Using cosmetic dentistry to change a smile by placing dental crowns.
About this cosmetic dentistry makeover:
This person wrote and stated that they had dental crowns placed on their center two upper teeth some decades ago.
Now they were planing to have those crowns replaced, in part so to reduce the size of their diastema (the gap between their center two teeth).
They also mentioned that due to their bruxing habits (tooth grinding) that they had noticed that their eyeteeth had worn down.
As a point of interest before we discuss this cosmetic makeover any further,
notice that even though the color matching between the center two crowned teeth
and the remainder of this person's upper teeth is not all that close the overall appearance of their smile is fairly reasonable.
That's because a person's smile is usually bilaterally symmetrical. When we look at a smile we expect to see that the
corresponding teeth on each side are similar in shape, size, and color.
In this case even though the color match of the dental crowns is off
this person's smile is fairly reasonable.
Just imagine how this same smile would look if only one tooth's color was off. The smile would not be nearly as pleasing.
Dentists usually like situations where creating a cosmetic change involves corresponding left and right teeth.
Getting acceptable cosmetic results is usually less of a challenge.
Our suggestions for a cosmetic dentistry solution:
Our "after" picture shows some cosmetic changes that we think most people would consider an improvement.
As with all of our cosmetic dentistry smile makeover simulation pictures our goal is simply
to provide a starting point that a patient can use to discuss the types of cosmetic changes they seek with
their dentist. The dentist in turn, after a thorough examination,
can explain precisely to what extent the changes we have illustrated are possible.
We would suggest that the cosmetic results illustrated in our "after" picture
should be made by placing dental crowns on all six of this person's center upper teeth.
This person mentioned to us in their email that they brux (grind their teeth).
In those cases where the dental restorations being placed will be under extreme forces
(such as in those situations where a dental patient bruxes)
the strength of dental crowns is usually needed. However, after evaluating this patient thoroughly the dentist
performing this work may find that porcelain veneers may suffice for some teeth.
The ideas associated with the changes illustrated in our "after" picture are as follows:
Cosmetic changes suggested for the central incisors.
In order to close the diastema (the gap) between the center two teeth clearly the new dental crowns
will need to be wider than the existing ones. The additional width needed to close the diastema
might result in making the center teeth look too oversized. Our "after" picture illustrates how
one side of the crowns could be over contoured (so to close the diastema) and the far side of the crowns under contoured so to achieve the needed
results without drastically changing the overall size of the center teeth.
In our "after" picture you will notice that we failed to close the portion of the diastema that exists down by the gum line.
It can be difficult for a dentist to design dental crowns to close this space completely. The degree to which
this space can be closed needs to be a point of discussion between the dentist and this patient before this
work is performed.
Cosmetic changes illustrated for the lateral incisors.
Since the contour of the far side of the center incisors has been reduced, the contour of the
dental crowns placed on next teeth over (the lateral incisors) will need to be slightly oversized so there
is no space (diastema) between these teeth.
Cosmetic changes illustrated for the eyeteeth (cuspids).
In our "after" picture we have illustrated restoring this person's eyeteeth to a length that
we expect is somewhat similar to the length they were before this person's bruxing (tooth grinding) habits
wore them down. The dentist performing this work would have to determine that all of the length that we have
shown being added is possible.
Additional notes about our cosmetic dentistry treatment plan.
Since this person is aware of their bruxing (tooth grinding) habits and since wear on biting edges of the
lower teeth is clearly visible, this treatment plan needs to include provisions for minimizing continued
tooth wear. Placing dental crowns on the upper teeth may restore them closer to their original pre-worn
state but these crowns could abrade the lower teeth at a faster rate than an enamel surface would have (quite possibly
this is why you see more tooth wear on the lower teeth in the region of the existing dental crowns than on the other teeth).
It is common place that a dentist will fabricate a plastic mouthguard for their dental patients. These guards are worn
during those times when the patient is most likely to brux, thus preventing the tooth wear that would have otherwise occurred.