Cosmetic dentists have the experience to know when a few millimetres extra in the right place or a few millimetres less can make all the difference in the way the teeth appear, and even quite subtle changes such as reducing the pointed tips of the two upper canine teeth can significantly improve a smile.
Dental contouring is commonly used to alter the length, shape or position of the teeth. Where front teeth are imbricated, i.e. slightly overlapping it is sometimes possible to carefully trim or strip away some enamel along the sides of the teeth to give a better appearance. This can be achieved with long thin tapered diamond burs and abrasive strips moved back and forth between the teeth. Then the teeth are smoothed and polished. Removing just a thin layer of enamel doesn’t harm the teeth in any way. The whole procedure may be carried out in one go or may require an additional visit to check the patient’s satisfaction and achieve the best result.
Contouring teeth may also help correct small problems with the occlusion or bite. Sometimes there may be a slight premature contact when closing the jaws together and this can cause a small deviation of the lower jaw. This is not always easy to accurately diagnose but if the prematurity can be located it can often be removed with judicious grinding, allowing the jaws to then close smoothly in the correct vertical plane.
Crooked or mis-aligned teeth can often be straightened in the adult by using either orthodontics or porcelain veneers, or a combination of both. Only mild to moderate crowding or protrusion can be aligned with veneers alone, but if orthodontic treatment is undertaken first it can often improve the position of teeth to a point where it’s then possible to overcome the remaining slight irregularity by using porcelain veneers to get a proper alignment of all the buccal surfaces so that the smile looks perfect.
Combination treatments are ideal for crowded and misaligned teeth that are also badly worn, discoloured or chipped and broken. It may be necessary to use a combination of composite bonding, porcelain veneers or crowns in order to achieve a good cosmetic result where there are several problems with the teeth, with some preliminary orthodontic correction as well.
A recent innovation called the Inman aligner is a useful way to straighten just the four front teeth, either upper or lower, by means of an appliance which applies counteracting forces on the front and back of the teeth. The pressure is exerted on the protruding parts of the teeth with the result that they are gradually pushed into line. Crowding of just the front teeth is a fairly common occurrence and this kind of treatment shows a lot of promise as a relatively straightforward way to correct the problem within the space of a few weeks or months.
Sometimes crowded front teeth can be fairly quickly improved using an Inman aligner prior to other forms of cosmetic treatment such as veneers. This is very useful in avoiding the necessity for otherwise radical reduction of tooth tissue that would be needed with extensive crowning alone.
Another recent innovation is the Invisalign system which uses clear acrylic aligners that snap over the teeth applying pressure at precise points to gently move teeth. A series of precision computer designed aligners is required to keep up the momentum to re-position the teeth as required over a period of months.
Lingual braces are another modern way for adults to get their teeth aligned without unsightly metal appliances being visible since they attach to the backs of teeth rather than the front as do conventional orthodontic appliances.
Porcelain veneers have become a popular method of re-shaping teeth because they can improve the colour of teeth as well as the shape, and are very versatile. Porcelain veneers are wafer thin slices of porcelain that are made to exactly fit the front surface of the natural teeth but can be made to a different shape themselves so that they can make a tooth longer or wider, or even make a misplaced canine or a peg lateral look like a normal lateral incisor, for example. The porcelain veneer involves a slight reduction of the surface enamel of the natural tooth in most cases and the veneer is bonded on with a low-viscosity resin cement. Once bonded in position the veneer becomes virtually part of the tooth and is quite strong. The thickness of the veneer porcelain can be adjusted in the making so that when all are fitted they match up perfectly on the buccal aspect and the smile is more regular. Porcelain veneers can thus close gaps between front teeth or compensate for teeth that are worn down or inherently diminutive.
If too much tooth substance would need to be removed for veneers, thus endangering tooth pulps, then it is necessary to consider alternatives which might entail orthodontics or possibly full crowns.
In cases where patients have a combination of problems such as crowded teeth which are also heavily worn it requires a consummate analysis of the bite before a treatment plan can be formulated and is more likely to involve full crowns on a number of teeth in order to achieve a proper stable occlusion as well as a nice appearance. Careful treatment planning is the key to success in cases involving more than one problem or severe problems in any one area.