Improving the apparent alignment of teeth with dental crowns.

If a person wants to make an improvement with their misaligned teeth, they really only have two options.

  • They can either decide to have orthodontic treatment.
  • Or else have their dentist improve the apparent alignment of their teeth by placing dental restorations (usually crowns or porcelain veneers).

When the latter is chosen, there's frequently some type of aesthetic trade-off that must be made. And if so, it then becomes an issue of if just placing restorations can create an acceptable outcome.

So with this case, we decided to illustrate it as if just crowns were placed to make changes, and then point out the limitations that implementing this plan involves.

Then if this person doesn't like the type of results that seem to be possible, they'll know that choosing orthodontic treatment is the way to go.

Case issues and concerns:

  • No doubt this person's chief complaint is the alignment of their upper teeth.
  • The bottom teeth also have some alignment issues too, although due to the way they are covered over by the upper ones they're less noticeable.
  • This person's upper left lateral incisor seems to have a deteriorating white filling.
  • The biting edges of the center two teeth show wear and tear.
 
  • Crowded upper anterior teeth.
    Crowded of upper anterior teeth. Crowded upper anterior teeth.
  • Improving apparent tooth alignment by placing crowns.
    Improving apparent tooth alignment by placing crowns. Improving apparent tooth alignment by placing crowns.
 

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Treatment solutions:

In a world where time, money and inconvenience are not an issue, it would be easy enough to just recommend having orthodontic treatment to everyone (at least as an initial step). And in most cases (including this one) that would probably be considered to be "ideal" treatment.

The real world.

Many people just aren't interested in pursuing orthodontic treatment. And if not, then the only other way to make big changes with the alignment of teeth is via the placement of restorations.

In our "after" picture we've illustrated how this smile might look if dental crowns or porcelain veneers were placed. (We say either one because it's up to the treating dentist to decide which of the two makes the appropriate choice. Also, sometimes the distinction between the two can become quite blurred.)

The difficulties with this case.

(Before we discuss the obstacles with treating this case we should mention that we'd expect that this person's dentist could get a better result than we've illustrated. We're only so good at photoshopping pictures.)

The gum line issue.

Dentists can use crowns to totally reshape teeth. But only within the confines of where the tooth is already positioned in the jawbone. So in this instance, since the lateral incisors were short to start with, they will still be short after being crowned.

As a solution, the treating dentist could use "crown lengthening / gum sculpting" (see link below) to increase the amount of tooth that shows (push the gum line up).

Tooth thickness.

Another challenge for the dentist in this case is keeping the thickness that the crowns add to the teeth to a minimum. Bringing the retruded teeth forward will require quite a bit of additional bulk. If the restored teeth are too thick, it can interfere with tooth function or the person's speech.

One solution for this problem is to perform minor orthodontic work first, so to position the most troublesome teeth at least somewhat more ideally. Then place (more normal sized) crowns or veneers.

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