Using dental crowns to repair the damage caused by bruxism.

This digital smile makeover provides an example of teeth that have worn, primarily due to bruxism (tooth clenching and grinding).

In our "after" picture, we show how a repair might be made by placing dental crowns. But, as we explain below, the long-term success of this, or any other treatment approach, can only be guaranteed if factors associated with this person's bruxing activities are brought under control.

Case issues and concerns:

When looking at this case's "before" picture, we notice the following points:

The upper teeth have worn, fairly significantly. (The angle at which they've worn and the chipping of their biting edges is consistent with wear caused by tooth grinding.

The lower front teeth have an irregular alignment. The center two in particular are positioned too far forward.)

The alignment of the upper center teeth appears crooked. Although, that may be an illusion created by the fact that these teeth have worn to different lengths.

One of this person's lower left bicuspids appears darker than its neighbors. This may be due to the presence of a large metal filling.

Other than that issue, the coloration of this person's teeth seems quite pleasant.

The upper front teeth have been worn by the lower ones.
After dental crown placement on the upper teeth.

Photo submitted by website visitor.

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Treatment solutions:

The source of the problem.

This person's sent in several pictures of her teeth, one of which shows how she can hold her jaw in a position where its center teeth rub directly against her upper ones.

Doing so is what has caused her tooth wear. She probably holds her jaw like this subconsciously (quite possibly in response to stress) or else while she sleeps.

Placing dental restorations.

If the bruxing activity wasn't an issue, the types of changes we've illustrated for the upper teeth would just boil down to some very basic dentistry.

For example, placing crowns, veneers or possibly even dental bonding on the most-worn upper teeth could generally create the look we've shown. (Although each type of restoration would still have its own specific advantages and disadvantages.)

The dilemma.

The difficulty is, if this person continues to clench and/or grind, damage to their teeth will continue.

The forces of the bruxism might break any new restorations placed. Or, and especially in the case of crowns, the new restorations might cause her lower teeth to wear at a faster rate.

Controlling the bruxism.

It's possible for a person to consciously control their bruxing but, of course, that's only a solution during waking hours.

If protection during sleep is needed, a night guard would need to be worn. A person with a serious problem might even wear their night guard some during the day too.

Completing this case.

Here's what we've tried to illustrate with this makeover.

Placement of crowns.

We've tried to illustrate how dental crowns might be used change the appearance of 3 of the upper teeth. (The extent of the length changes that are possible would be dictated by issues associated with this person's "bite.")

Orthodontic treatment.

We've also shown how minor orthodontic treatment might be used to improve the appearance of the lower front teeth and resolve some of the "bite" issues they create.

As an example of what might be done, dentists sometimes trim selected teeth so they can be realigned more perfectly in the same amount of space. Here's a graphic that illustrates this technique.

Side note:

A person's malocclusion can be a contributing factor in why they grind their teeth. For that reason, this person's dentist might feel that more extensive orthodontic treatment could be beneficial for this person.

The lower left.

We've lightened the color of the dark tooth on the lower left in our "after" image. This might be accomplished by placing some type of "bonded" restoration (white filling). Or for strength reasons, a dental crown might be required.

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