Mar 14

I don’t like the way my teeth look, can you fix them?

I hear this statement a lot from patients.  Shade or color may be the easiest fix, however, careful assessment and patient questioning of this complaint is very important.

In smile design, a very thorough collection of information is required before proceeding with any restorative treatment or alteration of tooth structure.

Proportional size and shape of the six front teeth and the relationship to one another is critical.  The body morphology or tooth morphology that is pleasing esthetically is very well known.

For instance, the ideal porportional size for the two front upper center incisors should be about 10.5 mm in length with a width of about 8 mm.  This width to length ratio is critical.

On occasion, I have a patient state, “I think my teeth are too big, what can you do to change them.”

A measurement of the width to length will find that the teeth fit the 8×10 requirement.  However, an exam will reveal that the gum between the teeth, what dentists call the papillae,  is short.   Ideally the gum should extend to 40% of the length of the tooth.  When the gum is at a deficit, the teeth look too big to the observer’s eye.

When closing spaces in front teeth, careful assessment of the final “size” proportion needs to be taken into account.

Many times patients arrive from elsewhere stating that they are displeased with either a direct bonding that has been performed or some porcelain veneers.

When I examine this patient, I find a perfectly performed technical procedure.  However, the patient and the doctor “painted” themselves into a corner with the final size.

By attempting to close a space between two front teeth, what we call a diastema, the teeth became square.  The critical width to length ratio of 80% is gone.

When a tooth is 10×10 mm no matter how white or naturally characterized it has a “Chicklet” look.

This body morphology size will be only amplified on the two front teeth when the lateral incisors, the teeth next to the two front teeth, are smaller which is usually the case with a midline  diastema.

I will explain to the patient the space needs to be divided or shuffled between all four front teeth.

With space for the lateral central incisors midline half (what is called the mesial) being created by preparing the going backward third of the two front teeth (what is called the distal).

Many times in order to demonstrate this on a patient’s own tooth structure, I will perform it on a plaster model of the patient’s own teeth.

This diagnostic step (is called a Master Diagnostic Wax Up).

The teeth and the gum line are recreated in wax just like a Madam Trudeau wax museum.

Patients when seeing these models are always thrilled with the appearance and this gives them a behind the scenes view of the work that needs to be accomplished.

For porcelain laminates Dr. John Dibling will even make the patient’s temporaries in the shape of the diagnostic wax up.  This way we get a test run of size, shape, width, color  and length before completing the final restoration.

Temporaries should always resemble the premanent restoration as close as possible.  So, as the permanents are being fabricated at the lab, we can decide if any alteration needs to be made during the construction phase.

So when the permanents are delivered, there should be no surprises for shade, shape, length or width.

Planning is critical and you can see testimonials of Dr. John Dibling’s patients on our website so you can hear for yourself the care,  planning and delivery that was taken in their treatment.