Tetracycline Discolouration of Teeth Fixed – Patient Story

Initial Presentation

The patient, when presenting, was most concerned about her worn smile line and severe tetracycline related tooth discolouration.

The difficulty here is not only the tooth discolouration but also the severe wear caused by bruxism (tooth grinding – in this case night time bruxism). We need to control these forces on proposed porcelain veneers, therefore an important part of the treatment protocol is the wearing of a nightguard to protect the new porcelain veneers.

To improve the length of teeth, display during smile and speech dynamics, the direct diagnostic composite mock is critical in formulating how we design these restorations for an optimal aesthetic outcome.

Chief concerns: improving the aesthetic appearance of her smile:

1. To improve the the teeth length, upper arch shape and smile line as well as tooth colour.
2. This lovely socilite patient wants to smile, understanding the complexity and the precison of the work required.

Note the extent of tooth wear and flat/reverse smile line. Crowded lower arch with severe tooth wear.

Diagnosis: Unacceptable tooth colour and wear: creating an aesthetic disturbance.

Diagnosis & Patient centred treatment planning

Once we have determined their needs and expectations and when the patient is ready, we begin to restore their teeth to optimal function and aesthetics.

Diagnostic Mock Up

Diagnostic: mock-up and assessment. Finalise the degree of gum and teeth showing during smile and speech dynamics, maxillary arch form and smile width.

We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome.

Our Aim: to improve the aesthetics of the upper arch: tooth shape, display, tooth colour, length, symmetry and smile line in general along the upper arch involving 12 maxillary teeth porcelain veneers.

This was accomplished with minimal discomfort to the patient and using no tooth intervention. No provisional veneers were required.

Treatment

We tested the diagnostic mock up for patient acceptance that guided the final desired aesthetic outcome.

Following with discussion of all risks and treatment modalities with our patient that included:

1. No treatment: this is not an option as the restorations are failing and affecting aesthetics
2. Repair existing teeth with tooth surface loss (TSL): this is a temporary measure and not accepted by the patient
3. Porcelain veneers both arches: best long-term solution, Fixed option: accepted by the patient

Procedure & Results

1. Diagnostic: mock-up & assessment. Finalise degree of gum and tooth showing during smile & speech dynamics, maxillary arch form & smile width
2. Recontour sharp worn teeth
3. Impressions for porcelain veneers
4. Issue the porcelain veneers

The work was completed in two visits. In general it takes about 3-4 weeks from diagnosis to final outcomes.

Smile Lift with porcelain veneers on both arches creating balance and symmetry. 20 Porcelain Veneers, 10 veneers per arch to complete the smile.

Note how all compositional elements of teeth gums lips and face are in concert together. We have improved tooth: colour, shape form & arrangements

The aesthetic effect should establish harmony and balance between dentition and surrounding soft tissues

Final treatment outcome: we have restored aesthetics using porcelain veneers on both arches. However most importantly we have complimented our lovely patient’s facial aesthetics. Hence the term: dentofacial rejuvenation.