Straightening teeth with crowns vs. orthodontic treatment.
Here’s a case submitted for a digital smile makeover where the treating dentist seems to have two possible approaches to choose from. They might –
Instead, place dental crowns that give the appearance of improved tooth alignment.
Between these two, it’s the crowning approach that poses more outcome limitations. So for that reason, that’s the one we’ve chosen to illustrate in our “after” picture. That’s because if this person discovers that this approach can’t deliver the look they want, it will be obvious to them that having orthodontic treatment makes the right choice.
Case issues and concerns:
Actually, there are two fundamental issues at hand here. They are:
a) Tooth alignment.
One can only assume from this person’s before picture that it’s the misalignment of their upper teeth that must be their chief complaint. And to a lesser extent, their lower teeth have alignment issues too.
b) Tooth shape.
The other issue at hand is one of tooth shape. The biting edges of the upper center teeth show developmental notches. Also, there would be some question if the upper lateral incisors have a normal shape and appearance.
“Before” photo submitted by website visitor.
In terms of aesthetic outcome, a big issue with the choice between using braces or crown placement as a way of improving the alignment of teeth has to do with what the latter can’t accomplish.
When a crown is made for a tooth, the dentist has the ability to extensively change the tooth’s shape (and hence its apparent alignment). But what can’t be done is alter where the tooth exits the gum line.
You can see this deficiency in our “after” picture. The alignment of the center 4 upper incisors is reasonable enough. But they seem separate as their own unit of 4 teeth.
The eyeteeth (which should be grouped with them) don’t hold their expected prominence in the smile. So as stated previously, if this look isn’t acceptable to this person, then having orthodontic treatment is the only way to go.
Advantages of braces over crown placement.
There are other very good reasons to favor having orthodontic work as opposed to placing crowns. To maintain a perfect look, it’s expected that crown replacement would be needed at one or more points during this person’s lifetime. In comparison, the results of orthodontic work can last a lifetime, if the person wears their retainer as directed. Also, it’s generally easier for a person to clean their teeth and maintain good oral health with natural teeth as opposed to those sporting restorations.
There’s also the issue of how much the teeth will need to be trimmed for the crowns. Especially in the case of the lateral incisors, the teeth may be inclined enough that so much tooth trimming will be required that it’s likely to expose their nerve space. If so, root canal treatment will be needed.
Problems associated with using an orthodontic approach with this case.
At the top of this page we mentioned the tooth shape issue that exist. So even after realigning the teeth, other dental work will still be required.
It might be possible that just placing tooth bonding (a relatively inexpensive and simple procedure) can make the needed corrections. But if not, porcelain veneers or crowns would be needed (each has about the same overall cost).
If so, that means not only will using an orthodontic approach take longer than just placing crowns, it will wind up being substantially more expensive.
All and all, there are no simple solutions for this case. This person will simply have to weigh all of these considerations with their dentist and determine which seems to make the best plan.