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.
Now came the fun stuff. We saw Robert one last time to fine-tune his bite and check for any other minor adjustments. Afterwards Robert was kind enough to let me take a few portrait photos. I was really proud of the final results and so was he!
Here’s a ‘before’ portrait:
and ‘after’… what a change!
Looking at Robert’s final result, I have to agree with him. Even smiling as big as he can, no one can see the gum-line area of his crowns. In this case the tissue did not need to be changed to have an excellent final result. If his lip rose above the tissue/crown meeting area at the gum-line, these crowns would not have been as pleasing to look at. Here he is at ‘maximum’ smile:
We’ve talked a bit about getting the teeth in the right position before restoring, or fixing them. Now let’s say they’ve been moved correctly, or are already where they need to be. What’s the next step?
Here’s another example of what we discussed. Robert came to me at the end of his orthodontic treatment. His orthodontist had moved his teeth to the right general area for restoring. Robert and I went over the options and decided to fix his top teeth first, followed by the lower front teeth later. He wasn’t happy with the color and shape that he currently had. I think you’ll agree: 
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.
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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?
I’ll admit something up front…I’m a much better dentist than graphics designer! With that in mind, take a look at my rendition of what some patients look like after having unnecessary extractions before orthodontics. Yes, as I stated earlier, the TEETH are straight. But the ultimate result is a ‘caved in’ or ‘pulled back’ look to the lower face. The next time you take a look at someone who has braces or needs them, keep this in mind.
And don’t worry….I won’t be trying a new career as a Photoshop editor!
So to continue with the last post. Yes, I know I’m a Charlotte dentist, and not orthodontist. But I still find the current state of moving teeth (orthodontics) to be as much an art as science. As I discussed before, straight teeth are not the only ultimate goal. 
The final ‘profile’ of the patient is just as important. Extracting a bunch of teeth to expedite treatment ultimately only helps one person….the orthodontist. When does someone need to have teeth pulled? It sure varies on a case-by-case basis, but one thing is absolutely true…..it happens WAY too often! Here’s a ‘normal’ profile after orthodontic treatment (with NO extractions!):
Saw an interesting case a few days ago. Lady had been told by a local ‘cosmetic’ dentist she needs a slew of veneers and was looking for a second opinion. She didn’t like the spacing or positioning of her teeth and was concerned with the difference in the level of the gum tissue around her front teeth. After examining and photographing her teeth I determined there was NO reason to have veneers. The teeth were perfectly healthy with no fillings or excessive wear. They were the correct ’size’ and proportion. A few months with Invisalign braces, a trip to the gum specialist for a slight alteration in her tissue heights, and some whitening (or bleaching) is all she needed. She’s heading to see the orthodontist to get started!
How many times would she have been told she needs veneers, when some ‘minor’ tooth movement is all that is necessary?
Check out a brief description of veneers here: Veneers
