How a cosmetic dentist can restore a worn smile using dental crowns, porcelain veneers, and teeth whitening treatments.
Dental discussion: Repairing worn teeth and improving smile symmetry.
How wear from tooth grinding can affect a smile.
When you look at this person's smile what really catches your eye is the amount of wear that has taken place. A lot of times when teeth wear down it takes away some of the "youthfulness" of a person's smile and face. This type of wear is usually horizontal in nature, meaning that the tooth wear is uniform across the biting edges of all of the teeth. In our cosmetic dentistry makeover case here the tooth wear that has occurred has resulted in a very asymmetric and ragged appearance. In this situation this smile probably doesn't so much give this person's face the illusion of age, the teeth instead simply look worn out.
Any cosmetic dentist looking at this photo would anticipate that this person has a habit of grinding their teeth (dentists call this activity "bruxism"). Notice how this person's lower front teeth seem quite a bit taller than their back ones. This implies that when this person closes their back teeth all of the way together that their front upper teeth overlap their lower teeth significantly, possibly hiding them almost totally. This type of bite relationship is termed a "deep overbite" by dentists. A more normal bite is one where the upper teeth overlap the lower teeth only slightly.
Related to the deep overbite that is present in this cosmetic dentistry makeover case, during those times when this person is grinding their teeth they will have a tendency wear away tooth structure on the back side of their upper front teeth. As more and more backside tooth structure is lost a point is reached where the wear affects the appearance and shape of these teeth as viewed from their front side. (As evidenced in the "before" makeover photo.) Sometimes the worn tooth structure is so thin that bits of it, both large and small, chip or break off with some frequency.
Examples of different types of tooth stain.
When you look at the "before" smile makeover photo you will notice that this person has a number of locations where there is yellow and brown tooth stain. Some of this discoloration (especially that located on this person's upper left teeth) seems to be the staining of existing white dental fillings. White colored dental fillings can be expected to pick up stain over time, especially if they are regularly exposed to chromogenic agents such as coffee, tea, and tobacco products.
The yellow and brown tooth stain that you see on the lower front teeth is probably the type of discoloration that can be removed during a professional dental cleaning. And in similar fashion as with the stain associated with this person's white dental fillings, the presence of these stains on the lower teeth is probably associated with the consumption of chromogenic agents such as tea, coffee, or colas.
Perfecting smile symmetry and therefore improving face symmetry.
The cosmetic dentistry treatment plan we suggest below provides an opportunity where the dentist performing this work can have great influence on the overall symmetry of this persons smile. Notice how this person's teeth and smile seem to have a slant towards their left side. A great deal of this is due to the prominence of the upper left eyetooth. A cosmetic aspect of the proposed dental treatment will be to reel this tooth back so to give this smile, and subsequently this face, more left and right symmetry.
Cosmetic dentistry treatment plan:
Cosmetic and structural changes for the upper teeth.
The dental work needed to make the changes we've illustrated for the upper teeth in our "after" smile makeover photo would need to be some combination of dental crowns and porcelain veneers. Clearly many of the makeover changes we show, especially for the front upper teeth, are both structural as well as cosmetic. Many of the changes we have illustrated for the back upper teeth are more cosmetic in nature, and therefore somewhat optional.
As we have mentioned previously, the wear pattern found on this person's teeth suggests that they have a habit of grinding their teeth. This means that the dental restorations that are placed must not only be pleasing from a cosmetic standpoint but also possess enough strength to withstand the forces they are subjected to. It would be up to the cosmetic dentist performing this work to decide which types of restorations (dental crowns or porcelain veneers) would be the most appropriate for which teeth. A great deal of this determination will be based on the dentist's evaluation of this person's bite.
Cosmetic changes for the lower teeth.
We didn't illustrate any significant changes for this person's lower teeth. To a great degree most of the changes we have shown in our "after" smile makeover photo for the upper teeth involves restoring them so they are somewhat close to their original shape. We thought a cosmetic dentist could reasonably be expected to be able to achieve this.
If a cosmetic dentist planned to create significant changes with both the upper and lower teeth they would need to have a good understanding of this person's bite. We can't ascertain that type of information from a photo. Rather than illustrate a gross misrepresentation of what a cosmetic dentist might be expected to be able to achieve, we chose instead to just illustrate major changes with this person's upper teeth. We think most people would be quite happy with the cosmetic improvement that this treatment alone would provide for both their smile and face.
Making a smile brighter with teeth whitening treatments.
In our "after" smile makeover photo we've tried to illustrated how teeth whitening treatments might be utilized to make this person's smile a bit brighter. Since we anticipate that essentially all of this person's upper teeth will be covered with either a dental crown or porcelain veneer, teeth whitening treatments would not be need for them.
Since we deliberately chose not to illustrate major changes with the lower teeth in our "after" smile makeover photo these are the teeth would be candidates for a teeth whitening process. The whitening process would need to be completed some weeks before the shade of porcelain used to create the dental crowns and porcelain veneers for the upper teeth is chosen. We discuss
over-the-counter teeth whitening products
as a separate topic on Dental-Picture-Show.com.
Additional notes about our cosmetic dentistry treatment plan.
It is fairly easy for a dentist to make cosmetic changes with a person's smile. You sit, the cosmetic dentist does the work, and you get to a point where the treatment is completed. The results, a new perfect smile. What is both much more important and much more difficult is for the cosmetic dentist to create a perfect smile for a patient that will withstand the wear and tear of time.
With this cosmetic makeover case a great deal of the longevity of the new dental work will have to do with the dentist counseling the patient in ways that can help to control their tooth grinding habit. Typically this grinding is either a subconscious daytime activity or else something that the person does while they sleep. If the patient and the dentist can't find ways of controlling or minimizing the effects of this grinding habit the results of this cosmetic makeover simply will not last.
Additionally, our "after" smile makeover photo illustrates great changes in the size of this person's upper left eyetooth. Trimming away enough tooth structure to create great shape changes can compromise the tooth's nerve and create the need for root canal treatment. The cosmetic dentist and patient together must determine if this outcome is acceptable. If not, shape changes to a lesser degree should be planned.