Designer Smiles
CASE STUDY Crooked teeth

Place this as the new cover

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Patient initially presented for improving the aesthetic apperance of upper teeth (upper arch crowding). 

Examination, x-rays, photos and study models and composite mock up confirms the following:

  1. Anterior cross bite 12/42, patient refused any form of orthodontic treatment-invisalign/lingual/labial.Patient wanted a quick fix option due to TV/modelling engagements.
  2. Moderate smile line with optimal thick lips, narrow upper arch-large dark corridors with upper teeth midline is in symmetry with upper lip. During full smile we have asymmetrical exposure of gums. Upper lip tends to cant during full smile (right side lower) and lower lip is symmetrical.
  3. Upper skeletal and dental midlines are correct.
  4. The smile wear pattern has created reverse smile line as is evident during full smile, where the lower lip hides upper anterior teeth during full smile.
  5. The periodontal health is optimal, all teeth tested vital.
  6. Normal range of craniomandibular (jaw) movements: jawfunction.
  7. Composite mock up was completed and the patient was happy with the initial effect.

Treatment proposed as per composite mock up that has confirmed amount of gum and tooth exposure required for improved aesthetics and lip support.

We discussed all modalities, risks and benefits of composites, porcelain and orthodontic treatment. Patient was happy to proceed with composite veneers and accept that some adjustment of 11, 12, 21 and gum recontouring of 12, 21 etc may be required for optimal outcome. This will be followed by immediate composite veneers on upper ten teeth 15-25, to balance the smile as we discussed during composite mock up). 

Composite mock upNote how closely it simulates the final smile

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It is imperative to stress that orthodontic levelling & alignment is the best treatment for the patient. This decision as not taken lightly as the patient had an important career to pursue.

We discussed all possible options, as well as no treatment;

A             Ideal treatment using orthodontics & restorative correction of worn teeth and further smile enhancement

B             Composite veneers

C             Traditional veneers-porcelain combined with lower orthodontic treatment.

Following considerable discussion of all the options, we decided to proceed with composite veneers on upper 10 teeth.

This minimally invasive concept as per composite mock up will achieve the following:

  1. Immediate cosmetic improvement
  2. No intervention with existing veneers
  3. Minimal post-op discomfort.
  4. Easy to make modifications
  5. Options for future orthodontictreatment

As always, following cosmetic dental procedures a habituation period of few days is anticipated. This will allow us to improve colour and harmonise the smile to create a naturally pleasing appearance. Any sensitivity, which is rare, is usually transient.

We also discussed that any bruxing/grinding habits will play an important role in the future longevity of the restorations and  dentitions as a whole.  A night guard will be provided to control any bruxing.

Most importantly this treatment is conservative and the least biologically invasive to the tooth structure.  It will maintain the integrity of your tooth structure and repairs are easy to make.  The composite mock up confirmeda better more pleasing tooth/smile exposure would be achieved by improving the smile line and restoring “dark lateral corridors” –improving the width of the smile (this will be combined with gum recontouring of teeth 21, 12) to create flow, to balance the smile and pleasing teeth emergence profile. 

We need to regard this as a long-term provisional measure to serve us as a guide in future reconstructions: porcelain veneers if required etc. However we can from time to time extend the life of these restorations by resurfacing the veneers with new composite materials at a minimal cost. In the future porcelain veneers(if required) etc. can commence by removal of these veneers, since your teeth are sound underneath the composite veneers

We pride ourselves with the quality of dentistry we provide however, there are always limitations placed on us by materials and oral environment.  One can be reassured at the end of the treatment that all will be well, however if anything unexpected does show up or unusual symptoms occur, we ask our patients to please let us know. We are always here to look after you. Should any problems occur with the composite veneers within 2 years, we will replace themat no cost to you, provided regular 6 monthly check-ups and maintenance visits which will enhance the longevity of the restorations and your oral health.

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Note the cross bite at teeth 12/42. This was a major concern for this attractive patient that would affect her career at this stageinher life.

Patient requested a restorative correction which we would expect to be an orthodontic treatment. Due to her career in TV and modelling, the restorative option with minimal intervention was chosen. This gives the patient future options for orthodontic treatment, when and if the need arises.

It is quite apparent that the smile should be viewed also from oblique view. This view is the most revealing, because we are off-guard and not straight in front of the mirror. The same smile below restored using One Visit SmileLiftprocedure. Composite veneers on upper 10teeth.

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Achieving harmony: Aesthetic integration

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      One smile says it all!

Note the crowding of upper front teeth. Again the best treatment is orthodontic treatment followed by tooth whitening or veneers. Due to patient’s professional career, we decided to place non invasive composite veneers on upper ten teeth and lower tooth whitening. Naturally, in the future we can place lingual braces and complete the orthodontic treatment, while preserving and maintaining aesthetics.

 Non invasive composite veneers on upper ten teeth and lower teeth whitening.

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One Visit Smile Lift and Lower Tooth Whitening  – frontal view

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One Visit Smile Lift: Almost ZERO intervention to the tooth structure. The smile must complement the lip and the face.

All above procedures performed by Dr Sarkis Nalbandian. 

Final treatment outcome and we have a happy patient

However most importantly we have complemented our lovely patient’s facial aesthetics.

 Hence the term: dentofacial rejuvenation by Dr Sarkis Nalbandian

Dr. Sarkis Nalbandian

Registered Specialist   

Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Pros) King’s College, Uni London

  1. Clin. Dent (Pros) Uni Syd, FRACDS, MRACD (Pros)
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