Chrissie | Smile Makeover


See below for detailed photos and a look at Chrissie’s complete reconstruction process.

BEFORE AFTER


Chrissie came to us with a lot of challenges.  Her immediate concern was function.  She had experienced a lot of dental treatment that was failing.  Cosmetics of that dental treatment was pretty poor.  Her exam included a TMJ (temporomandibular joint) and a facial muscle exam which were both negative, however Chrissie told us that at the end of the day her back teeth ached.  This was an indicator that she was probably bruxing and clenching during the day.
One of the biggest challenges was her bite.  When a person has a normal bite their lower front teeth nest just inside and behind the upper front teeth.  Chrissie has an end on bite, as you can see in the photo.  This made her a prime candidate for Orthodontic treatment before beginning her reconstruction and cosmetic work.  Chrissie declined ortho and requested that we correct as much as possible with crowns.
 

Chrissie had a lot of previous dental work in her mouth. Much of it was beginning to break down. She had crowns on all her upper front teeth as well as numerous fillings and crowns which were redecaying. The cosmetics of her work were very poor.

Chrissie has a big smile that shows a lot of teeth and tissue. I offered the option of recontouring her gums and lengthening the crowns to eliminate much of the gum tissue visable when she smiled. She agreed that would be a good solution.

Notice the dark areas at the gum lines. This is due to the metal that is in the crowns. Her new crowns will not have any metal and will have a very natural gum line.

The first step in Chrissie’s treatment was to establish a baseline measurement to determine whether her bite should be opened.  Here we are taking a bite registration.  We determined that her bite should be opened up about 3mm.  That isn't much, but I believed it was enough to ease the clenching that was occurring during the day.

More measurements. This is a critical stage in her treatment. If the measurements are off, or inaccurate, the outcome will be compromised. This is one appointment we don't rush. 

Chrissie appears in pain, but she in just concentrating very hard. We are instructing her how to hold the materials.

March 26, 2008 was selected as the big day. We encouraged sedation because of the length of the appointment. We expected her surgery to last about 6-8 hours and we believed that length of time would be exhausting for her.

Here we have cut through the porcelain into the metal. Her new crowns will have no metal in them at all.

Click here to see actual surgery pictures 

Here her upper teeth are prepped.  We still have the lowers to finish.  She is sedated and comfortable at this time.

Here we are beginning the tissue recontouring and crown lengthening.  Her gums were tender for a few days, but she healed very quickly.
Click here to see actual surgery pictures 

You can already see the difference between the length of the teeth as they were originally and the length as the surgery progresses.
Click here to see actual surgery pictures 
All her teeth are prepared.  We are five or six hours into the appointment at this time.  She is ready for temporary crowns to be inserted.

Her temporary crowns are made of acrylic and constructed in the office lab. They are all attached together to increase stability. Because we opened her bite by 3mm, we wanted her to wear them for about three months before taking her final impression and constructing her permanent crowns. If she experienced difficulty with her bite, we could correct it before finalizing the treatment.

Notice she still has an end on bite which is not ideal, but the function and cosmetics are much better.

Here she is a few days later with her temporary crowns and a big smile.
Her crowns are back from the lab.  We are ready to finalize her treatment.  Cementation of the crowns took about three hours.
Chrissie's case took about four months start to finish.  We were able to improve the cosmetics and function dramatically.  As you can see the pictures below, she still has an end on bite which we were not able to correct.  She would have required orthgnathic surgery in order to correct that.  She declined that option.  We lengthened the teeth which improved the cosmetics a lot.  We also  used all ceramic crowns which gave her better function and cosmetics than did the porcelain-fused-to-metal (PFMs).