Many times, patients come to us in varying stages of treatment. In Brandon’s case, he had been in braces for some time and was told he would “soon be done.” Brandon’s mother had some concerns with what she had been told would come next and sought a second opinion with us. Evaluation of Brandon’s situation revealed that while the majority of orthodontic correction had been completed in that the teeth were straight, there were some issues with the position of the teeth as far as correcting the size and shape of the teeth. Brandon perfectly represents an issue we see far too frequently. Many times there is insufficient communication between the orthodontist and the cosmetic dentist with regards to where to put the teeth to optimize the cosmetic outcome. Brandon’s teeth were too small and misshapen. In the original orthodontic position, the size deficiency was corrected by moving everything to the middle and leaving space behind the lateral incisors. This presents a serious problem for us in creating natural-looking proportionately sized teeth. We requested that the orthodontist move the front four teeth so that the spaces were equally divided amongst them. This spacing then allows us to optimize the size and shape relationships of the front teeth. Photo four shows Brandon’s final orthodontic result on the day that we prepared his upper four front teeth for Avante stacked porcelain veneers. This case was completed as a “no-prep veneer” situation. Since the teeth were already too small there was no need for us to remove additional tooth structure to provide room for the porcelain veneers. The goal always is to affect the teeth as little as possible to achieve a given goal. No-prep veneers allow us to accomplish this goal while still providing a superior cosmetic result. Photo 2 shows Brandon’s final result on the day of insertion of the veneers. One can see the significant improvement in the length and width proportions of the teeth. This case highlights the need for a team approach to cosmetic dentistry. When all practitioners are communicating effectively and with the same end goal in mind, the results are dramatically improved!
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