August 15, 2018

Looking Ten Years Younger and More Attractive – Porcelain Veneer Smile Makeover Combined with Laser Gum Reshaping Achieves Great Results

laser gum reshaping

Top: Lauren had short, worn teeth and wanted longer, whiter teeth, Second from top: Another issue is that Lauren had too much gum tissue around her two front teeth. This made her teeth appear even shorter. A nice smile has the gums of the front six teeth at about the same level. Dr. Huefner recommended using the dental gum laser to make the gums of her two front teeth at the same level as the adjacent teeth. Third from top: Dr. Huefner reshaped the gum tissue with the dental gum laser and placed Lauren in temporary veneers (also called "trial smile"). Bottom: After Lauren's gums healed Dr. Huefner removed the "trial smile" temporary veneers and placed Lauren's permanent porcelain veneers.

Lauren is a doctor from Ladera Ranch, and cosmetic dentistry was on her mind.  Although only forty years old, the stress she has endured in medical school and her practice over the years had started to ruin her front teeth and smile!  She is a dental bruxer (she grinds her teeth at night) and had already worn off 3 millimeters (about 25%) of the original visible tooth length.  For some people stress is the major factor in increasing clenching and the bruxism habit.  Her teeth were already short now, but at the rate she was going in ten more years would be even shorter, maybe just little stubs would be visible when she smiled.

Recognizing on her own that she needed to do something about her worn teeth, Lauren came in to discuss her options with Dr. Huefner.  She knew she need to restore her upper front teeth, and that meant that she wanted to make them longer, hopefully as long as they originally were when she was in high school or college.  (See tooth length) Then she said something we oftentimes hear from our patients, “Well, if I do restore my teeth, then I want them whiter too.  If I’m going to do something about the length of my teeth, I want to make sure that in the end I have a nice white smile!”

To give Lauren a nicer and whiter smile Dr. Huefner recommended placing porcelain veneers to follow up with a night guard bruxism appliance to protect her from damaging her teeth when she’s in bed .  Porcelain veneers and a bruxisms appliance would do the basics of what she needed.  But Lauren also said she want her teeth to really look nice.  So, looking a bit closer we noticed something that Lauren had never thought about.  There were more gums around her two upper front teeth than all the rest.  That contributed to her front two teeth looking even shorter than the really were.  We explained to Lauren that upper incisors should be rectangular and longer than they are wide.  In her case her two centrals weren’t rectangular at all, they were square, as wide as they were long.  This is almost the opposite to the way her front two teeth should look.  This had resulted because of the shortness at the edges caused by her teeth grinding habit, in addition the excess gum tissue that still remained around her central incisors (this is oftentimes referred to in dental terms as delayed passive eruption) made her teeth look even shorter from the gum area that encircles her teeth.

Lauren said she couldn’t really visualize what we were trying to explain to her.  So, we took photos of her upper front teeth and showed them to her.  The photos made is much easier for her to understand what we were trying to explain to her.  We further explained to Lauren that she was really lucky because she was an excellent candidate for another common dental procedure that would help solve her excess gum problem.  Called laser gum reshaping, it is a very simple, relatively non-invasive procedure with virtually no bleeding, very quick healing time (5-7 days), no discomfort during the procedure and after the procedure very little discomfort during the post operative and healing phases.  The dental gum laser we use very precisely dissolves the excess and unnecessary gum tissue that overlies her teeth.  By removing this excess gum tissue and placing porcelain veneers to make her teeth the normal length, Lauren could have the great smile that she has always wanted.

After a little more discussion to answer a few more questions Lauren was excited about following our recommendations and getting her smile restored.  After completing her examination with dental x-rays and study models we were ready to get started.  She came back for her first treatment appointment, Dr. Huefner used his dental gum laser and reshaped the gums around her upper front two teeth.  Then he prepared her teeth for seven porcelain veneers and Lauren left that appointment with her “trial smile” of seven temporary veneers. She wore the trial smile veneers for two weeks while her permanent porcelain veneers were being made by Dr. Huefner’s ceramist Dave Stohlman at LK Labs.

Lauren came back two weeks later and Dr. Huefner gently removed her temporary trial smile veneers and tried on her permanent porcelain veneers for her approval.  “Wow,” she said, “these teeth are beautiful!”  After getting Lauren’s written approval, Dr. Huefner permanently bonded her seven porcelain veneers into place with his dental bonding laser.  He also took impressions for Lauren’s night guard bruxism appliance, which he gave to her to wear at her follow up visit three days later.

Later on we asked Lauren if anyone had said anything to her about her new smile?  “A few of my friends commented that I looked different and I’m glad that everyone didn’t remember how bad they looked before, ” she said.  “My best compliment was from my gentleman friend.  He said I looked much younger, and as far as that’s concerned, that’s a good thing!  But for me it’s just a great feeling to look at myself in the mirror or photos and know that the cosmetic dentistry I had done really makes me look better.  And when I look better, I feel better too!”

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita

Teeth Grinding (Bruxism) Can Destroy Teeth

teeth grinding

This 50 year old patient was a severe bruxer. His night time grinding wore away 50% of the original length of his lower front teeth above the gum line. Fortunately this was caught in time and there was enough tooth structure left to allow protective crown treatment. If more of the teeth had worn away this wouldn't have been possible and a denture, bridge or implants may have been the only treatments that could have been offered to him.

The silent killer of teeth is bruxism or teeth grinding.  For most people, this happens at night while they’re sleeping.  However, oftentimes the spouse or sleeping partner will hear the annoying noise of tooth against tooth wearing away.

Tooth enamel is the hardest thing in the human body, and yet it is not indestructible.  After years of attrition, or wearing down their teeth, the grinding patient eventually grinds completely through the white enamel and into the more yellow root dentin under it.  Unfortunately the root dentin is only about 25% as hard as the enamel, and thus the rate of wearing away of the tooth drastically speeds up once the enamel covering had worn a hole through it exposing the root dentin.  When you look down at a tooth that had been worn through the enamel it will be clearly obvious as there will be two layers, an outside ring of whiter enamel and a center portion of yellow root dentin.

bruxism treatment

Looking down at the teeth one can see the "bull's eye" appearance of severe attrition. Once the protective enamel has worn away the attrition greatly accelerates. Eventual tooth loss is the result in situations like this that do not undergo appropriate treatment.

But it doesn’t end here.  The damage to the teeth continue on over the years.  When several millimeters of teeth have worn away the teeth then start wearing into a third area of the tooth called the secondary or repairative root dentin.  This area is again a circular area in the center of the visible top of the tooth, but this third area is darker yellow or brown.  The give away that this point has been reached is that there are now three visible layers and the tooth will have the appearance of a bull’s eye with three concentric rings.

dental night guard appliance

A dental night guard is a custom made appliance of thin plastic that fits over the tops of the teeth to protect the damaging effects of tooth against tooth wear.

If you could go back in time, this secondary root dentin is the area that once was occupied by the tooth nerve and pulp in a younger, healthy tooth.  However, due to aging and trauma, the tooth nerve recedes away from the impinging trauma, and in attempts to protect or heal itself, the tooth puts up a layer of internal tooth.  It is this protective layer that is center of the “bull’s eye”.  Usually this means the tooth has lost at least 30-50% of the original tooth that first appeared above the gum line (dentists call this the “clinical crown”) when the patient was a youngster.

One can easily understand that the tooth will continue to wear down until there is very little tooth there and oftentimes dental patients waits too long before they finally decide to go back to their dentist and to do something about it, and then it’s too late.  If the tooth can’t be saved or crowned, then a denture, bridge or implant might be the only treatment left.

bruxism appliance

Most night guards are made to fit over the patient's upper teeth. This photo shows a night guard made on top of a model of the patient's upper teeth. The dentist will then fit the appliance to the patient's bite.

Fortunately for most patients who go to the dentist the damaging effects of bruxism can be detected early enough to treat.  Almost always the most preventive approach is to make a dental appliance to be worn over the teeth while the patient sleeps.  It’s called a “night guard” or “bruxism appliance.”  This slows down the process, but for most people bruxism cannot be stopped, and thus these appliances only slow down the process and doesn’t not cure it.  There are many instances where the dentist will determine that placing a protective crown on several teeth are necessary to preserve what is there and prevent further loss of tooth enamel and dentin.  Dental crowns seldom wear down, and if they do it is only the fraction of the wear that would occur if the tooth hadn’t received a protective crown.

Dr. Norman Huefner, Orange County Cosmetic Dentistry and Porcelain Veneers. Serving the surrounding cities of Laguna Niguel, Irvine, Newport Beach, Mission Viejo and Rancho Santa Margarita
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