Advancements in a variety of dental technologies, porcelain fabrication processes, specialized bonding compounds and more recently, new choices between noninvasive (no prep) and minimally invasive (low prep) dental components have enabled patients to obtain nearly any cosmetic change or result they want in their smile. Even the term "makeover" has become a common term, thanks to the popular ABC TV network program.
One popular version of a smile makeover involves the use of porcelain veneers to create new enamel "jackets" that do a great job of resizing, reshaping, and creating the effect of new, bright, and beautiful teeth and smiles.
Crowns are used in cosmetic makeovers when veneers are proven to be inadequate due to: severe staining, a rotated tooth that can't be laminated, an old crown that is worn out (can't put veneers on crowns reliably), long-term wear and tear on the biting surfaces (loss in tooth height), or simply having missing teeth.
Smile Makeover Failures
We have all seen and heard the stories of true makeover magic. Through the creative use of several different combinations of products, treatments, and porcelain bonding create life-changing new smiles, superb cosmetic change, and cumulative effects on his/her life.
Little is heard about the failures, however. They exist in the form of horror stories...dentistry gone bad-- crooked smiles, mismatched teeth, jaw joint and ear pain, migraine headaches, veneers that discolor or fall off, bleeding gums, extreme tooth sensitivity, etc.
As mentioned elsewhere on our website, failures rarely occur due to product failure. Isolated issues (like a veneer popping off or a new crown causing immediate sensitivity or pain) can be remedied quickly with a revised technique to "repair" the symptom caused by faulty technique.
A failure in full mouth smile reconstruction, however, is much more complex and occurs for either a single technical error or oversight that mushrooms into a series of seemingly independent failures.
The Best Reconstruction that Lasts the Longest
Everyone considering a full mouth smile makeover (or dental function rehab) of course wants the best that modern dentistry has to offer with an outcome that lasts a long time.
Crowns, bridgework, veneer products, and implant bridges are known to last up to 20-30-35 years or more. With proper care and good oral health habits, premium products endure surprisingly well.
The best reconstructive plan -- to create a plan of treatments that includes an assessment of the things that need (or should) be done to eliminate or minimize technical errors that will cause future failures in cosmetics or dental function.
Functional Causes of Cosmetic Needs or Desires
This confusing topic usually makes the most sense to those who have the unfortunate experience of a cosmetic treatment failing.
The cosmetic features of any (untreated) smile are typically an accumulation of: the basic dental care we experienced as children; orthodontic treatments we did or didn't receive during adolescence; eating habits and food preferences; life-long flossing and brushing regimens (yes, nobody is perfect); and functional relationships we all end up with in early adulthood.
Cosmetic features often become combined with functional issues by the time we reach adulthood-- again reflecting, with more focus, on what we did or didn't do with orthodontic treatments, wearing our retainers consistently, getting too many extractions, sports and trauma injuries that seem to grow, etc.
Accommodating the Cosmetic Patient
Patients seeking cosmetic treatments or outcomes have a rough or exact idea of what they want to see. A smile that not only looks good, but seems to "fit" their overall facial structure-- not too big, not too gummy, not too narrow, etc, but "just right" with the right amount of whiteness or brilliance. For some it may be a desire to look better, maybe more attractive.
The adults who have had "incomplete or insufficient treatment histories" (as mentioned above) will typically have the usual cosmetic goals but with added requests like: get rid of the gaps, make the teeth look even, line up the teeth better, or straighten out a couple of teeth.
As doctors, we all strive to be the best dental health provider we can be. Our goal is to provide exactly (as much as possible, at least) what a patient wants. It is the strength of that relationship and the quality of communication and education that influences the final outcome of nearly any complex treatment.
The Reconstructive Dental Practice Defined
Practices that routinely maintain a focus on what makes things look the way they do can be expected to always include one recommendation, among several, that provides a map for getting the most out of what is best for achieving the best.
For some patients, recommendations that don't have any immediate apparent value may become of little interest to the patient.
Herein lies the situation where a patient's reasonable and sound decision (based on time factors, number of appointments, length of treatment plan, cost, etc) later plays a role in having a makeover that doesn't have the cosmetic or functional endurance everyone wants out of any dental treatment.
Cosmetic and Reconstructive Case History Example
Our patient (pictured here in several pre-treatment and post-treatment photos) first presented in our office with a request for treatments that would make her teeth look brighter (for a nicer smile) and to "fix" her chin, which she thought stuck out too much.
Because she was born and raised in a foreign country, she didn't have access to treatments that are considered to be routine orthodontic services. A treatment history of treating common childhood illnesses caused the dark bands of staining on almost all of her teeth (severe tetracycline stains).
During routine occlusal studies and analysis, Dr. Nazarian determined that certain orthodontic treatments could be provided on an accelerated schedule that would repair or fix the orthodontic abnormalities of an adult underbite, combined with treatments to address a minor crossbite condition.
Because of the mismatched pairings of upper and lower teeth in several areas of her jaw, the patient soon understood that, while some tooth structures would respond well and endure with custom veneer laminates, there were several other tooth relationships that would destroy a veneer application because of the biting characteristics of each upper and lower tooth pair.
Biting surface realignment can be achieved through traditional orthodontics (long term), orthognathic surgery (costly and time consuming), and custom fabrication of dental components (crowns) that effectively reconfigure and shift the occlusal surfaces.
Adjusting Bite Dynamics
Since the client wanted to have her lower jaw repositioned, Dr. Nazarian determined that, for creating the correction she was seeking, a complex treatment of short-term orthodontics could simultaneously open the bite, shift the lower jaw into a more natural position, and also tilt the lower teeth into a more desirable position. The repositioned lower teeth were then fitted with either veneers or custom crowns to optimize the positioning of biting surfaces between the upper and lower jaw.
The adjacent picture shows the actual crowns and veneer products that were used to alter the biting surfaces of nearly every tooth in the lower jaw as a means for addressing the patient's cross bite issue.
Cosmetic and Reconstructive Drama
The premium grade of porcelain for creating the appearance of new tooth enamel on the tetracycline-stained teeth successfully blocks the stain from being seen.
The combination of short-term orthodontic straightening and bite opening moved the jaw into the position that Mother Nature failed to produce. Lastly, Dr. Nazarian's choices of veneers and porcelain crowns on different tooth structures assure that occlusion-caused breakage will not occur.
The Elements of Successful Reconstructive Dentistry
Patients who have had significant issues with a bad or a disturbed bite will tend to focus more on the functional aspects of treatment. As with most reconstructive dentists who thrive on achieving the most dramatic results possible with any given choice of treatments and products, Dr. Nazarian maintains a watchful eye on the dynamics of change desired by patients.
Patients who prefer cosmetics over function are assured bite factors are factored into aesthetic treatments. Patients who are addressing major bite correction or alignment issues are provided with a choice of reconstructive components that are attractive and complement the functional changes.
Call our office at 248-434-6117 to schedule a consultation or use our online Consult Request Form to learn more about cosmetic and functional dental makeover procedures.