What wasn’t covered got trashed. Thank goodness we were planning on getting new carpet! The old stuff looked like a kindergarten class has a day of free-form painting!
I keep talking about Windows XP and, behold! There’s a ‘new’ version coming out….well, sort of. Read more about it here:
Windows XP: The OS that won’t die?
Here’s a side view, after the final orthodontic movement:
To finish things off we thought we’d increase the width of the lateral incisors, too (they’re right next to the middle teeth).
After she completed the final phase with the orthodontist, she returned to me like this:
The orthodontist closed the gap, and these teeth are now in the correct position! But let’s look closer at the teeth on either side of these. What about their size?
The central incisors can then be moved together predictably by the orthodontist because the bonding that has been placed on these teeth has made their width ideal. Once they touch, he’s done! Also, he can then make additional room for the laterals, allowing for a more conservative preparation of these teeth, too. As we talked about before (See text here), one of the BIG advantages of involving the orthodontist is the ultimate outcome. The teeth are ideally positioned, the preparations can be more conservative, and the case will look better and be more stable.
The gum specialist asked about the size/proportion of Suzanne’s teeth. After examining her I thought the best solution was a combination of bonding and orthodontics. Since her front teeth were too small width-wise (from left to right) they appeared skinny and thin. These teeth will ultimately need veneers to correct this discrepancy. But until then, bonding is the solution. We decided to make her central incisors (her middle two front teeth) the CORRECT size with bonding. The orthodontist could then pull them together until the bonding touches. This way we know these teeth will be in the correct position to allow for very conservative veneer preparations.
Let’s take a closer look at her teeth.
Both the central and lateral incisor, the two pictured above, appear slightly small. They are quite long, but not wide enough. So this gives a thin, unflattering appearance to these teeth. Also, they are not the ideal size for her face (not pictured here). There are many causes for this, including the reasons we discussed before (gum tissue in the wrong place or improperly contoured). But to keep things moving, the answer is that these teeth are simply too narrow. They have the proper tissue height/contour. They just need to be wider to fit the space and her facial characteristics.
So Robert had his teeth positioned correctly, and now wanted a cosmetic enhancement. Our conversation revolved around a few things. First, he wanted ‘whiter’ teeth, but not ‘too’ white. He used the term ‘natural’. I was in agreement. Too often people get their teeth fixed with white ‘Chicklette’-looking crowns or veneers. They’re SO white that any characterization is lost. Since Robert is fairly fair-skinned, that would have looked horrible.
The many spaces that existed between his teeth could be filled in with correctly-sized teeth since the orthodontist had moved the teeth into the right general areas. My only other area of concern was the different levels of his gum line around these teeth. They were uneven and could be dramatically improved with a bit of recontouring. After careful consideration, Robert decided to leave them at their current level. He reasoned that he never smiled large enough to see them anyway!
Let’s look at a great example. Greg had front teeth that needed to be restored after having plastic (or composite) veneers for many years. But the spaces between his teeth were very large. To properly restore these teeth and make them look their best I recommended Greg see the orthodontist first. He wasn’t happy. Especially after he got the braces placed on his teeth.
. 
But the treatment time wasn’t too long and afterwards I was able to craft a beautiful new smile with only a few porcelain veneers. The ultimate result required less work, involved fewer teeth, and looked FAR better than if we tried the ‘instant’ method!
So to continue, the instant ortho craze has been fueled by people’s desire for an immediate change. And it can be impressive. Who wouldn’t want to walk in with a mouth full of yellowed, worn, misaligned teeth and leave with a gleaming, straight, gorgeous smile? Few things can change a person’s appearance as dramatically and easily.
But let’s look at it differently. If the same teeth can be moved to a more ideal position first, a few things occur. First, the final ‘look’ many times will be enhanced significantly because the spacing between teeth will be ideal, allowing for the correct size of the new teeth. Second, less teeth may have to be worked on to get this great new look, saving the patient money. Also, less work may have to be done on each individual tooth. What I mean by this is that a more conservative preparation (or less ‘grinding’ of each tooth) will occur if it is in the right spot.
Often the decision comes down to an ‘immediate’ fix versus one that takes a little longer, but frequently is more conservative. Which way would you go?
