A makeover case where orthodontic treatment is needed.

There are some instances where wearing braces seems to make a better treatment choice than some other alternative, such as placing tooth bonding, crowns or veneers.

Then there are other cases, like this one, where making use of orthodontic treatment really seems the only way to go.

With this case, the only other option that could create the same "after" appearance would be to extract the offending teeth and replace them with artificial ones. As discussed below, that really doesn't make for an ideal solution.

Case issues and concerns:

Two of this person's upper teeth (their lateral incisors) have failed to come into normal position. From just a picture and at this stage however, it's not really possible to provide an explanation of why.

In some cases, the force of a person's upper lip against crooked teeth like these might ultimately have an effect where it helps to drive them more so into place. But if the space available is narrower than the teeth themselves, then only limited improvement can be expected.

The extreme orientation of the lateral incisors might be caused by the presence of extra (supernumery) teeth that lie impacted (still buried in the jawbone) across their roots. A dentist's x-ray examination is needed to rule out this possible complication.

Some of the upper teeth have staining, ranging from white to brown.

This person's lateral incisors are severely misaligned.
Orthodontic treatment has created the perfect smile.

Photo submitted by website visitor.

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Treatment solutions:

A) This case is best treated as an orthodontic one.

Without question, full orthodontic treatment (perfecting the alignment of all of the teeth) would be the best way to resolve this case.

(Related content: Types of dental braces.)

Nothing in the "before" picture suggests that this person has any major dental problems. (Of course a thorough examination would be needed to confirm this.) So, why not just realign the teeth? Case closed.

a) Full treatment considerations:

  • The amount of time needed for full treatment would probably run on the order of 1 to 2 years.
  • In the "before" photo, it's hard to tell if the upper teeth could be trimmed and buffed to give them the same shape as we've simulated in the "after" picture. If they can't be, and it's a big issue, then porcelain veneer placement would have to be considered once the orthodontic treatment has been completed.

b) Partial treatment.

Instead of "full" treatment, orthodontic work might be used to just realign this person's upper front teeth. If this approach is possible, it's not a better choice, it's a compromise.

  • Less treatment time would be needed.
  • The dentist would need to trim the width several of the upper teeth, so to make the space needed to realign them. (This animation gives an example.)
  • If much tooth trimming is needed, porcelain veneer or even dental crown placement might be required to create the desired end look. One would have to expect that at some point during their lifetime (and possibly several) this work will require repair and eventually need to be replaced.

c) Inaccuracies in our makeover simulation.

In our "after" picture, we've illustrated the repositioned lateral incisors as being narrower than they possibly would be in real life. That's due to the nature of a digital makeover where teeth are simply retouched within the confines of an image.

Full orthodontic treatment could be used to create as much width as is needed to accommodate the full size of the lateral incisors. So, in that case, they would be larger than we've illustrated. If partial treatment is used, then the laterals would likely need to be trimmed and probably would have the save width as we've shown.

B) An alternative treatment approach.

Without straightening the teeth, the only other way that could be used to achieve the look we've illustrated in our "after" picture would be to extract the malpositioned teeth and replace them via the use of tooth implants, dental bridges or else a partial denture. (A plan similar to this case.)

The amount of treatment time needed for this approach would be less than that needed for an orthodontic one. Other than that, we see no upside to this treatment plan at all. In brief, this approach results in the loss of otherwise healthy teeth and replaces them with dental work that will require maintenance, eventual replacement and special care over the course of this person's lifetime.

Tooth Color

If an orthodontic approach is chosen, and no restorations are needed to complete the case, then the coloration of this person's teeth might become an issue.

a) Grayness

The teeth show a fair amount of grayness. It's hard to know if this is their true color or simply the way they look in this picture.

It's common that very translucent teeth show grayness toward their biting edge. As a solution, any type of whitening process (like the use of whitening strips) tends to rob a tooth of some of its translucency. As a result, the tooth becomes both lighter and more uniform in color.

b) Brown stains.

Due to its location on the teeth, we're assuming that the brown tooth staining is caused by dental plaque and tartar build up. Having a routine dental cleaning should resolve this problem.

c) White discoloration.

The streak of white seen on the upper right central incisor is probably due to fluorosis. This issue is usually easily resolved by trimming away some of the stain and then covering it over with dental bonding.

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