“I am tired of hiding my teeth with my upper lip and hand. I feel my front teeth are so much bigger than the ones next to them, and the space and yellow color just make it worse. What can you do for me?”
I believe it is critically important for people to see what I see when I examine the mouth. With today’s digital technology, it is very easy to do. With the patient’s permission, we take a picture of whatever their concern is and put it on a big monitor. It makes more sense when the patient can be involved in the problem solving for their own mouth.
What are her options? If you were the patient, what would you want to know?
WOULD BRACES WORK?
Moving these particular teeth is not going to get the desired result. All you would end up doing is creating spaces between all of the front teeth plus the two front teeth would still be stained and ugly.
WHAT ABOUT CROWNS?
What if you just crowned the two front teeth to get the color right? It is a sensible question that can be answered by studying the picture. If you closed the space just using the two front teeth the crowns would be gigantic, out of proportion to the others and stick out like Bugs Bunny.
Beautiful people, animals, plants, buildings and teeth are pleasing to the eye because they are proportional. There is a mathematical formula called the Golden Ratio, but there is no need to know it because the eye and brain naturally recognize what is right and what is wrong.
In order to get this patient’s front teeth proportional, we had to crown the front six teeth. A highly trained dental laboratory can manipulate the length and width of each crown so they are proportional and fit the Golden Ratio. Because all six crowns are made at the same time, they can be made the same color, giving the patient the beautiful smile she has always wanted. This patient does not have a very wide smile, so in some cases more teeth would be treated to ensure the whole smile looks great! (8-10 teeth are more common, but as an example, Julia Roberts shows 14 top teeth when SHE smiles!)
GETTING A PREDICTABLE RESULT
It is always important for the patient to be able to see what the end result will look like before we ever touch the teeth. This is possible by taking a model of her teeth and simulate the outcome by using a life-like, tooth-colored wax. The “Wax Up” is the first trial run, so to speak.
Once the patient agrees to treatment, I prepare the teeth for crowns and use the waxed up prototype to make plastic temporaries. The temporaries are the patient’s second chance in making sure she is getting exactly what she wants. She gets to “test drive” her new teeth in plastic. The after picture is the plastic temporaries.
If she decided she wanted the teeth to be more square or more rounded, I could have added or taken away the right amount of plastic to give her the desired look. Once she liked what she saw, we take another impression of the altered temps, so the lab can duplicate what she likes.
This process gives the dentist and patient well-controlled and expected outcomes. She came in for her appointment and in a couple of hours, left with a smile she is proud of. Three weeks later, she will have her beautiful, finished result. In the above photo, the patient is planning to whiten her lower teeth to match her beautiful new top teeth.
Dr. Andrea Stevens is a cosmetic and family dentist in practice in Kanata, Ontario. If you have dental questions, you can call her at 613-271-7091 or visit her at kanatacosmeticdentist.com Please also feel free to leave comments or questions below, and Dr. Stevens will be happy to answer!