Rehabilitating Patchwork Dentistry
Most people obtain dental treatments as they are needed. Routine fillings (tooth colored or amalgam), minor composite bonding to repair a surface crack or chip, and perhaps a crown or two over the span of several years.
As we progress through young adulthood and into the middle aged years it is not unusual to have what was once some great looking tooth colored restoratives… show the effects of different aging processes.
Different Products – Aging Effects
It is not uncommon to be treated by different dentists throughout these years… all of whom use different types of products, procedures and protocols. Understandably, as the number of cosmetic treatments accumulate, it can become frustrating trying to get everything to match.
High Visibility Career Demands
The patient pictured here works with the public and was unhappy with what she felt was a “mish mash” of colors in her smile caused by the different dental fillings and accumulation of discolored crowns.
In addition to the loss of color matching, certain changes in fit of her crowns produced an appearance of asymmetrical teeth…. they didn’t seem to match in size and shape the way they are supposed to.
She felt strongly the cosmetic sizing issues needed to be addressed, along with how her gums appeared at certain tooth structures. More specifically, she wanted her gingival arches to “match” the way they should..on both sides of her central incisors (front teeth).
A wedding was in the making which added to our patient’s desire to have a picture perfect smile with perfect color and balance. This cosmetic concept is commonly referred to as the LVI Rules of Golden Proportion and the Natural Smile Line.
A precise, mathematical relationship in tooth sizing (width and height) is followed that produces the tooth symmetry that Mother Nature is supposed to provide, along with a curvature of the incisal edges (biting surfaces) of the upper teeth that follows the natural curve of the lower lip.
Gum Recontouring – Crown Lengthening
To achieve the balance of gingival contours she wanted for her overall smile, a gum lift or reshaping procedure was used, as pictured here. Dr. Winter uses an electro-surge instrument as needed to gently remove excess gum material and minor amounts of bone that creates natural contours.
Notice there is no bleeding of gum tissue. The special instrument is self cauterizing, producing superb results.
Crown Removal with Least Invasiveness
To assure integrity of the underlying tooth structure, the old worn out dental crowns are easily removed with a special diamond tip instrument that sections the porcelain material for safe and easy removal.
This extra step eliminates the major risk of tooth damage if the crown is removed by trying to twist or pull it off.
The sectioning effect simplifies the process, enabling Dr. Winter to literally “pop off” the sections without impacting the original tooth structure.
Leakage is evident on one of the crowns.
Notice the accumulation of black material on one tooth structure, compared to the adjacent tooth.
Leakage is commonly caused by accumulation of bacteria at the base of a crown or the flexing of a cementation joint caused by excess biting pressure. Once a cementation joint is compromised, leakage is almost inevitable.
Left untreated for too long, leaking crowns will slowly deteriorate a tooth structure to the point where it is not serviceable, possibly requiring an implant or bridge product.
Composite Bonding Removal
Composite resin products had been used over the years on some of the old crowns for cosmetic purposes.
In the adjacent photo Dr. Winter gently removes some of the compound to facilitate the removal of the adjacent crowns and to protect the underlying tooth structures.
Re-prepping the Tooth Structures
Once all of the old crowns are removed, the tooth surfaces are reprepped with special cleaning and etching agents that will optimize the eventual recementation of new restoratives.
For this patient, the decision to select an Espe Lava Bridge (Zirconia 3M product) would overcome the weaker stability of individual crowns.
The Lava bridge product has become a popular restorative used in cosmetic and reconstructive makeovers. The dreaded risk of having exposed metal substructure as the restorations age, over time, is eliminated.
Zirconia is a popular abutment material for posts and implant devices and is currently being developed as a material for manufacturing dental implants in the future.
Reconstructive – Cosmetic Bridge Temporary
The patient is provided a provisional or temporary bridge product that will function as the prototype or model of the final Lava bridge product. Worn for a few weeks, the temporary bridge is made of material that allows easy adjustment and trimming, enabling the patient to assure the perfect smile line desired.
The mirrored bridge product pictured above shows off not only the attractive smile line result but also the amount of cementation area across the entire span of the bridge that will assure a rock solid attachment to the patient’s anchor teeth.
Special temporary cement is used on the “try-in” bridge to assure easy removal during the final smile design stage.
Temporary to Permanent
The last two pictures show the cosmetic and functional result of the patient’s desired treatment outcome.
After several days of minor adjustments to the temporary bridge for fit and feel, the final Lava Bridge was fabricated… which was literally identical to what the patient and Dr. Winter had modified during the try-in.
The results were quite dramatic for the patient in more ways than one.
As with many extensive reconstructive and cosmetic makeovers, the generalization or “spill over” effects of having a brilliant or dazzling smile can affect the way we feel about ourselves and issues of self confidence.
It is a rather subtle process where we start making changes in our appearance and even the way we dress. In a short time, the final effects can be very dramatic. This is commonly referred to as the “makeover experience.”