Category Archives: Case album

Uneven crown

Case1AA1

Case1AA1

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

AA002

Her left front incisor is shorter than her right front incisor

AA003

AA003

Her smile line is pleasant, the short left front incisor is the only distraction.

AA004

AA004

We mock up a proposed tooth using composite resin to test out the effect on her smile. Patient was pleased.

AA005

AA005

Close up of the mock up to mirror her natural front right incisor. We use this mock up as a guide.

AA006

AA006

Crown lengthening was a small gum surgery to make the tooth longer.

AA007

AA007

It takes 8 weeks for the gum to stabilize. We refined the temporary crown during this period.

AA008

AA008

When the gum has healed, we removed the temporary crown to take impression.

AA009

AA009

The final crown looked natural. Gum has adapted well to the ceramic crown.

AA010

AA010

The final result is a natural and balanced smileline.

AA016

AA016

A happy patient.

Gap between teeth

Case 2AC

Case 2AC

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

AC002

Center line of the upper front incisors did not match the lower.

AC003

AC003

Gaps are visible when he smiles.

AC004

AC004

Note missing teeth and gaps of the upper jaw. There is a retained baby tooth.

AC005

AC005

Generally his teeth are small. We realized that veneers are needed to increase the width of his front teeth.

AC005A

AC005A

Braces were put on both upper and lower teeth to move teeth. It took 24 months.

AC006

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

AC007

Once the final position of teeth confirmed, upper braces was taken out to allow implant placement.

AC008

AC008

Upper left side before implant placement.

AC009

AC009

Implants ready for exposure.

AC010

AC010

When the bone has grown around implants to become firm, temporary posts were put on to make temporary teeth.

AC011

AC011

Upper front teeth restored with veneers.

AC012

AC012

Side view after completion of treatment.

AC012a

AC012a

The final implant crowns and veneers appeared natural.

AC013

AC013

Three dental implants were placed in the upper jaw.

AC014

AC014

The lower jaw did not need implants because the orthodontist managed to close all the gaps.

Worn and shortened teeth from grinding and bruxing

Case3DB

Case3DB

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

DB001

Patient smile line showed short lower face and strong cheek muscle indicative of overactive chewing or bruxing.

DB002

DB002

Upper front teeth are much shorter than lower front teeth. They are in

DB002A

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

DB002B

During normal function, upper and lower teeth only come into contact for 15 minutes in 24 hours.

DB003

DB003

The upper front teeth are so worn that dentine was exposed. During bruxing, teeth come together for hours. In

DB004

DB004

The lower front teeth were mildly affected. However, the molars had repeated history of lost fillings---another signs of bruxism.

DB005

DB005

Patient facial proportion was restored.

DB006

DB006

The upper front teeth now overlap the lower front teeth so that they are protected from the bruxing forces.

DB006A

DB006A

Natural appearance of crowns

DB006B

DB006B

Side view of bite

DB007

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

DB008

Lower molars were restored with gold onlays.

DB009

DB009

Upper front teeth were replaced with porcelain fused to high-precious metal crowns for cosmetic results

Misaligned teeth and jaw

Misaligned

Misaligned

D is a cheerful homemaker with a

DM001

DM001

Her chin and lower jaw swing to the right as she bite together.

DM002

DM002

Teeth on her right side is higher than the left side.

DM003

DM003

Most of her upper teeth were filled with amalgam fillings. Her right front teeth were capped with crown and bridge.

DM004

DM004

Some of her lower back teeth had amalgam fillings. Her teeth were not symmetrically arranged.

DM004A

DM004A

Her smile line is inverted.

DM004B

DM004B

The upper left front teeth are worn and are shorter than the right counterpart.

DM005

DM005

A splint was worn to reposition her lower jaw to the center.

DM006

DM006

The splint also increased the height of her bite.

DM007

DM007

This splint is made of hard plastic. It is worn at all times except during meals.

DM008

DM008

Once the new bite felt comfortable, a set of temporary crowns were made according to the new bite.

DM009

DM009

The smile test to check out all cosmetic aspects. Note her chin is repositioned to the center.

DM010

DM010

Her smile line is low, gum does not show when she smiles. We have decided not to change her gum line.

DM011

DM011

All her upper and lower teeth were capped with full ceramic crowns and bridges.

DM012

DM012

Teeth which she can be proud of.

DM013

DM013

The smile line is now in harmony.

DM014

DM014

Side view of well constructed crowns and bridges.

High showing gums

Case-5JE

Case-5JE

High showing gums

JE001

JE001

His smile line is high showing gums.

JE002

JE002

His front teeth were prominent and uneven.

JE003

JE003

Mild overlap of upper front teeth.

JE004

JE004

Gum recession of the lower front incisors.

JE005

JE005

His upper teeth were healthy with minimal fillings.

JE006

JE006

His lower front teeth were rotated. Minor amalgam fillings in the molars.

JE007

JE007

Teeth in good condition are more suitable for veneer rather than crowns.

JE007As

JE007As

Gum recession noted in the upper left canine.

JE008

JE008

Final result with upper and lower veneers.

JE009

JE009

Gum recession was treated with gum grafting.

JE010

JE010

Note gums are well adapted to the ceramic veneers.

JE011

JE011

Realistic appearance of veneers.

JE012

JE012

Unevenness was camouflaged with veneers.

JE013

JE013

Veneers are bonded to the front side of the teeth.

JE014

JE014

Veneers on lower teeth.

JE015

JE015

Right side view.

JE016

JE016

Left side view.

JE017

JE017

Improved colour and harmony of his smile.

JE018

JE018

Happy smiling patient.

Implant to replace broken tooth

Case6LSY

Case6LSY

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

LSY001

Upper front crowns showing leaking margin.

LSY002

LSY002

Broken tooth from excessive biting pressure on front teeth.

LSY002A

LSY002A

Upper front teeth are restored with crowns and bridge.

LSY003

LSY003

Lower front teeth are crowded and rotated.

LSY004

LSY004

Lower right molar teeth are missing. Lower teeth had overclosed.

LSY006

LSY006

Lower left molar tilted. Upper left molar is non-functional.

LSY007

LSY007

Final results achieved with implants and crowns.

LSY008

LSY008

Upper broken teeth were removed and replaced with dental implants.

LSY009

LSY009

Lower front teeth were restored with crowns, back teeth with implant crowns.

LSY010

LSY010

Teeth are arranged so that there is more space between upper and lower teeth.

LSY011

LSY011

The missing lower molars were replaced with implant crowns.

Failed upper bridge

Case7CMY

Case7CMY

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

CMY001

Note the long span bridge of 10 teeth from right to left. Caries developed under bridge.

CMY002

CMY002

Upper left first molar was removed. Upper right first and second molars are missing.

CMY002A

CMY002A

Lower right second premolar and lower left first molar is missing.

CMY003

CMY003

Lower right second molar tilting into the empty space.

CMY004

CMY004

There is grey-brown tetracycline stain of the lower front teeth.

CMY005

CMY005

Upper front teeth are restored with implant-supported bridge.

CMY006

CMY006

The upper right molars are replaced with 2 medium size implants.

CMY007

CMY007

Bone graft and soft tissue graft added volume to the front gum.

CMY008

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.

Veneers

Case8NM

Case8NM

NM01

NM01

Patient was not happy with her front teeth. It has large fillings and space between teeth.

NM02

NM02

Space between front and side teeth.

NM03

NM03

Teeth are well aligned. Other front teeth had no fillings.

NM04

NM04

Four veneers transformed her smile.

NM05

NM05

Good colour match with other teeth.

NM06

NM06

Veneers closed black triangle between teeth.

NM07

NM07

Very conservative preparation.

NM08

NM08

A very happy patient.