Hiding My Smile
At his first appointment with Dr Andrea Shepperson, our patient told us he has been hiding his smile and is self-conscious of people seeing his teeth.
The Damage To Teeth
Fizzy and energy drinks are often consumed without knowing the damage they can do to teeth. Our patient had been drinking fizzy and energy drinks for several years. They contain potent food acids that can damage teeth. The damage was severe, and his smile had gone from a natural curve to an inverted V shape.
As teeth disappear, the bite changes and becomes over-closed. The front teeth overlap deeply.
Enamel dissolves in food acids, leaving the inner yellow dentine of teeth – the softest part of the tooth. Hollow zones are created on teeth, and they become very sensitive.
Acid Tooth Wear and Rebuild
The images show the hollow teeth that acid had created. Front teeth were thin and fragile. We can see the amount of tooth we had to add back, and how we had to open the bite to make space for lost tooth material.
This treatment requires a dentist skilled in re-engineering a bite, to make it comfortable and ensure the new dentistry is longlasting. Dr Andrea Shepperson is a graduate of the Kois Center in Seattle where reconstruction of worn mouths is a significant part of the curriculum.
Step 1: Planning the Smile
We began with a 2D simulation using the Digital Smile Design (DSD) App to show him the possibilities with longer teeth and a whiter smile.
Step 2: Deprogramming - Creating A New Bite
Tooth wear leads to an over-closed bite with shorter muscles and reduced face height. It is necessary to re-programme muscles and joints to find a new stable place.
We make a small appliance called a deprogrammer that is worn during the day where possible, and at night. After 3 weeks we record a consistent bite that is very comfortable. The facial muscles relax and clenching, grinding and facial discomfort often disappears.
Once we have established a new bite, we scan and start designing with Digital Smile Design.
Step 3: 3D Digital Planning
First, we analyse the face and decide on the correct midline, smile curve and length of the teeth.
The design process is a careful planning exercise in 3D, using scans, X-rays, photos and facially driven tooth position to create harmony in the smile. These images show some of the detailed digital design we undertake to get precision, predictability and a smile that is in harmony with facial proportions and soft tissues.
Analysing from all angles.
Top teeth with new shapes.
Design by Digital Smile Design.
Step 4: Test Drive Your Smile
Once the design was finalised, we scheduled a Mock-Up appointment so that our patient could test-drive his new smile. By seeing and feeling his new smile, our patient got a glimpse of the emotional impact it would have on the rest of his life.
The Mock-Up is also an important stage where the patient can visualise and understand their treatment alternatives. Our patient could see what shapes and colours he preferred.
Before (Left) and After (Right) Mock-Up.
Final: Porcelain Restorations On Upper Teeth
Porcelain restorations were designed to restore length to 8 upper teeth. The result is stunning, and these are hard wearing, very durable material.
The patient was extremely happy with the final result.