Patient initially presented for improving the aesthetic apperance of upper teeth and gum exposure.
Following examination, x-rays, photos and study models and composite mock up etc. confirms the following:
Smile Dynamics frontal and lateral profile Views
1-High smile line with upper teeth midline is in symmetry with upper lip. During full smile we have symmetrical exposure of gums. Both upper and lower lips are symmetrical. The presence of deciduous retained teeth: 55 & 63 and impacted canine 23 palatally. Patient had consulted orthodontists in the past and we discussed in length for orthodontic treatment, where impacted upper left canine 23 would be exposed and placed with traction into an arch form during a prolonged orthodontic treatment. However, because at this stage in his life accepting that an orthodontic treatment is an ideal option, patient opted for a quick fix situation, that still leaves this option of orthodontic treatment open for future consideration, because the natural teeth-that is the enamel of the tooth is not invaded: maintaining the integrity and the health of the original tooth! This is different from other invasive so called “cosmetic” dental treatments that destroy sound tooth structure for the sake of cosmetics.
Naturally there are situations that invasive treatment is required, however this is indicated where teeth have structural integrity that is compromised and requires reconstitution, or the patient has specifically requested this procedure and accepts all risks of future tooth related complications such as root canal therapy and further ongoing treatment, since all dental work will fail with time. There is no treatment that lasts life time. It is more important to maintain the longevity of the tooth that supported the restoration. The beauty of the treatment provided by Dr Nalbandian is that cosmetic dentistry in many ways should be regarded as fashion statement, we can use newer, better materials in the future, simply resurfacing the teeth, since the integrity of the enamel is maintained.
Detailed smile analysis is required for correct aesthetic and functional outcome.
2- The periodontal health is optimal, all teeth tested vital. Teeth 85, 75 & 55 deciduous teeth in the future would require implant replacement as teeth start to exfoliate.1
3-Normal range of craniomandibular (jaw) movements: function.
COMPOSITE MOCK UP- see how closely it simulates the final smile
Following composite mock up us agreed that better more pleasing tooth/smile exposure would be achieved by slightly widening upper arch: restoring “dark lateral corridors” –improving the width of the smile (this will be combined with gum recontouring of teeth (14 to 63) to create flow, to balance the smile and pleasing teeth emergence profile. This concept as seen during composite mock up would allow lesser emphasis on “longer upper front teeth” and give the effect of emphasizing full arch teeth that are part of natural smile.
It is after asked by the patients as how much does this treatment cost. The answer is Dr Nalbandian cannot give your this answer on the phone unless we consult you and diagnose the problem and also carry out diagnostic aesthetic Mock up to assess the final treatment outcome and have it “tested by you” in your mouth such as speech, comfort, able to habituate etc.
This minimally invasive concept as per composite mock up will achieves the following changes;
Following considerable discussion re; various options of treatment which included: no treatment, orthodontics, porcelain veneers etc. we decided to proceed with restorative treatment using composite veneers on teeth (55-25) for improving overall gum symmetry, arch form, tooth colour and arrangement.
As always, following cosmetic dental procedures a habituation period of few days is anticipated. This will allow us to improve colour and harmonise your smile to create a naturally pleasing appearance. Any sensitivity, if present is usually transient.
I must stress that any bruxing/grinding habits will play an important role in the future longevity of your restorations and your dentitions as a whole. A night guard will be provided to control any bruxing.
Note the symmetry and the health of the gum margins. Naturally we have symmetry across the midline. There is a general flow in a smile line. Naturally look smile was requested by the patient, which we feel has been achieved.
We need to observe the smile in all directions and not simply from frontal view. This is an Oblique view, most common images taken of patients who are “off-guard”. Note that since the patient exhibits complex smile (full smile with upper and lower gums and teeth are in the view) we have achieved a reasonable result that compliments this handsome mans facial beauty.
Therefore ass emphasised in other parts of this website, it is the facial features that the smile must compliment and not simply the teeth in itself.
Smile design by Dr Nalbandian 2 years Post Op
The treatment fee is itemised as follows
Items 582×10/245 x10
Most importantly this treatment is most conservative and least biologically invasive to the tooth structure. There may be some sensitivity, which is usually transient.
The treatment proposed is non invasive, and will maintain the integrity of patient’s tooth structure. Repairs are easy to make.
This will improve incisal/smile plane, aesthetics and function in general.
Creating new arch, tooth and gum symmetry
This treatment was completed in two main visit.
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 orthodontic treatment, porcelain veneers 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, oral environment, etc. One can be reassuring at the end of the treatment that all should be well, however if anything untoward does show up or unusual symptoms occur, please let me know. We are always here to look after you. Should any problems occur with the composite veneers within 2 years, I will replace it with no cost to you, provided regular 6 monthly check-up and maintenance visits help to enhance the longevity of the restorations and your oral health.
It is certainly true that people smile with their eyes. All we did was to compliment this handsome man’s facial features
Pictures are more than 1000 words
Smile at rest