Using dental crowns and veneers to realign and repair worn teeth.
Here’s a case where a smile has both tooth wear and alignment issues. The “after” portion of this digital makeover shows how it might be improved by placing a few dental crowns and porcelain veneers.
Case issues and concerns:
Because this person was kind enough to send in multiple pictures when they requested their digital makeover, we’ve been able to formulate the following impression about their dental situation.
They appear to have what’s termed a “deep overbite,” meaning that their upper and lower teeth overlap significantly when they’re closed all of the way together.
When this type of condition exists, it’s not uncommon to see a significant amount of tooth wear.
The biting edges of the upper central incisors have worn, most likely due to the way the lower teeth rub against their backside during jaw movements.
The upper left lateral incisor is more pointed in shape than might be expected.
This person’s upper right lateral incisor is out of alignment and looks small in comparison to its corresponding tooth on the other side.
While the picture we’ve chosen to edit hides this fact, there has been significant wear of some of the lower front teeth. (Once again, likely due to the deep overbite.)
“Before” photo submitted by website visitor.
Treatment solutions:
Approach #1: Making straightforward repairs and corrections.
In our makeover simulation, we’ve shown the type of cosmetic changes that pretty much any dentist should be able to make just by placing a few dental crowns and veneers.
While it’s always up to the treating dentist to decide, veneers are generally used to make relatively minor changes for a tooth while placing a dental crown makes larger alterations possible. (Here’s more information about when each type of restoration is usually placed.)
We would anticipate that with this case, both of the centrals and the left lateral incisor could be veneered. But the large alignment change shown for the right lateral incisor would probably be best made by placing a crown.
We’ve illustrated a minor change for the upper right eyetooth. Quite possibly that could be made just by placing some dental bonding (white filling material).
Gum Sculpting
A slightly improved cosmetic outcome could be gained by making changes with the gum line level on the short-looking right lateral incisor.
Using a minor surgical procedure (gum sculpting), the tissue could be trimmed back to a level that gives this tooth the same look (length) as the one on the left side.
Approach #2: Adding in orthodontic treatment.
In their email, this person mentioned that they might be open to the idea of having orthodontic work performed.
From the additional pictures that they submitted, it was possible for us to observe that there are issues at hand with this case that having braces of some type could certainly help to improve. For example, we’ve already mentioned that they have a deep overbite and that this condition often results in tooth wear.
It would provide for a better outcome.
With our makeover picture, all we’ve illustrated is how a cosmetic improvement might be made. The underlying condition that caused the wear (the overbite) still exists. The difficulties it causes have not been address and for this reason wear and tear will continue to occur.
Including orthodontic work (partial or complete) as part of the treatment plan would provide for a more comprehensive, probably longer lasting, solution.
After braces, would other work still be required?
There would be some question as to whether just orthodontic treatment is needed, after which the shape irregularities of the teeth could be corrected just by trimming and shaping them (we’re not entirely sure this is possible). Or whether some teeth will still need to be rebuilt (it seems likely that at least some will).
Making a decision.
Of course, this is where a consultation and examination by this person’s dentist comes into play.
If it’s determined that the latter case applies, including orthodontic work in the treatment plan means not just additional time but also additional expense (since some of the same work we’ve illustrated in our “after” photo will still need to be done anyway).
If this person is relatively young, or time and money are not much of a concern to them, then the benefits that including orthodontic work in the treatment plan provide would be a very positive thing. (This is the more “ideal” treatment approach.)
For relatively older patients, or those for whom time and finances are more of a concern, this might be an option that’s not chosen. Obviously, only the patient and their dentist can weigh the pros and cons and make this decision.