Obviously, a tooth grinder! Both form and function were restored to the upper front teeth with porcelain veneers and crowns. Notice how the eye teeth are again pointed instead of flat. This will enable him to move freely from side to side, without wearing down the front teeth agains.
The trained eye sees a lot of things wrong with this smile. There is excessive wear and chipping to the edges of this man’s teeth, as well as spacing. The teeth make this smile look like one of a much older man, and cosmetic dentistry certainly will make the smile younger, more vigorous-looking. Notice the thin brown crack lines in the front teeth, and how the line connecting the edges of the teeth is not a flat plane (which is desirable to enable the teeth to come together simultaneously) but rather, quite a roller-coaster occlusion. Also notice how the two front teeth drop down much lower than any other teeth in the arch at the gum line.
Something very important to realize is that when we work our cosmetic/porcelain magic, we talk about the porcelain being the picture, the gums being the matting, and the lips being the frame. In the after pictures, the roller coaster is gone, and thanks to a little lasering of the gum tissues, we have enhanced the “matting” around the picture. Observe how this is a very masculine smile. The front teeth and the ones next to them, the lateral incisors, all have square edges. Rounded edges would be more effeminate.
What do you see when you look at the upper teeth?
Do you see:
1. The half-moon shaped wear on the front teeth? That might come about because the patient is a nail-biter, or the opposing lower tooth might be too far forward, and interfere with the way the teeth close together.
2. One upper lateral is way behind the curve of the front teeth, the other is way shorter than the central next to it.
3. The teeth are yellow-ish.
4. The lower front teeth are not only crooked (especially if you were able to look at them from above), and there is no level plane, rather, the tips of the teeth, if connected by a pencil line, would be another one of those roller coaster occlusions we talk about.
This is the advantage of being able to blueprint a case. Everything planned out well in advance of starting treatment. The lower plane of occlusion is established first, and then the way the teeth come together in front is built off of that plane. Note in the after photography:
1. The Edges of the upper front teeth are uniform, symmetric, and natural looking.
2. The lateral incisors are all just slightly shorter than the centrals. Look how nicely all the porcelain emerges from the gum tissue.
3. The shade is much improved. Although many dentists would look at a case like this and treat a minimum of 20 teeth, we treated this case in accordance with the patient's wishes to minimize expenditure. When we are not changing the "height of the bite", cases can be done in phases, as long as the patient can tolerate the two-toned nature of things until they are happy.
4. The lowers and the uppers fit together, without interferences in any of the jaw's movements.
This woman sought to undo the ravages of time and adverse forces which caused the significant chipping of the teeth. She also had a roller coaster bite, like so many of the other smiles you’ve seen here, where the objective is to develop a flat plane of occlusion so that all the teeth come together simultaneously.
This problem was solved with multiple Edge crowns and 6 Edge veneers on the six lower front tooth. An exquisite result.
Here’s a fun exercise: Look only at the pictures with the lips in them. How old is the patient with the yellow teeth? How old is the patient with the white teeth? They are actually both in their mid 50’s, but you’d never guess that looking at how yellow her teeth had gotten, would you?
We had a lot to deal with on this extensive case. Foremost, there were bite issues which the layman would be able to tell looking at the lower front teeth, but did you know that those tell-tale notches at the gumline are related to clenching issues?
The dark grey teeth were because of all the mercury fillings in them. This was an extensive Edge porcelain case, with great looking results.
A severe wear case that resulted in an extensive article publication in Inside Dentistry a few years back. This wear was the result not just of tooth clenching, but also of a prior history bulimia.
The results gained accolades from the dental profession, because what was done for the upper teeth were 12 veneers on just 6 teeth! To preserve as much worn tooth substrate as possible, none of the contacts between the teeth were broken. To accommodate the porcelain thickness, the bite on the lower needed to be increased in height! A complicated case made much simpler by using a great lab technician.