Creating the illusion of straighter, more perfect teeth using dental crowns.

With a lot of the makeover submissions we receive, it's readily apparent to us that the person's case would be best treated orthodontically. That's because the teeth themselves already have a nice appearance, it's just their current alignment that's the problem. (Our previous virtual makeover is an example of that type of case).

The approach we've taken with this case.

With this submission, while it's obvious that the irregularity of the teeth detracts from the smile, there's another difficulty too. Due to their misalignment, tooth wear has taken place. (For example, you can see that the outline shape of the center two upper teeth are no longer mirror images of each other.)

Because this change has already taken place, that means that after performing orthodontic treatment (braces of some kind), further dental work would still be required. At least two dental crowns (or porcelain veneers) would be needed to improve the appearance of the misshapen center incisors.

So, as an alternative to that approach, we decided to illustrate the type of changes that might be possible by just placing selected dental crowns. Using them as a way to both repair and improve the apparent alignment of the teeth.

The results.

As you can see in our "after" picture, the final outcome of this approach isn't as perfect as a more extensive one utilizing orthodontic treatment first and then placing restorations. But from a stand point of cost and treatment time involved, this approach offers advantages.

Case issues and concerns:

  • Generalized tooth crowding - On both the upper and lower arches.
  • Tooth wear - While you can see some beveling on the lower front teeth, most of the wear has taken place on the center upper ones.
  • There's a "pattern" that's obvious in the upper right central incisor. This might some sort of developmental defect in the enamel, due to tooth wear or a previous repair, or even just an artifact in the picture. We requested information about it from this person but received no reply.
 
  • This case displays severe crowding and worn front teeth.
    This case displays severe crowding and worn front teeth. This case displays severe crowding and worn front teeth.
  • After the placement of dental crowns.
    After the placement of dental crowns. After the placement of dental crowns.
 

Photo submitted by website visitor.

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Treatment solutions:

1) The upper teeth.

Our "after" picture illustrates the type of changes that placing 3 dental crowns and dental bonding (in just one area on the upper left eyetooth) could make for the upper teeth of this smile.

As we mentioned above, even if utilizing an orthodontic approach there would still be a need to place restorations (crowns or veneers) on the deteriorated 2 upper central incisors.

So we're suggesting that rather than going to the trouble of actually straightening the teeth, the illusion of having done so could be had at the additional expense of placing just 1 crown and some dental bonding.

There are trade-offs with using this treatment method.

While the end result isn't perfect, it's certainly an improvement over what this person started with (both the general alignment of their upper teeth and left-right symmetry is greatly improved). The advantage of accepting this trade-off would be that much less treatment time and possibly less expense would be needed to complete the case.

Issues we must mention.

a) When showing and discussing this simulation with their dentist, they might take issue with the degree of position change we've shown for the upper right lateral incisor. To get that look using a crown, the dentist might feel that the tooth would need to be moved forward (orthodontically) first.

Even so, doing so would require just a few weeks of wearing a removable appliance verses the 1 to 2 years needed for full-mouth braces treatment.

b) One primary deficiency with the way our "after" picture looks is how the gum line on the upper incisors is not at the same level all of the way across. We plan to discuss and illustrate a solution for this issue as its own makeover case in the future. (The case has been completed.)

2) The lower teeth.

People are often more concerned about the appearance of their upper teeth than their lower ones (primarily because they show more). But if this person was so inclined, the apparent alignment of their lower teeth could be improved by placing crowns on them too (placing 3, or possibly even just 2, should be able to give the look we've illustrated in our "after" picture).

Of course, orthodontic treatment could be used instead to realign these teeth. Only this person and their dentist can make a determination about which approach makes the best choice.

3) Other treatment options exist.

Just because we've illustrated this makeover the way we have doesn't mean that doing so makes a better choice than having full-mouth orthodontic treatment and then placing restorations. It just represents one option that this person and their dentist have to choose from.

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