Using crowns and veneers to adjust the comparative lengths of front teeth.

This digital smile makeover provides an example of how dental crowns (or possibly even porcelain veneers) might be used to improve the look of a smile by changing the relative length and size of its teeth to a pattern that's more usual.

Case issues and concerns:

This person's chief complaint has to do with the look of their upper front teeth.

  • Their central incisors are very short. With most smiles, the centrals have a similar length as the eyeteeth (canines).

    These teeth also seem slightly undersized when compared to their neighboring lateral incisors.

  • Besides being comparatively large, the lateral incisors are much longer than one would expect.
  • The eyeteeth seem longer than expected too.

Additional considerations.

Beyond the issues above, this person mentioned in their email that they had recently completed periodontal (gum disease) treatment.

That condition had caused gum line recession in the area of the upper central incisors. (In our makeover pictures, you can just barely see a hint of this (a space) between the right lateral and central incisors.)

Fortunately, this person has a low lip line (even when they smile their lip covers over part of their teeth) that helps to hide the gum line changes that have occurred.

At this point in time, we would have to assume that this person is generally in good dental health and receives appropriate dental supervision. They mentioned that they see their periodontist (gum specialist) for cleanings on a 3-month basis.

 
  • The center teeth are too short, the ones to the side too long.
    The center teeth are too short, the ones to the side too long. The center teeth are too short, the ones to the side too long.
  • After dental crown placement.
    After dental crown placement. After dental crown placement.
 

Photo submitted by website visitor.

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Treatment solutions:

Our "after" picture illustrates how this smile could be improved by placing some combination of dental crowns and porcelain veneers on the 6 center upper teeth.

The dentist treating this case is the one who will determine which type of restoration makes the appropriate choice for which teeth. For the purposes of our makeover simulation, however, this issue is a moot point since both types of restorations will give the same cosmetic end result.

Related: What is the difference between veneers and crowns?

Placing the restorations:

For the most part, we'd expect that the dental work needed to complete this case would be fairly routine, at least for the 4 teeth on the right side. That's because the amount of change we've illustrated for them is relatively minor.

Root canal treatment may be needed for some teeth.

In comparison, the length changes we've shown for the two teeth on the upper left (the lateral incisor and canine) are fairly substantial.

Making this much of a transformation will involve trimming away a significant amount of tooth structure. And in some cases, possibly these, the amount that must be removed will result in the exposure of the tooth's nerve.

If the treating dentist thinks that this is likely, root canal treatment will need to be performed for these teeth first.

Periodontal concerns.

An added area of concern with this case is that this person has a history of having periodontal problems (gum disease).

In the case of placing crowns and/or veneers:

  • The edge of each restoration will end right at the gum line, and this edge can be difficult to keep clean.
  • If adequate oral home care is not maintained, the dental plaque that accumulates at this edge will cause further periodontal problems (including more gum-line recession).
  • As this recession occurs, the edge of the crowns and veneers will become visible, thus spoiling their appearance.

This is only a potential complication and not a reason not to proceed with making the changes discussed above. And, in fact:

  • This person's comparatively low lip line will help to mask any changes that might occur.
  • Placing all-ceramic dental crowns will help to minimize the degree to which this complication (if it occurs) is noticeable.

But this person does need to keep in mind that the longevity of the cosmetic improvement achieved will be affected by their ability and motivation to maintain good oral home care.

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