Retreating a tooth-gap case.
Here’s a case where a person has had a gap between their two center teeth closed (dentists call these spaces a diastema) but they don’t like the way things came out. They feel that the dental crowns that have been placed make their teeth look oversized.
We see what they’re referring to. Unfortunately, this is not an uncommon outcome.
We’ve created digital makeovers for a number of cases that involve relatively large tooth gaps. And with each one, the increase in width of the teeth is always an issue on our mind. In fact, with this case we felt things looked best if the person’s diastema was not fully closed.
Case issues and concerns:
Here are some of the issues we noticed with this case.
The center upper teeth.
As stated initially, the crowns used to close this person’s tooth gap tend to make these teeth look bulky and oversized.
They’re also somewhat square in shape, which tends to give this feminine smile a more masculine look.
The other teeth.
This person mentioned that they had had a porcelain veneer placed on their upper left eyetooth, which has since come off.
The overall alignment and look of the lower front teeth is irregular.
“Before” photo submitted by website visitor.
This person’s submission email mentioned that they thought it might take having orthodontic treatment to get their smile to look the way they want it to. We agree. Here’s why.
When a dentist places a crown, they have a great deal of control over the tooth’s overall shape. But what can’t be altered is the position where the tooth comes out of the gum line.
That’s the problem here. The dentist that placed the existing work was hampered by the positioning of the two center teeth.
Each one is so far off to the side that the crowns have to have a wide, square shape. Because each crown has to extend from where its root comes out of the gum line all of the way over to the center of the mouth (so to close the gap).
A treatment approach:
1) The upper teeth.
Step #1 – Orthodontic treatment.
In our “after” picture, we’ve illustrated the upper central incisors as being slightly smaller and the lateral incisors slightly larger than they were to start. Orthodontic treatment needs to be performed keeping this final arrangement in mind.
As compared to full-mouth cases, realigning 4 incisors should be a relatively quick affair. The dentist will simply trim away some of the porcelain from the center two crowns (right where they meet), thus making enough empty space that the realignment of the teeth is possible.
By the time the orthodontic work has been completed, between trimming on the crowns and repositioning the teeth, the end result will be one where there are visible gaps between the upper front teeth. But this is just a temporary state.
Step #2 – Place new crowns.
Once the teeth have the ideal positioning, it’s a simple matter to place new crowns that make the type of size and shape changes we’ve illustrated in our “after” picture.
Step #3 – Replace the missing veneer.
At the same time, a new porcelain veneer can be made for the upper left eyetooth.
2) The bottom teeth.
We’ve illustrated how a combination of tooth bonding and dental crowns might be used to improve the appearance of the lower front teeth. While not perfect, the results are reasonable.
As an alternative, this person could choose to make changes (and get a more perfect result) via the use of orthodontic treatment.