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
This tooth recently had a root canal. The specialist referred her so that we could improve the esthetics of the corner or edge. Our solutions included a veneer, a crown, or bonding. Although the tooth may need the other more invasive procedures later, we opted to try and improve the look by altering the existing bonding.
Tooth before new bonding
So we cleaned the cavity out of both, filling the front tooth and placing a porcelain crown on the one next to it. The resulting change was dramatic! And our patient was VERY happy to get both of these teeth fixed….and looking MUCH better! (Again, for reference, the old porcelain crown- with the obvious margin where the tooth and crown meet-is located directly behind our new crown).
Crown and filling-after
So to review: A wakeboard accident cracked this tooth:
Cracked tooth
His mom was concerned about fixing the tooth and making it look ‘natural’……but I think we were really successful, don’t you??
Repaired tooth
Repaired tooth
A ‘wake board’ is what took care of the edge of this tooth. Ideally we’d like to retain the fractured portion of the tooth and try and bond it back onto the remaining tooth structure. When fit properly the crack is almost imperceptible and the tooth remains stable for a very long time. But since this was long-gone (sitting at the bottom of a lake somewhere) we would have to re-build the tooth out of composite.
Fractured tooth
Cracked tooth
A fun day of boating led to this cracked tooth. There was no hot, cold, or bite sensitivity so it became and esthetic issue. What was the best course of action to quickly repair this tooth?
