Chipping of the front teeth.
This case is about a young girl who was referred to me after trauma to her front teeth. She fell with her face down and broke her front teeth 5 days before her birthday. She was referred to me to as an emergency, and i stayed after hours to do whatever was necessary to take care of her. The young girl was very embarrassed to smile and did not want to appear with a broken tooth on her birthday. She was confident she could cover her lip laceration with make up but could not do anything about her front teeth. My goal was to make her ready for her birthday and improve the aesthetics short term and provide her long lasting restoration for the future.
Patient had a diastema (Space) between her front teeth and asked me to keep it. I used e-max press combined with layering technique to mimic her natural teeth. Characterization of the surface was done by a talented Ceramist to provided the same surface texture and white spots to blend them with the rest of her teeth.
Not all “porcelains or ceramics” are the same. They have different characteristics and their application varies from case to case. Their strength, optical characteristics (translucency, transparency), etc. are vastly different. Using one type of porcelain for all cases is most certainly compromising the goal of the treatment. Prosthodontists in contrast to most general dentists are the decision makers when it comes to choose what type of material to use rather than leave it to the laboratory technician to choose what they consider best which is a more common practice. Mixing different materials, will cause optical mismatch with ultimately leads to patients dissatisfaction in some cases and in other material failure.
Tooth preparation for a veneer can be challenging and may lead to early failure if it is not filed properly. Over filing the teeth for veneer is not an uncommon complication and can lead to a lot of frustration for patients.
Application of different types of porcelain requires vast knowledge about dental ceramics. If you think your health matters, go to a professional in the restorative field. Find a prosthodontist today to discuss what is best for you.
Porcelain veneers after orthodontic treatment
The case below is about a gentleman who had orthodontic treatment as an adult to align his teeth, but after 2 years being in braces the two lateral incisors could not be moved. They were diagnosed as being ankylosed, which means being fused to the jaw bone. The over outcome of the orthodontic treatment was good, but the patient was not satisfied with the rotated lateral incisors. After giving it a lot of thought, he decided to have the front teeth veneered to idealized the outcome. It was one of those cases that he really pushing for the excellence to maximize the cosmetic appearance, even though the initial impression of his teeth was fairly acceptable in my view. However, as they say beauty is in the eye of the beholder.
Initial exam of the patient and meticulous attention to details in collecting relevant data such as, evaluating the smile, taking notes of what needs to be changed, gum exposure teeth shape, shade, texture, facial form, uneven features, fullness of the lips, etc. Photography with professional camera and ring flash, instead of a cell phone, under different lightening will help tremendously to capture valuable information to communicate with the master ceramist when it comes to idealize the smile. Some people like natural looking teeth, and others like fashion model. Shaping teeth for a powerful masculine personality vastly differs from a soft and more feminine personality. Also, the shape and shade of the front teeth can be as such to express a young age or an aging dentition. That could be a reason why some people choose to go to a prosthodontist to achieve the highest level of care and some other choose a general dentist just to replace their missing teeth.
Getting back to our case. I started the work with a wax up mock up and before touching his teeth, i gave him the chance to visualize what i was going to do and after his approval a tooth preparation guide was used to file down VERY CONSERVATIVELY in such a way that most tooth surface was still covered with enamel to maximize the bonding and longevity of the restorations. Failing to keep enamel on the surface of the prepped teeth means early failure and de-bonding of the restorations.
a set of 7 super thin veneers were fabricated by a master ceramist and they were bonded meticulously one at a time. it almost took me 2.5 hours to bond 7 veneers and check the occlusion.