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Broken and Leaking Fillings and Crowns, Uneven Tooth Wear,
Lack of Semetry, and Toothbrush Abrasion
Diagnosis
Patient #5 was ashamed of her teeth. Her central incisors were turned in at the midline and the incisal edges were severely worn. Her right lateral incisor was badly stained around the old, white filling. Her left lateral incisor was a crown with exposed dark margins which appeared very long. Both her right and left canines had toothbrush abrasion and her left lateral and canine were 3 to 4 millimeters higher than the right side. The large old silver fillings were severely leaking and broken.
Treatment
The lower anterior teeth and the upper canines were bleached approximately two shades lighter. Almost all of the back teeth were crowned with metal ceramic crowns. The toothbrush abrasion on the canines was restored with white filling. The four front teeth were crowned with metal ceramic crowns. The incisal edges of the central incisors were brought out to the lateral incisors incisal edge, creating a boundary which matches the lower lip. When the teeth "smile at you" rather than frown they are more attractive. In order to make the left lateral incisor appear less long we made the top look like the root of the tooth with recession.
Future Treatment
She is very happy with her teeth. We see her every 6 months.
She grinds her teeth in her sleep, which is why she wore down her central incisors so severely. We made her a "Night Guard" which is a thin plastic appliance we place over the upper teeth to protect both the upper and lower teeth from excessive wear and fracture.
We expect an average of 5 years for the fillings and 12 to 14 years for the metal ceramic crowns.
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