If this case looks similar to another on my site, it is because this is a family relation. Mom was so pleased with what we had done for her that she decided to do the same for her son. Again, direct bonded composite, conservative and will look great for years. Can easily be replaced or redone if needed someday. With some offices, this type of treatment takes hours, if not several visits over several days. I, with my ceramist, have developed a technique that makes this a much less time consuming procedure, while yielding a excellent result. While not quite perfect in my eyes, this case took us about 3 hours to complete, which is a long appointment, but not too long for the amount of work and the results that we accomplished. A nice result, that lead to a smile that was still glowing as he walked out of the office. This was a fun morning!
Many times orthodontic treatment does not totally solve the problem. That is the case with this patient, who was referred to me by her orthodontist. She had what we refer to as a tooth size to arch shape discrepancy. Or put another way, she has small teeth. So after her orthodontist got everything straight, we were tasked with closing the spaces. The more permanent way to approach this would have been to use porcelain veneers, either “prepless” or traditional. But due to various reasons, this patient wanted me to close her spaces with composite bonding. And it looked great. This is all superficial, thus very conservative and when it begins to wear and show, she will still have the opportunity to replace this with porcelain. But until that time, a pretty lady has a very pretty smile! Thank you to the patient (and Dr. Groves) for allowing us to be a part of her care.
Sometimes teeth just grow in shaped incorrectly. A common example of this is “pegged” shaped lateral incisors. This sharp 16 y.o. young man has just come out of braces and needs to have both of his lateral incisors shaped correctly by adding composite resins directly to them. This is very conservative as it usually involves little to no preparation of the tooth structure, and is a totally additive process. In this case this patient did not even need to be numb. It took us a little over an hour to do both sides, and sorry for the array of photos, I forgot to take the true before. But you can see that we achieved a nice conservative result for him. In time these will need to be replaced, and we will use porcelain veneers at that time. This procedure is to keep him happy until he is old enough for them.
A lot of chipped teeth happen in the summer courtesy of the old swimming pool. Sometimes they are more serious than this and require more treatment, but most are of this nature and can be replaced with simple composite bonding. Using layers of different colors and opacities, we can pretty much replicate the color, translucency and depth of the natural tooth’s characteristics. This patient chipped her tooth on the side of the pool, and her pedodontist referred her to us to repair it. This is a very conservative repair and should last the patient many, many years. Thank you for allowing us to take care of you. I am glad that it was not much worse. Let’s all be careful out there. But when accidents like this patient’s occur, we will be here for you. Dr. W.
Treatment: Direct Bonding with Composite I am fortunate to work with a couple of Pedodontists who refer to me cases such as this. The child fractured his front tooth, and at his age the only way to fix it is with direct composite bonding. In restoring this tooth we must pay attention to not only shade, but the amount of translucency and the anatomy and surface texture of the surrounding teeth. We need to restore this tooth so that no one knows it was ever broken. And I think we did. A tooth that has been damaged like this one needs to be followed to make sure there is no nerve damage. Composites strongly and predictably seal and reinforce the remaining tooth structure giving the nerve of the tooth a great chance to heal and remain vital. —Dr. W.
If being incredibly cute would keep you from being accident prone, this child would be invincible. But accidents do happen, and then it is our job to fix it. By layering different opacities of composite and matching the incisal translucency of the adjacent teeth, we are able to fix it in such a way that the end result is invisible. The best result we can have as a dentist is doing our job so well that no one knows what we did, or that we were there. If our end result is invisible, we did our job we. This little patient will need braces in the future, and this restoration will not prohibit that. All will be well!