How a cosmetic dentist can use dental crowns to repair teeth worn down from bruxism.
Dental discussion: Repairing worn teeth.
About tooth wear and bruxism.
In the sense of creating an "after" picture that seemed achievable, this was a difficult smile makeover simulation case for us. With every smile makeover case we address our biggest limitation is that we only see a single photo of a person as opposed to actually examining them. With all of our simulations and especially this one our intention is to simply provide a starting point from which a patient and their dentist can begin a discussion about the types of cosmetic changes that might be desirable. Only after a dentist's examination and evaluation can specific issues be addressed. In this case, most likely we have overstated the degree to which the shape of the worn teeth can be restored.
Clearly this person's teeth have worn. By far the most logical explanation for this wear is that this person clenches and grinds their teeth (dentists call this activity "bruxism"). It seems that the overall goal with this case should be to attempt to return this person's teeth somewhat closer to their original length and along the way try to create the left-right tooth symmetry that one normally expects to see when they look at a person's smile. More specifically, here are some of the cosmetic aspects we noticed with this smile photo:
All six of this person's upper front teeth are worn excessively.
The shape of the two center upper teeth is not symmetrical.
This person's eyeteeth are not symmetrical. The right one is much larger than the left.
Cosmetic dentistry treatment plan:
Cosmetic and structural changes for the upper teeth.
Our "after" smile makeover photo shows how dental crowns might be used to change the shape of the upper six front teeth. Only the cosmetic dentist performing this treatment will be able to determine how much length can be restored. As we have stated previously we have probably illustrated these teeth as being longer than is possible, however the length we show probably isn't that much different that what these teeth were initially before the wear took place.
Clearly this person's two center upper teeth do not demonstrate a bilateral symmetry, one is more triangular in appearance than the other. A dental crown can be used to change the general outline of a tooth, however before the crown is made a proper tooth-gum relationship must exist so to accommodate this new shape. The gum tissue around the right center tooth would need to be repositioned (using a surgical procedure, typically performed by a periodontist (gum specialist)) so to provide the optimal conditions for making and placing the dental crown.
Our "after" picture attempts to achieve some bilateral symmetry for this person's left and right eyeteeth. Clearly the right eyetooth is much larger than the left one. The placement of a dental crown on the right tooth gives the dentist an opportunity to reduce its size, thus making it appear less bulky.
Increasing the size of the left eyetooth would require the same type of gum repositioning as required for the front center right tooth. After this was done a dental crown could be placed that more closely mimicked the size of the right eyetooth. Achieving this symmetry does achieve a left-right balance for this smile. The trade off is that these eyeteeth appear more fang-like.
Additional notes about our cosmetic dentistry treatment plan.
Undoubtedly the single most important aspect of this case is controlling this person's clenching and grinding habit ("bruxism"). That seems to be what has caused the destruction of these teeth. Over time it would most likely lead to the destruction of the dental work we have suggested above. There is not good out come for this case, with or without dental treatment, if this bruxism habit continues.
Sometimes a person can control their daytime bruxing activities simply by becoming aware of them. Control of nighttime bruxing typically requires wearing a nightguard type appliance, this way the plastic of the nightguard is worn away not the person's teeth and dental work.
Typically when a dental crown is made the final crown is the same size or larger than the tooth was originally. If a reduction in size is needed it simply means that the dentist must grind a larger percentage of tooth structure away for the crown creation process. The extra tooth reduction needed can compromise the nerve in a tooth and cause a need for root canal treatment. While this is not a certainty it is a matter that should be discussed and anticipated before the work is begun.