Using dental crowns to both repair and straighten teeth.

The upper teeth in this digital smile makeover provide an opportunity to illustrate how dental crowns can be used to make repairs for teeth and simultaneously straighten their alignment.

The lower arch provides an example of how the replacement of missing back teeth can help to complete the look of a makeover.

Case issues and concerns:

Here are some of the points we notice when looking at this case's "before" picture.

  • The upper left central incisor has an area of darkness where it overlaps its neighbor. This is probably tooth decay.
  • Most of the upper right central incisor has a similar dark coloration. This might be a sign of extensive decay and/or an indication that the tooth is in need of, or has had, root canal treatment.
  • Tooth alignment - The upper center teeth are crooked. The lower left eyetooth is in crossbite.
  • On both sides, in back, there appear to be some teeth missing.
  • Crooked teeth that also show signs of tooth decay.
    Crooked teeth that also show signs of tooth decay. Crooked teeth that also show signs of tooth decay.
  • After dental crown and veneer placement on the upper teeth.
    After dental crown and veneer placement on the upper teeth. After dental crown and veneer placement on the upper teeth.
 

Photo submitted by website visitor.

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Treatment solutions:

1) The upper teeth.

Our "after" picture shows how placing dental crowns on just 3 upper teeth could go a long way toward resolving a lot of this smile's problems.

We've also illustrated how making minor shape and color changes for two other upper teeth (the left lateral incisor and eyetooth) helps to complete the makeover.

a) Dental crowns.

Crown placement makes the best choice for the upper right teeth due to the fact that they require substantial repair and/or shape changes.

Crowns are routinely used to rebuild and strengthen teeth that have had extensive decay, as well as those that have had root canal treatment.

In regard to making alignment changes, if each crown is made slightly narrower than the tooth was before, the dentist can create the illusion of having straightened these teeth.

b) Porcelain veneers.

Veneers would probably make the best choice for making changes with the upper left teeth. They can provide the same type of appearance change as a crown, but their placement involves much less tooth trimming.

An even more conservative approach might be to make the color and shape changes needed for the lateral incisor by placing dental bonding. And then using teeth whitening treatments to make the color change needed for the eyetooth.

2) The lower eyetooth.

The biggest obstacle on the lower arch is the lower left eyetooth that's in crossbite. In this position, it detracts significantly from the smile. And with some techniques, it makes replacing the missing back teeth somewhat more difficult.

a) Orthodontic treatment.

Our "after" picture illustrates how orthodontic treatment might be used to move this tooth to its normal position.

In terms of cost, time needed and even method used, there's a big difference between full-mouth orthodontic treatment and moving a single tooth. So, possibly repositioning this tooth can be included in this person's treatment plan.

If not, making alignment changes for this same tooth by way of placing a dental crown might be a possibility. However, this would be a lesser choice, and doing so would not give as nice of a look as we show in our "after" picture.

3) Replacing missing lower teeth.

We've illustrated how replacing the missing back teeth also helps to complete the transformation of this smile. Placement of dental implants, dental bridges or even just a partial denture might each be considered.

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Input from site visitors.

Long tooth.

The left center tooth still looks longer than the right one. Can this be corrected? I have this same problem.

Yes and no.

Amy,
Dental crowns and veneers can't be used to adjust the position where the tooth comes out of the gum line. But gum surgery can be performed to make such an adjustment.

The common approach is for the gum line of the shorter-looking tooth to be repositioned further up, so the crowned portion of this tooth is longer and therefore matches the look of its neighbor.

Crowns or Veneers

Hello,

I just had 2 consultations here in Philly today. I clench my teeth and the front four are worn and thin after 10 years of this. They also affect my speech since they are a bit sensitive at times. One dentist suggested 8 Lumineers across the top row of teeth but later after e-mailing questions I was informed that they are wrap around veneers "essentially crowns" she said.

The second dentist recommended 4 crowns on the top front teeth but said my teeth won't be ground down to a nub. I'm leaning toward the crowns even though there's a lot of tooth sacrifice regardless of what he said because I'll still continue to clench my teeth and the crowns seem more likely to address functionality rather than appearance. Would you share your thoughts please?

Thank you,

Deb

Deb

Hopefully the following will help you formulate more questions for your dentists.

We're not entirely sure that what the two are offering are complete opposites, at least for the 4 teeth that evidently have the most wear.

One dentist says they're placing veneers that wrap around the teeth so they're almost full crowns. (But for all 8 teeth rather than just the 4 the other dentist plans to treat? If the other dentist thinks they can treat your situation by working on just 4 teeth, why do an additional 4 require veneering?)

The other dentist says they are placing crowns but not grinding the teeth down as fully as what might normally be expected.

Generally speaking we'd lean toward the crowns but are the planned ones all-ceramic ones? (They must be if the tooth will be ground down less and usual.) If so, not all types of all-ceramics are as strong as others. The ceramic used to create Lumineers (Cerinate) is known for it's strength (a positive for the Lumineer "crowns"), as are some but not all types of porcelains used to make all-ceramic crowns.

Like you mention, your clenching habit won't cease just because your teeth have been rebuilt. And the effects of your future grinding will simply affect the weakest link that remains (possibly breaking your new restorations, result in wear or breakage of the opposing teeth, or result in a loosening effect of your teeth).

So whichever dentist acknowledges this and has a plan for helping you to mitigate the effects of your grinding (usually by way of wearing some type of appliance, at night or even during the day if needed) would seem to us to be the one who has a better grasp of what's needed to create a successful result.

Since you live in a large metropolitan area where no doubt some are available, we will mention a "fixed" prosthodontist is a type of dentist that specializes in just placing veneers, crowns and bridges. So if you think your case might be one that needs that level of expertise you might considering consulting with one.

Best of luck on this.


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