Transforming a smile with orthodontic treatment and porcelain veneers.

When this person submitted their picture for a makeover simulation, they mentioned that earlier in their life they had had orthodontic treatment but the results had since lapsed (due to not wearing their retainer).

They also mentioned that at some point their dentist had reshaped (buffed down using a dental drill) their upper teeth and they were unhappy with the resulting shape.

Case issues and concerns:

The lower teeth.

Clearly this person's lower teeth are no longer in perfect alignment. And as they stated, retainer wear could have prevented their relapse.

(This case is just testament to the fact that all orthodontic patient's need to understand that at least some level of retainer wear, possibly for the remainder of their life, is always a part of their treatment plan.)

What works against this person's situation is that their lower teeth show quite prominently.

That's not usually the case with most people. Usually only about 1/2, or likely less, of a person's lower teeth can be seen. Because here they show 100%, correcting this issue will be an important part of making an improvement.

The upper teeth.

There seem to be two issues at hand with the upper teeth. While less so than the lower ones, their alignment is no longer perfect either. The other issue is one of tooth shape.

  • This person mentioned that at some point a dentist had "sandpapered" the biting edges of their teeth off. That's not terribly uncommon. Dentists often use that technique to resolve minor issues quickly and easily. Of course, the trade off is that the teeth loose some of their characteristic shape, as well as some degree of length.
  • Another issue regarding shape is one of outline form. When you look closely at some of the upper teeth in the "before" picture you'll notice that their outline curves in in areas where you would instead expect them to be more rounded. Overall, this gives this smile a slightly less pleasing appearance.
 
  • This case displays worn upper teeth and crowded lower ones.
    This case displays worn upper teeth and crowded lower ones. This case displays worn upper teeth and crowded lower ones.
  • After veneer placement and orthodontic treatment.
    After veneer placement and orthodontic treatment. After veneer placement and orthodontic treatment.
 

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Treatment solutions:

Our "after" picture simulates how this smile might look after performing orthodontic treatment and then placing porcelain veneers on the upper teeth. The specifics about the treatment plan would need to be determined by the treating dentist but here are some issues they would need to address.

Performing orthodontic treatment.

Clearly the most detracting aspect of this person's smile is the misalignment of their lower teeth. And there is no "cosmetic" procedure (bonding, veneers or crown placement) that could suitably make the type of transformation needed here other than having orthodontic treatment. (This person might have several options as to the specific method used.)

Also, if the lower teeth will be treated, there's no reason not to go ahead and perfect the alignment of the upper teeth at the same time too. And yes, whatever alignment changes are made will need to be protected over the long-term via some type of retainer wear.

Issues with our makeover simulation.

We should point out some issues with our simulation that in real life can likely be overcome. The most obvious is that the midline of the lower teeth doesn't match the upper ones. The other is the apparent height discrepancy between the lower front and back teeth. These are simply issues that the patient and dentist must discuss.

Placing veneers.

Once the alignment of the upper teeth has been perfected, porcelain veneers can be placed so to restore and improve their shape.

Actually, our "after" picture illustrates the type of outcome we think could be achieved without straightening these teeth first. But veneers typically give the best, most predictable, service and results when just used to make relatively minor alignment improvements. So straightening them first does make the best plan.

Issues with our makeover simulation.

In the "before" picture, this person's upper front teeth have a generally triangular shape. In our "after" picture we've made their outline more square. This person will simply need to discuss this issue with their dentist.

One reason we chose the shape we did was to help hide the space that's formed between the center two teeth. It seems the gum level in this area is lower than between other ones. And in some cases this type of void ("black triangle") can be a somewhat difficult issue to hide or correct. However, between performing orthodontic work and placing veneers, it should be one that the treating dentist for this case can overcome.

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