What she wanted: Fix and replace old broken and chipped porcelain; more dominance of the teeth; white but very natural smile.
What we saw: Chipping of the edges of some upper porcelain restorations. Fairly good lab work on existing porcelain. Patient’s envelope of motion came right across the chipped porcelain, focusing the grinding forces in a pinpoint manner that ended in fracture. These are very subtle details that can make or “break” the long term durability of porcelain restorations.
What we did: Remaking one or two porcelain restorations to match the remaining restorations if very difficult, especially when they are not in symmetrical positions. For this reason, and since the patient had other cosmetic goals for the teeth, we chose to replace all the upper eight restorations. The outcome looked very beautiful and natural, and with attention put into a harmonious bite pattern, they should be very durable.
What she wanted: To be able to smile with confidence.
What we saw: Worn out crowns and fillings; narrow teeth; chipped teeth; black triangles in between the teeth from recession. Tooth proportions would be a big challenge in avoiding a look of overly long and skinny teeth due to recession.
What we did: Placing highly esthetic crowns on the upper front teeth allowed us to get rid of all the old failing restorations, minimize the black triangles between the teeth, and rejuvenate the smile. The patient was extremely pleased with the result and excitedly planning to continue with the lower teeth.
What he wanted: Repair the severe decalcification that occurred years ago during orthodontic treatment.
What we saw: Severe brown and white decalcification mottling on upper and lower teeth.
What we did: The lower teeth were decalcified only near the gumline, so we were able to repair those teeth with conservative resin bonding only along the gumline, with an excellent color match. The upper teeth were severely damaged and the decalcification extended between the teeth as well. Therefore, for durability and consistency of color matching we placed porcelain veneers on the upper teeth. After mentally consigning himself that this was a condition he would probably just have to live with, the patient was literally blown away at the difference it made. This really was a life changing procedure for him.
What she wanted: Whiter, straighter teeth that would allow her to smile with confidence.
What we saw: Old restoration and recession made for a propensity for staining along the gumline; Misalignment; Natural tooth color in the grey range which made them resistant to conventional tooth whitening techniques.
What we did: Ten conservative full coverage highly esthetic upper porcelain restorations. Smile became much more pleasing with the decrease in visual tension, and you can see the patient became much more relaxed and confident in her smile.
What he wanted: Patient has a very fun outgoing personality and he wanted a smile that he could also feel confident with.
What we saw: Patient had extreme wear on his front teeth, old mismatching crowns, spaces between the teeth, and what is called “super-eruption” of his upper front teeth. Super eruption happens as the upper and lower teeth continue to try to work as a team and erupt to compensate for the wearing and shortening of the teeth. This then causes the gum line to be uneven and the teeth to not be in the right place on the face.
What we did: We removed the worn lower front teeth, re-contoured the ridge, and did a four tooth implant retained bridge. With the upper teeth, we did a “gum lift” to get the gum line in the right position, plus new highly aesthetic porcelain restorations got the teeth in the right position in the face and achieved his other aesthetic goals in a very natural looking result.
What she wanted: Bigger straighter teeth, no gaps, less gums.
What we saw: Patient has a broad, gummy smile that further accentuated her small teeth. In dentistry, we describe ideal upper central incisors as having “dominance”, with the lateral incisors being the personality teeth. The undersized teeth left her with gaps in between and the feel of a smile that is too gummy. Ideally, with a full smile, the lips would only reveal the triangles of gum tissue between the teeth (papilla) and a small amount of pink above the teeth. Additionally, there were rotation and angulation problems with the teeth as well as a deep overbite.
What we did: We started with orthodontics to level the bite and evenly align the teeth. In this case, we actually wanted the orthodontist to leave spaces so we could enlarge the teeth afterward. When orthodontic treatment was finished, a “gum lift” was performed to reposition the gum line upward and reduce the gummy appearance. Finally, extremely natural porcelain veneers were placed on the upper teeth to complete the look. The patient was very happy with the result and the deliberate process really paid off.
What she wanted: Brighter smile and to correct worn and chipped front teeth.
What we saw: Patient had a nice smile but was experiencing breakdown of the front teeth due to a “tight” bite that restricted the natural freedom of movement and focused the forces on the front edges. In addition, the natural color of the teeth being in the grey range does often not whiten well with conventional bleaching techniques.
What we did: We knew in this case the best way to brighten the smile would be through porcelain veneers due to the grey color of the teeth. Rather than do orthodontic treatment to correct the tight bite, we decided with wax mock-ups on her models that the tight bite could be corrected and need for orthodontics eliminated by carefully and correctly shaping the final porcelain restorations. Although the case looks pretty straightforward, this takes a lot of planning and preparatory work to make sure the bite is harmonious and gentle for porcelain longevity, that the teeth will look good on her face with no surprises, and that her speech is not affected by the new shape. The patient was very happy with the result.
What he wanted: Straighter, whiter teeth.
What we saw: Patient is a classic case of crowded teeth and heavy grinding that over time causes uneven wear and ends up with a jumbled look. Normally orthodontic treatment followed by conservative restorations would be the plan of choice, but the patient being in the fishing industry and away for prolonged periods of time made the very regular adjustments required for orthodontic treatment a challenge.
What we did: We began with a very important model wax up to visualized a reasonable outcome and act as a guide for the proper conservative preparation of the teeth. Since the backs of the teeth were as misaligned as the front, full coverage yet conservative crowns were made of high strength zirconia core material for durability with the patients strong bite. The zirconia was then layered with esthetic porcelain in the non-stress areas for beauty. The patient is very happy with how things turned out.
What he wanted: Fix broken and chipped up porcelain and achieve a consistency of color.
What we saw: Old porcelain restorations of various ages that were chipped, broken, and discolored with failing leaking bond to the teeth.
What we did: This patient has one of the strongest bites in our practice, so using the highest strength lab zirconia was a must. All biting surfaces were made in monolithic zirconia, with only a small veneer of esthetic porcelain used for esthetics. In this case we sacrificed a bit of esthetic value in favor of strength, which was ok with the patient since he wanted the “super white” look anyway.
What she wanted: Bigger teeth with more dominance and consistency of color and a smooth even position in the arch.
What we saw: Small teeth that tended to be more triangular than rectangular in shape. Uneven color with some teeth obvious darker than their neighbors. The upper eye teeth were set out to far in the arch, and the premolars were hiding behind them, creating what we call “dark corridors” of shadowy open space near the corners of the mouth. (Think the opposite of the full and wide Julia Roberts smile).
What we did: A quality wax model of the possible result was used to create an in the mouth mock-up that allowed the patient to visualize and critique and modify the result before we even started. That way all the lab technicians needed to do was copy the form of the mock up and make the porcelain beautiful and appropriate for a young woman. She absolutely loves how they turned out.
What he wanted: To rehabilitate his teeth and smile if possible. Patient was very discouraged by his teeth.
What we saw: A variety of old restorations made of with lots of different materials and techniques and done at different times and eras of his life. Nothing really matched. This was complicated with decay having gotten established under most of the old restorations, along with some recession.
What we did: Full mouth rehabilitation starting with a diagnostic waxup on models to provide the vision and direction of where we were going. All restorations are made from high strength zirconia cores layered with highly esthetic porcelain by a very high end ceramist. The subtleties of the porcelain work, even on a microscopic level, are impeccable. This is a great example of the difference it makes to have a comprehensive approach where the same ceramist, a high end ceramist, is doing all the work at the same time. The teeth truly look realistic and natural from both conversational distance and up close, which is the hallmark of upper echelon skill. This was a very rewarding case for me to be trusted with, and the result was life changing for the patient as well.