Making teeth look straighter by placing crowns and veneers.

This digital smile makeover illustrates how dentists can create the illusion of straightening the alignment of teeth by way of placing dental crowns.

As an advantage over orthodontic treatment, this type of approach can provide comparatively "instant" results (although the actual time frame, start to finish, may involve 2 weeks or so).

As a disadvantage, otherwise healthy teeth will be trimmed and receive restorations, as well as the burden and potential complications that come with placing them. Additionally, complete transformations, even when compared to braces, can become quite pricey.

Case issues and concerns:

  • This type of approach can provide comparatively "instant" results (although the actual time frame, start to finish, may involve 2 weeks or so).
  • This person's upper teeth are crowded, to the point that the center two teeth are overlapped.
  • The biting edges of the center teeth have chipped.
  • The lower teeth display tooth crowding.
  • Overlapped central incisors teeth.
    Overlapped central incisors teeth. Overlapped central incisors teeth.
  • After crowning the center two teeth.
    After crowning the center two teeth. After crowning the center two teeth.
 

Photo submitted by website visitor.

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Treatment solutions:

1) The "ideal treatment" plan. -

We don't think that 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) A "cosmetic dentistry" approach - Straightening the teeth with dental crowns. -

Our "after" simulation shows the types of difficulties that are often encountered if placing crowns (or veneers) 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 crowns or veneers would be very difficult, if not impossible (the degree tooth crowding creates an obstacle, as well as the irregularity of the relative root positioning of these teeth). 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:

  • 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 minimal ability to change the current gum level on the teeth, with out the use of an additional surgical procedure (see below).
  • No really significant improvement can be made with the lower teeth.

d) 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.)

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