desired, however, either in-office or at-home treatments could be utilized.

This treatment would need to be completed before the dental crowns were made. (Only teeth will respond to tooth-whitening treatments, not dental crowns.)

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Input from site visitors.

Coerced and cheated to believe?

I have strong, healthy teeth - something my family dentist used to tell me every time I came in. I took pride in this and take care of my teeth with a raw, vegan diet, and good oral care.
A year back, I went in for a routine check-up, after years of being on the road as a traveler.
I was told that I "brux" (grind/clench my teeth) and that they're worn down in the front "like an old person", and that I'm at risk for dental complications further down the line if I don't do something about it immediately.
I didn't think they were "that bad" and couldn't recall my family dentist saying anything about brux, but I attested this new issue to my years of travel and excessive stress levels associated with it.
So I asked the new dentist what their recommendation was and they replied, "veneers".

As they told me what it was and how beautiful my smile would be - "not like an old person's smile" - I started to fall for it.
They didn't share details about the procedure, but kept it general, telling me that this would be best and would repair the "damage" caused by clenching and grinding.

I had temporaries placed on for some time, while the veneers were made.
And when I finally came into the office for the full procedure, I voiced a concern that I had - "Is it true that my teeth, underneath will rot?"
The response from the dentist and his assistant was a nervous and evasive one.
I didn't get my answer, but I was naive and trusted them far too quickly.

It was then that they gave me some shots to anesthetize/numb and began to grind my teeth down.
I recall feeling highly sensitive and that it was a very painful procedure for me, even with the multiple rounds of shots.
But, the veneers went on and, so, a new smile was formed - "not like an old person's".

It has been less than a full year since the procedure and one of my veneers fell off - intact. The sensitivity of my dentin makes it unbearable to not wear my veneer, so as to have some kind of protective cover, even though it's not on properly and comes off in my mouth at night.

I've struggled with feeling coerced and scammed by this dental office over time, and, with my veneer falling of and revealing a deeper lingering sensitivity, I am very concerned that I've made a horrible decision that has impacted the health of my otherwise strong, healthy teeth.
And as I read through these highly informative pages on traditional veneers vs. modern trends in drilling away the enamel, I'm beginning to get the sense that I've been cheated.

I am scared that I may not be able to afford further costs of veneer repair, at this rate, and may have even lost my enamel for good.
I don't know what to do, or who to go to, whom I can trust.

DEW

If you feel something wasn't correct about your initial diagnosis or the work performed, your state's Dental Board probably offers an avenue by which you could pursue a complaint, without entering into outright litigation.

In general terms, bruxism (teeth grinding) typically is considered a contraindication for the placement of veneers.

And while some types of crowns can be expected to fare better under the extreme forces typically associated with bruxism, even they can wear, break or cause excessive wear of opposing teeth.

The usual plan is one where the bruxism habit and/or its effects are controlled first. Then the new dental work is placed.

(In many, probably most, cases, the best that can be hoped for is controlling the effects of the bruxism by way of the patient wearing some type of mouthguard appliance during those times when they grind their teeth. Completely stopping the habit of teeth grinding can be very difficult for a patient to accomplish.)

It is true that companies continue to develop stronger and stronger ceramics from which veneers and crowns can be made (possibly an explanation why your veneer was strong enough to debond without breaking).

But the restoration being able to withstand forces without breaking is a different issue than if the restoration can stay attached to your tooth (like your veneer). Or how the new restorations will affect (wear) the teeth it opposes during periods of tooth grinding (although possibly this issue isn't a factor with your case).

As stated above, addressing the bruxism should always be the first step (so look for a dentist that stresses that). Rebuilding the teeth after that has been accomplished is the second.

In cases where veneer retention proves to be a problem, better control of the bruxism habit (you don't mention you are currently wearing a nightguard) or else crown placement is usually the way a case will progress.

Cavities won't form under veneers as long as they are proper placed and bonded, and that bond stays intact. Proper brushing and flossing is needed to insure that decay doesn't form elsewhere on the teeth.

You might call your previous dentist and explain your current situation (you seem to suggest your veneer is still off and that needs to be remedied). See what they have to say and ask about costs for recementation if possible (they might be sympathetic to your cause since they placed the veneer). If they're not interested in taking any responsibility, take the hint.


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