So to review….this patient has a fractured front tooth that will need a crown. But he’s not ready for that yet, and still wants to have a better looking smile.
A few minutes later, the tooth is once again presentable and will function well for the near future.
So this gentleman is not ready to crown his teeth, but there is a large fracture. It doesn’t hurt, but esthetically it looks less than ideal. He’d like a temporary ‘fix’ until we can crown it (which, again, he is not ready to do right now). What to do???
This young man has recently finished braces, and the orthodontist sent him to us because of the gap that was left between these two teeth. All the other teeth were placed ideally, and if this space was closed the other teeth would be in the wrong spot so they would not function correctly or look right. So we talked about bonding to solve the problem.
And so to review…..we started with two very small lateral incisors.
Small laterals before ortho and bonding
Ultimately we decided to go with the first discussed option…..leaving ideal spaces and then bonding them closed. Now I have to warn you—-the orthodontist has to be VERY good for this work. If not, you will end with two teeth that do not match in size or proportion. Here’s the first tooth, before and after:
Small tooth with spaces before bonding
Tooth after bonding to close spaces and correct the size
We (the orthodontist and myself) discussed our two options.
1. Move the lateral incisors into the middle of the spaces, bond the teeth to make them ideal for size and proportion, finish the orthodontics.
2. Complete the ortho, leaving ideal spacing for the laterals, THEN bond the teeth after the orthodontics is finished.
Both are fairly difficult. We’ll talk about them in separate posts.
Your discussion should revolve around the ultimate goal for these teeth. If the size discrepancy is small, then everyone may agree to simply close the spaces during the orthodontic treatment. However, many times the size difference is too great to do this:
Just saw this patient and thought we’d take photos of the procedure because I could see a ’shadow’ in the tooth, but absolutely nothing on her x-ray. Having done many teeth similarly, I thought this would be a good teaching case. Here’s a photo of the tooth before we started:
Tooth with cavity
And a few minutes later, we were finished! The patient was VERY happy with the results!
Newly repaired tooth
With the broken piece bonded into place this patient will be able to function just fine until he can get back with us to make a new crown for this tooth and the one next to it. He was just relieved to have the tooth back together in one piece!
Bonded broken porcelain
