Why some teeth with dental crowns just don't look right.

When you first look at this smile you might not notice much of a problem. But the issue we've decided to address with this digital makeover is the upper right eyetooth, and how it looks too big and long.

Actually, this case is a continuation of a previous makeover we created (that case's "after" picture is this case's "before" photo.).

Case issues and concerns:

As you can see in the "before" picture, our first attempt at making an improvement with this smile did a pretty good job. But it just bothered us that it was so close to perfect, with the exception that there was no way to get the eyetooth to look better than we did.

The whole problem stems from the fact that this tooth is simply malpositioned. And even though you can change a tooth's angulation and shape, even significantly so, by placing a dental crown on it, there's no way to make improvements with its positioning.

A tooth's position is what it is. And in some cases, like this one, just crown placement will never be able to make the tooth look perfect in its smile.

  • The upper right eyetooth looks too long.
    The upper right eyetooth looks too long. The upper right eyetooth looks too long.
  • After orthodontice treatment.
    After orthodontice treatment. After orthodontice treatment.
 

Photo submitted by website visitor.

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Treatment solutions:

Of course, the solution here is to move the eyetooth using some type of orthodontic treatment. The method chosen would simply depend on what the goals of the treatment were.

Approach #1:

If you'll go back and look at the initial conditions of this case, you can see that many of the teeth that received treatment were crowned or veneered simply to improve their apparent alignment.

So, one approach would be to use orthodontic treatment to perfect the alignment of all of this smile's teeth (including our problematic eyetooth). If that were done, several of the teeth that received a crown or veneer in our initial makeover would have needed no treatment at all. That's a very positive thing.

Complications and considerations.

There are some issues associated with this plan:

  • The tooth that needs to be extracted can't be permanently replaced until after the orthodontic treatment has been completed. That means some type of temporary tooth would have to be rigged up. That's certainly not impossible but is a nuisance.
  • Full-mouth orthodontic treatment would probably require 1 to 2 years of treatment.
  • Treatment methods: Traditional braces or possibly Invisalign®.

Approach #2:

The other choice would be just to use orthodontic treatment to reposition the malpositioned eyetooth.

  • The advantage would be a shorter treatment time, and probably some type of removable orthodontic appliance (including Invisalign®) could be used.
  • As a disadvantage, more teeth would need crowns and veneers to finish off the appearance of the case.

It's a trade off either way, and simply a situation where the dentist and patient need to discuss all issues and determine together what seems to be the best choice. Which do you think that would be?

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