A makeover case involving an anterior crossbite.

This digital makeover case involves a smile that would be very difficult to improve just by placing dental restorations. That's because the current positioning of the teeth is very asymmetric.

If you imagine how this smile would look with each of the upper teeth idealized in shape and the missing teeth replaced, it's easy to see that the replacement tooth on one side would need to be much larger than the tooth on the other side.

Due to that difficulty, the cosmetic issues of this makeover would be best addressed orthodontically (having braces).

Case issues and concerns:

Here are some of the things we noticed with this smile.

Tooth decay is present. This is a giant issue and the one we discuss first in our Treatment Solutions section.

There's generalized severe crowding of the teeth.

The upper lateral incisors are in crossbite. This term refers to the way they tuck behind their opposing lower teeth when this person closes.

(This situation is similar to a case we created a makeover for some years ago. With it, we described a treatment approach that didn't involve braces.)

There may be some missing back teeth (it's hard to tell from this photo).

Severe tooth crowding. Lateral incisors in crossbite.
After orthodontice treatment.

Photo submitted by website visitor.

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Treatment solutions:

a) Treating the active decay.

The absolute most important issue going on with this case is the presence of active tooth decay.

You can't really discuss taking a big step forward in making changes with a smile, until the most basic issues (like preventing cavities) are under control.

The "cosmetic" work (braces) needed with this case will involve substantial time, effort and cost. And during this treatment period performing routine oral home care will be even more difficult than it is now.

For all of these reasons, a foundation must be laid first. One where the active decay is repaired by way of placing fillings. And good home care habits are learned and practiced. Once this groundwork has been laid, the cosmetic portion on the treatment plan can be begun.

b) Having orthodontic treatment.

The next stage of this treatment plan would involve straightening the teeth using some type of dental braces.

This isn't a simple case. One would have to expect that the treatment time involved would be two years or so.

About our simulation.

In our "after" picture, we've done our best to illustrate a substantial improvement in the alignment of the teeth. But editing a picture has distinct limitations. For example, we've had to leave the lower midline (center point of the teeth) off to the right. After having braces, it wouldn't be.

c) Completing the makeover.

If this person has missing molars, they would be replaced at this point (after the completion of the orthodontic work). Dental bridges or implants might be placed.

An additional issue that might need to be addressed is the upper right central incisor.

In the "before" picture it looks chipped or worn. If it is, minor trimming may be able to give it a shape that's very similar to its corresponding tooth. If so, then case closed. If not, then a porcelain veneer, or possibly just some tooth bonding, could be placed on it so to give it the needed shape.

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