Using dental crown placement to create the illusion of smile symmetry.

This digital smile makeover illustrates a case where some fairly basic dental crown placement could do wonders in making a transformation. There is, however, one giant awkwardness with this smile. One front tooth is missing.

Symmetry is an important issue.

When we look at a person's smile, we expect to see bilateral symmetry (meaning teeth of matching size and shape on both sides). If we don't, the smile just won't look right, although we might not immediately realize why.

With this case, the dentist's challenge is to create the impression of symmetry, without it really existing. (One of our previous makeovers provides a similar example.)

Case issues and concerns:

When we look at this case's "before" picture, we notice the following issues.

  • Overall, there is a general misalignment of the teeth, which is especially noticeable with the upper front ones.
  • This person's upper right lateral incisor is missing. (The especially angled tooth on the upper left should have a corresponding tooth on the other side. With this case, it's missing.)
  • Two lower teeth are missing, one on each side toward the back.
  • The upper left central incisor is very dark. That's often a sign that the tooth needs, or has had, root canal treatment. (This slideshow explains why the darkening occurs.)

We should state, dental neglect is not the issue here. The dark center tooth relates to childhood trauma. All missing teeth and misalignment issues are due to her having (genetically) missing permanent teeth.

  • A smile with darkened and misaligned teeth.
    A smile with darkened and misaligned teeth. A smile with darkened and misaligned teeth.
  • After dental crown placement.
    After dental crown placement. After dental crown placement.
 

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Treatment solutions:

Our "after" picture illustrates how the placement of just 4 dental crowns on the front upper teeth could make a significant improvement for this smile.

Creating the illusion of symmetry.

As mentioned above, the goal with this case is to create the illusion of bilateral symmetry even though one tooth is missing.

To accomplish this, our "after" picture shows making the single lateral incisor as long and bulky as possible. That way it looks more like an eyetooth, which is its "matching" tooth on the other side.

As a result, when you glance at this smile (which is all most people do when they look at us), everything seems uniform enough to look OK.

Issues that must be addressed before crown placement.

a) The central incisor.

The center dark tooth must be evaluated and treated if needed. Quite possibly it needs (or possibly has already had) root canal treatment.

For the purposes of this treatment plan, the fact that this tooth has had (or will have) root canal is perfect. That means that it can be trimmed at will, without having to be concerned about compromising its nerve.

b) The lateral incisor.

This case's other obstacle is the extreme angle at which the crooked lateral incisor juts out.

During crown placement, this tooth will need to be trimmed quite a bit in order to bring it back into line. So much so, in fact, that it's nerve may be damaged or exposed (This slideshow explains). If so, this tooth will need root canal treatment before its crown can be placed too.

As an alternative, minor orthodontic treatment (possibly using some type of removable appliance) might be use to tip this tooth to a more favorable angle. Then its crown could be placed without needing to trim the tooth excessively.

c) Additional work.

In the case that root canal treatment is required for either of the above teeth, post and core placement would probably be needed before the crowns could be made.

Replacing the missing bottom teeth.

The missing lower back teeth could be replaced using dental bridges, dental implants or a removable partial denture.

Tooth color.

We've illustrated a slight whitening effect for the upper teeth. A modest change like we've shown could probably be accomplished via an at-home method like whitening strips or the use of whitening trays.

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