"Straightening" teeth and building up "pegged" lateral incisors using dental crowns.

Like so many of the cases we create digital makeovers for, this one might be treated in more than one way.

One approach could involve the use of orthodontic treatment and the subsequent placement of a few dental crowns (or possibly veneers for some teeth).

Another method would be to simply make a go of the person's current tooth alignment and see how much improvement could be made for their smile just by placing crowns and/or veneers.

Our result.

Choosing between the two wasn't much of a choice for us. Simulating the results of full orthodontic treatment is a bit beyond the scope of our photo-editing talents. So, we've illustrated just the latter approach but explain and discuss both below.

Case issues and concerns:

Here's a listing of some of the issues we notice with this smile.

Obviously, their teeth have some alignment issues, both on top and bottom.

They have what are termed "pegged" lateral incisors. That simply refers to the fact that the size of these permanent teeth is smaller than expected. This condition is more noticeable with the upper left tooth.

Together, the small size and misalignment of these teeth compounds this smile's irregular appearance.

From what we can tell from this photo, the general condition of this person's mouth seems good. There are no obvious signs of decay (or even existing dental restorations). The gums appear to be healthy.

This person has what is called an "open" bite. When her back teeth come together, her front ones still don't touch.

General misalignment. "Peg" lateral incisors.
After dental crown placement.

Photo submitted by website visitor.

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Treatment solutions:

Treatment Approach #1:

As stated above, our "after" picture shows what this smile might look like if it were made over by only placing dental crowns and/or porcelain veneers.

The new restorations would be used to both improve the apparent alignment of the teeth, and idealize their shape so there are no spaces between them.

Dental crowns vs. veneers.

The fact that this person has an open bite (their front teeth don't touch) suggests that great restoration strength isn't needed. If not, then porcelain veneers might make an appropriate choice.

On the other hand, for teeth that require a lot of trimming (so their new restorations can bring them back into alignment), dental crowns would be needed.

The pegged laterals.

One issue that might complicate this treatment plan is the current positioning of the upper lateral incisors.

Due to the way they flare out, they may need to be trimmed significantly. Or, their current positioning might make it impossible to place a restoration on them that has an appropriate shape right at the gum line.

If this is the case, then some type of minor orthodontic treatment could be performed for them, so to give them an ideal positioning.

Of course, with all of these issues, only the treating dentist can decide.

Treatment Approach #2:

The biggest problem with the approach above is that even with the improved appearance; due to their open bite this person still won't have any function with their front teeth.

As an alternative treatment plan, this person might consider having full orthodontic treatment. Here's why this makes sense.

  • It would give them full function of all of their teeth.
  • Once the lower teeth had been straighten they wouldn't need any type of restorations placed on them at all.
  • For the upper teeth, the pegged laterals would need dental crowns. But the central incisors, once straightened, might possibly look just fine.

From a standpoint of cost (using our dental-costs page and a relative comparison between the two treatment plans) we estimate that the expense for either method might be fairly similar.

As an advantage, with the exception of needing to wear orthodontic retainers, approach #2 would require less long-term maintenance and replacement work over the remainder of this person's life.

The biggest downside to approach #2 would be the time involved. You would have to expect that performing the orthodontic treatment would take on the order of two years.

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