How a cosmetic dentist can use dental crowns and porcelain veneers to enhance a smile.
Dental discussion: Smile and face symmetry.
When you look at a person's face your mind anticipates that it will see a set of features that display left and right symmetry. This type of balance is called "bilateral" symmetry and it simply means that the left side of a person's face is usually a mirror image of their right side, at least to a great degree. This same type of expectation of symmetry exists when you look at a person's teeth and smile.
When you view the smile in this makeover case take a look at this person's center two upper teeth. The point where these two teeth touch is considered to be the "midline". Dentists use this point to delineate between a person's left and right teeth.
Now, look at this person's lower teeth and find their lower midline. See how this midline lies far to the right of the midline of the upper teeth? Count how many teeth you can see to each side of this person's upper midline. We count six teeth on the right side and only five on the left. It appears that this person is missing one tooth on the upper left side. They seem to be missing what is termed an "upper left lateral incisor". This tooth usually occupies the position directly adjacent to a person's left center tooth.
We now have a dilemma. How can the cosmetic work of a dentist make a smile look bilaterally symmetrical when the dental patient doesn't have the same number of teeth on each side? Compounding this problem is the fact that, and especially with upper front teeth, each tooth of a person's smile has a certain characteristic relative size and shape. A person's central incisors are usually wider than their lateral incisors. A person's eyeteeth are often as wide as their central incisors but more pointed. With one tooth missing, how can a cosmetic dentist create symmetry?
Our approach to this cosmetic dilemma and the one illustrated in our "after" picture is that these types of problems really can't be overcome. The dentist can't create a precise bilateral symmetry for this smile. Instead they must make an attempt to create an illusion of it.
We think that a dentist could try to create a symmetry for this person's smile by clearly defining a shape for the center two upper teeth and then making the remainder of the teeth somewhat uniform in shape so to give the appearance of symmetry and evenness, even though it really doesn't exist. And while each of the individual teeth of the smile themselves won't necessarily have the classic characteristic shape one might expect, since each one is so similar and uniform no one individual tooth will stand out and disrupt the smile's overall appearance.
Cosmetic dentistry treatment plan:
We would suggest that the dentist treating this case should clearly establish which teeth are the center two upper teeth, thus clearly defining the midline. In the "before" picture you will notice that all of the upper front teeth are somewhat similar in width. In the "after" smile makeover picture we have redefined the center teeth. We have given them prominence by changing their size and shape.
With the remainder of the upper front teeth a dentist might take just the opposite approach. The attempt would be to make these teeth all blend in with each other by making them all look similar in size and shape. We don't want any one tooth to stand out. We don't want to make it easy for anyone looking at this smile to be able to count and determine that there are more teeth on the right side than there are on the left.
Because this person sent us a picture that showed their back teeth so prominently we assumed that the color of the metal restoration on their back teeth was on their mind also. We have illustrated in our "after" picture how white colored dental restorations could be placed so to give an improved cosmetic appearance.
The cosmetic dentist performing this dental work would have to make a determination about the precise way in which the changes we have illustrated could be made. It seems likely that some combination of both dental crowns and porcelain veneers would be needed.
We have also illustrated how this person's teeth could be bleached to a slightly lighter shade of white. This type of whitening treatment would be entirely optional and would be focused towards those teeth that would not have a dental crown or porcelain veneer placed on them. We discuss
over-the-counter teeth whitening products
as a separate topic on Dental-Picture-Show.com. If any teeth whitening treatment is performed it should be completed some weeks before the remainder of the dental work is begun.
Additional notes about the cosmetic results we have illustrated.
Our "after" smile makeover picture takes some liberties in the way it illustrates the cosmetic results of this case. As with all our makeover cases we never see the dental patient, only their picture. The dentist performing this work may find limitations related to this person's bite that are not readily apparent to us in the picture that may limit their ability to make the changes we have shown.
The changes we have suggested for the upper two center teeth of this smile illustrate a significant change in the width of these teeth. The accompanying gum line changes we show may or may not be easy or even possible to accomplish. This is a point the patient and the dentist must discuss before the work is begun so both parties' expectations are the same. In similar fashion, the amount of change we have illustrated for the lower front center teeth might exceed what is possible.
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