Tooth alignment that has relapsed after orthodontic treatment.
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"Straightening" teeth with porcelain veneers and dental crowns.

Treating a cosmetic case often boils down to choosing one of two basic methods. Should procedures such as crown and veneer placement be used to improve the appearance of the smile, or should orthodontic treatment (braces) be utilized instead?

The difficulty with the latter approach is that a retainer must be worn after treatment (possibly religiously). If not, the alignment of the teeth may relapse.

Actually, that's the situation with this case. At previous points in their life, this person had braces. Since then, their teeth have shifted.

Because this person has already experienced the orthodontic approach, we've decided to illustrate how crown/veneer/dental bonding placement might be used to mimic straightening their teeth.

And where it can't create perfection, show how it can at least tone down the irregularities that still exist so they're not so noticeable.

Case issues and concerns:

From a standpoint of appearance, this is what we notice when looking at this case.

  • The upper two center teeth (the central incisors) are slightly overlapped.
  • The teeth off to the sides (the lateral incisors, and somewhat the eyeteeth too) seem tilted in slightly (they are "lingually" inclined).
  • The midline of the lower incisors has shifted (it's off to the right).
  • The coloration of some of the lower incisors is very grey.
 

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  • Tooth alignment that has relapsed after orthodontic treatment.
    Tooth alignment that has relapsed after orthodontic treatment. Tooth alignment that has relapsed after orthodontic treatment.
  • After dental crown and porcelain veneer placement.
    After dental crown and porcelain veneer placement. After dental crown and porcelain veneer placement.
 

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Treatment solutions:

A) The upper teeth.

Our "after" picture illustrates how a combination of porcelain veneers (for the central incisors) and dental crowns (for the lateral incisors) might be used to improve the apparent alignment of the center upper teeth.

Note: When making these simulations, we're always at a disadvantage, in the sense that we don't know what the person's "bite" is really like. The way upper and lower teeth come together can certainly limit the degree to which a tooth's shape can be changed. With this case, this person's bite may limit the degree to which their lateral incisors can be brought forward. Only the treating dentist can make this determination

B) The lower teeth.

We've illustrate how placing porcelain veneers might be used to improve the shape, alignment and color uniformity of the dark lower incisors.

Dental crown placement would probably be needed to make the shape change we've shown for the remaining incisor. The lower left eyetooth's shape changes could likely be made just by placing dental bonding.

Notice how nothing about the true alignment of the lower teeth has been changed. But by creating a more homogenous color, shape and height for these teeth, their misalignment issues become much less noticeable.

Using an orthodontic approach:

In situations where a patient's teeth and gums are in good health (this "before" picture suggests that), and the patient is motivated (which would probably be the issue here), most dentists would probably argue that straightening teeth, rather than trimming them and placing restorations on them, makes the more "ideal" treatment plan (at least philosophically).

With this case, all of the cosmetic issues we've discussed could be resolved via orthodontic treatment with the exception of the color of the lower teeth.

Teeth whitening treatments might provide a solution. If not, then porcelain veneers would have to be placed after the orthodontic treatment had been completed.

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