Resolving severe tooth crowding via the use of orthodontic treatment.

With some of the virtual smile makeover submissions we receive, it's rather obvious that they would be best treated orthodontically. This case is an example of that.

Issues and concerns:

In this makeover's "before" picture, the misalignment of the teeth is easy enough to notice. But beyond that, at least to the degree that this photo reveals, that really seems to be the only major issue at hand. For example:

We notice no obvious signs of tooth decay, or even existing fillings.

There is some tartar build up on some of the teeth (the brown staining). But for the most part it seems to be just in areas that must be difficult to clean (due to the misalignment of the teeth). It looks like the type of debris that a routine dental cleaning could remove.

There are some areas (especially around the lower teeth) where the gum tissue looks slightly reddened and puffy. But we'd expect that this is (reversible) gingivitis, as opposed to a more advanced gum issue. A routine dental cleaning, followed with greater diligence when performing daily oral home care, should be able to remedy this situation.

Other issues.

Besides their misalignment, the only other noticeable shortcoming of these teeth is the way the biting edges of some of them look humped (or notched).

Using the prominent lower front tooth as an example, this look is due to the fact that its front side is composed of three side-by-side sections that have fused together during its development.

Actually, this appearance this the way that most front teeth look when they first come in. The difference is that in normal cases the humps (mamelons) soon wear down straight across as the tooth is used. With this case however, since the tooth doesn't have an opposing one it bites against, the humps remain.

This person's front teeth display severe crowding.
After orthodontic treatment.

Photo submitted by website visitor.

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Treatment solutions:

Since there are so many positives about this person's teeth, the right choice is to straighten them as opposed to trying to make changes via other types of dental work (crowns, veneers, etc...).

In decades past when conventional "metal" braces were the only option, it was understandable that someone might be hesitant to have orthodontic treatment. Nowadays, with so many options to choose from, having braces can be much less noticeable and less inconvenient.

Additional treatment notes.

Straightening the biting edges.

Once the teeth have been realigned, their biting edges can be buffed down so they have a straight-across look.

Tooth stripping.

With any orthodontic case that involves tooth crowding, the treating dentist only has two options:

  • They must either reduce the width of the teeth so they can realign them in the space that currently exists.
  • Or else they must make enough space (either by realigning the back teeth or extracting selected ones) so that there's more room into which the (original-sized) teeth can be realigned.

Simulating the realignment of back teeth is really beyond the scope of what we're capable of illustrating in our makeovers, so we've chosen to apply the approach where the front teeth are narrowed slightly and then straightened.

This is a common orthodontic technique. It's termed interproximal reduction or tooth "stripping" and we explain it here. If using it results in a look that this person finds objectionable, they should discuss this matter with their dentist before their orthodontic treatment is begun so other plans can be made.

The final results.

As a criticism of our work (and simply due to a lack of artistic ability), in this makeover's "after" picture the teeth still have a somewhat "bucked" (tilted forward) look.

We'd expect that in real life a more normal appearance could be achieved. Once again, if this issue is an important one to this person, this matter should be discussed with their orthodontist before their treatment is begun.

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