How a cosmetic dentist can make a smile more inviting by closing gaps and reshaping teeth using dental veneers and dental crowns.
Dental discussion about the cosmetics of this case:
Open bites, closing "gaps", and replacing missing teeth.
When we evaluated this smile there were a couple of items that caught our attention.
First off, clearly there is a gap between this person's two center teeth.
Dentists use the term "diastema" to refer to this type of spacing. There isn't anything inherently wrong
or troublesome with the presence of a diastema.
Choosing to close a space like this is simply a cosmetic decision.
Another thing we noticed with this smile was that this person seems to have
what is called an "open bite". That means that when this person closes their back teeth together
their front teeth do not overlap (as they would in a normal occlusion). And
finally, this person seems to have a tooth missing on the upper left.
Cosmetic dentistry treatment plan:
Decisions to make when closing a diastema ("tooth gap").
When dental work is chosen as a means for closing a diastema (as opposed to orthodontic treatment)
there are some characteristic obstacles that the dentist performing
the work has to deal with.
One of these concerns has to do with whether or not the gap
will be closed all of the way.
Our "after" picture illustrates how dental crowns could be used to completely close
the diastema found in this case. Of course this means that the crowns that are placed must be much wider than the teeth
were originally. If you only make the teeth wider their proportions can
start to look out of balance.
In our "after" picture, so to retain
some of the normal length to width proportions of the crowned teeth we made
each tooth longer also. If this person does in fact have an open bite
making these teeth longer should be possible.
Another problem that a dentist must deal with when closing a diastema is that
while the crowns that are placed can make the portion of the tooth that shows above the gum line
wider the root portion of the tooth (the part of the tooth where the edge of the crown sits) cannot be changed.
The dentist's crown must blend the crown's new wider width down to the fixed width of the tooth's root where it
emerges from the gum line. If the dentist allows the new crown to be bulked up and
lie against the gum tissue (pretty much like we have illustrated in our "after" picture)
a region can be created that can be difficult to clean and keep plaque free.
If the dental patient fails in their cleaning efforts (typically because of inadequate flossing)
there is certainly a danger that
gum disease will develop.
As an alternative the dentist might shape the dental crowns so they are less bulky and easier to clean around, however
the end cosmetics in this situation are not always what the dental patient has anticipated.
Our point here being that this topic must be discussed with the dentist performing
the work so a clear understanding is reached by the dental patient regarding
the expected appearance of the finished work, what effort they will have to take
to properly clean around the new dental crowns, and what consequences can occur if
they do not achieve proper cleaning.
In our "after" picture we have also illustrated making each of the teeth that
lie to the side of the center upper teeth slightly longer. We also show shortening
the eyeteeth a little. These changes could be accomplished by way of
placing either dental crowns or porcelain veneers. A decision about which type of dental restoration
would be more appropriate would need to be made by the dentist performing the work.
As a final change we have illustrated replacing the missing tooth on the
upper left with a dental bridge.
Additional notes about our cosmetic dentistry treatment plan.
Making dental crowns is usually a multi visit treatment. There is usually
a period of some weeks during which the patient wears plastic temporary
dental crowns while they are waiting for their new permanent crowns to be
fabricated.
This time period will give the dental patient a chance to evaluate
the new shapes we have suggested for their teeth. If problems with function
or cosmetics are identified while wearing the temporaries these plastic crowns can be reshaped.
The dentist can then communicate these shape changes to the dental laboratory
and the needed shape mimicked in the permanent restorations.