A is a 20 something professional who broke her front tooth in her teenage years. She had a crown put on the tooth but it looked uneven. She wanted to improve her front tooth.
Treatment sequence:
Mock up
Crown lengthening
Prototype
Full ceramic crown (Emax)
AA002
Her left front incisor is shorter than her right front incisor
AA003
Her smile line is pleasant, the short left front incisor is the only distraction.
AA004
We mock up a proposed tooth using composite resin to test out the effect on her smile. Patient was pleased.
AA005
Close up of the mock up to mirror her natural front right incisor. We use this mock up as a guide.
AA006
Crown lengthening was a small gum surgery to make the tooth longer.
AA007
It takes 8 weeks for the gum to stabilize. We refined the temporary crown during this period.
AA008
When the gum has healed, we removed the temporary crown to take impression.
AA009
The final crown looked natural. Gum has adapted well to the ceramic crown.
AA010
The final result is a natural and balanced smileline.
B is a young entreprenaurer in his 30s who is unhappy about gaps between his teeth. Even when he lost his baby teeth, some permanent teeth never grew. He was thinking about bridges to fill these gaps. After lengthy discussion, we have decided for combination of orthodontic treatment (braces) and dental implants.
Treatment sequence:
Orthodontic treatment
Space planning with bonding
Dental implants
Veneers
Treatment duration: 30 months
AC002
Center line of the upper front incisors did not match the lower.
AC003
Gaps are visible when he smiles.
AC004
Note missing teeth and gaps of the upper jaw. There is a retained baby tooth.
AC005
Generally his teeth are small. We realized that veneers are needed to increase the width of his front teeth.
AC005A
Braces were put on both upper and lower teeth to move teeth. It took 24 months.
AC006
Generally his teeth are small. We realized that veneers are needed to increase the width of his front teeth.
As teeth have moved to the desired position, we use composite bonding to widened the teeth temporarily and to secure the position.
AC007
Once the final position of teeth confirmed, upper braces was taken out to allow implant placement.
AC008
Upper left side before implant placement.
AC009
Implants ready for exposure.
AC010
When the bone has grown around implants to become firm, temporary posts were put on to make temporary teeth.
AC011
Upper front teeth restored with veneers.
AC012
Side view after completion of treatment.
AC012a
The final implant crowns and veneers appeared natural.
AC013
Three dental implants were placed in the upper jaw.
AC014
The lower jaw did not need implants because the orthodontist managed to close all the gaps.
C is a working professional in his early 40s. He grinds his teeth unconsciously. This has resulted in wearing and shortening of all his teeth. One of his molar teeth was so worn that nerve was exposed. He needed root canal treatment to relieve pain.
As he travels frequently for work, all treatment had to be well coordinated.
The goal of his treatment is to restore his teeth to normal length and to protect worn teeth and to design a bite that is not damaging.
Treatment sequence:
Crown all upper teeth and selected lower teeth
Treatment duration: 1 month
DB001
Patient smile line showed short lower face and strong cheek muscle indicative of overactive chewing or bruxing.
DB002
Upper front teeth are much shorter than lower front teeth. They are in
DB002A
Bruxism is a term used to describe hyperactivity of the jaw muscles which bring teeth together at times other than eating and chewing.
DB002B
During normal function, upper and lower teeth only come into contact for 15 minutes in 24 hours.
DB003
The upper front teeth are so worn that dentine was exposed. During bruxing, teeth come together for hours. In
DB004
The lower front teeth were mildly affected. However, the molars had repeated history of lost fillings---another signs of bruxism.
DB005
Patient facial proportion was restored.
DB006
The upper front teeth now overlap the lower front teeth so that they are protected from the bruxing forces.
DB006A
Natural appearance of crowns
DB006B
Side view of bite
DB007
The molar teeth were replaced with gold crowns because gold being a soft metal, can adapt to changes in bite. It can be worked to very fine thickness.
DB008
Lower molars were restored with gold onlays.
DB009
Upper front teeth were replaced with porcelain fused to high-precious metal crowns for cosmetic results
Healthy female in her 50s came to see us for her broken front tooth. All her upper crowns are leaking. She had lost most of her lower back teeth. As there are no back teeth to bite on as support, all her chewing was done by the front teeth. This had caused increased pressure at the front teeth causing them to fail.
The goals of treatment is to remove all hopeless teeth, replace missing back teeth and restore broken teeth.
Her treatment took 8 months.
Sequence:
Removal of broken upper teeth, lower tilted tooth
Dental implants for lower back right and left side
Lower front crowns
Lower back bridges
Upper front dental implant and crowns
LSY001
Upper front crowns showing leaking margin.
LSY002
Broken tooth from excessive biting pressure on front teeth.
LSY002A
Upper front teeth are restored with crowns and bridge.
LSY003
Lower front teeth are crowded and rotated.
LSY004
Lower right molar teeth are missing. Lower teeth had overclosed.
LSY006
Lower left molar tilted. Upper left molar is non-functional.
LSY007
Final results achieved with implants and crowns.
LSY008
Upper broken teeth were removed and replaced with dental implants.
LSY009
Lower front teeth were restored with crowns, back teeth with implant crowns.
LSY010
Teeth are arranged so that there is more space between upper and lower teeth.
LSY011
The missing lower molars were replaced with implant crowns.
Female in her 50s presented with toothache of her upper tooth under her bridge. The upper left molar had cavity under her bridge. Her upper bridge was sectioned and removed. She became very vary of bridge and would like to have implants to replace her missing teeth. However, there was not enough bone at the front under her bridge.
Treatment sequence:
Section bridge and remove upper left molar
Bone graft at upper front
Implant to replace missing upper and lower molars
Upper front implants
CMY001
Note the long span bridge of 10 teeth from right to left. Caries developed under bridge.
CMY002
Upper left first molar was removed. Upper right first and second molars are missing.
CMY002A
Lower right second premolar and lower left first molar is missing.
CMY003
Lower right second molar tilting into the empty space.
CMY004
There is grey-brown tetracycline stain of the lower front teeth.
CMY005
Upper front teeth are restored with implant-supported bridge.
CMY006
The upper right molars are replaced with 2 medium size implants.
CMY007
Bone graft and soft tissue graft added volume to the front gum.
CMY008
The lower left molar was replaced with a small implant. As we keep the natural teeth as single individual crowns, patient can floss and keep teeth clean preventing caries.