Smile Portfolio

When it comes to impacting tooth structure, we're conservative. The more natural tooth structure you can retain, the healthier your smile. Many people come to DeWan Dental Wellness and request dental crowns to correct imperfections of their front teeth. Crowns are a practical and predictable dental service, and we recommend them for many people. But before you decide, we recommend that you consider other dental services that also can perfect your smile with less loss of tooth structure.

The “imperfections” we see most often are teeth that are:
• Discolored
• Stained
• Chipped
• Cracked
• Worn down
• Unevenly spaced
• Slightly crooked

Here are five case studies that employ various dental services to enhance smiles and conserve
as much tooth structure as possible.

Professional Tooth Whitening & Bonding Replacement

Here is a case in which a woman had bonding placed when she was a child and, over time, the materials
darkened. She was getting close to college graduation and wanted to make sure her smile
matched the high level of her new skills.

We began with whitening—the most conservative treatment, as it removes the least amount
of tooth structure. In fact, whitening does not remove any tooth structure and is great to use
in the case of discolored or stained teeth.

Because whitening only affects natural teeth, the teeth that had bonding did not whiten.
This gave us an excellent foundation to build a beautiful smile for her. To correct staining on
bonding, we use materials similar to those we use for tooth-colored fillings. These materials
can fill gaps, repair chips and even lengthen teeth. For this woman, we:
• Removed old bonding and any decay,
• Abraded the enamel surface,
• Applied the composite resin material,
• Light cured and polished.

Two hours later, she was ready for her job interviews!

Treatment Time Commitment
Two weeks of at-home whitening and two hours of restoration.

Occlusal Therapy, Dental Veneers &
Other Restorations

Here we have a woman who spent more than a decade caring for a loved one and time for herself evaporated. When she was able to find time for herself, she decided that fixing her smile was a top priority.

In her first diagnostic visit, it was clear that she exhibited signs of occlusal disharmony. Previous restorations, mostly crowns and fillings, interfered with her natural bite. You can see from the photograph on the left that she had a crossbite, meaning her lower teeth were outside her upper teeth. Her jaw did not come together in an optimal way, causing her teeth to break and her bite to be unstable. We started with diagnostic models and a “wax up.” Basically, we tested the proposed restorations to make sure they would restore function and enhance appearance. Then we balanced her bite and focused on restoration.

You can see that the fuller shape and brighter shade of porcelain veneers on her front teeth brought her smile front and center. Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your smile’s appearance. In addition, we restored her back teeth with crowns and fillings, which were the best options in this case.

Treatment Time Commitment
Within six months, she had the smile she wanted.

Dental Implants

In this example, our patient lost a front tooth, which created a gap in her smile. She was happy with her
tooth color, so we got right to work on getting an implant in place.

Dental implants are titanium cylinders that are surgically placed in the upper or lower jaw
where they function as an anchor for replacement teeth. Treatment generally is a two-step
process. First, the implant is surgically placed into the jaw. Once the dental implant is fully
integrated, it is uncovered and a post is attached. Then a custom artificial tooth, called a
dental crown, is fabricated and attached to the post.

But before we did anything, we fixed the gap in her smile with a temporary partial so that
she could grin with abandon.

When placing a dental implant, as with any dental restoration, the accuracy of her bite was
critical to her dental and temporomandibular joint (TMJ) health. Without precise pre- and
post-operative measurements, the dental implants could ultimately fail. It’s important to
note that implants not only replace a tooth, they help re-grow bone, which shores up facial
structure. Today, implants are the treatment of choice for tooth loss.

Treatment Time Commitment
Three to six months for the implant to integrate; several weeks for implant restoration.

Braces, Whitening & Porcelain Veneers

This young man had small, irregularly shaped teeth and excess spacing. After braces,
whitening, and porcelain veneers, he can’t stop smiling!

You can see that his teeth were uneven in color with dark and lighter areas on the tooth
surface. Professional whitening evened out the color so that the most complementary veneer
color could be chosen.

Dental veneers can be made from porcelain or from resin composite materials. This young
man chose porcelain veneers because they resist stain better than resin veneers and better
mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require
removal of less tooth surface before placement.

Treatment Time Commitment
Once his braces were removed, whitening and final restorations took about a month.

Whitening & Porcelain Veneers

Here our patient's goal was straighter teeth, and her mission was accomplished! Whitening and
porcelain veneers created a brighter, fuller and more even smile.

To achieve the best aesthetic dental results, form must follow function. For her, we began
with fully understanding the “look” she wanted. Then we analyzed the foundations of her
dental health: her TMJ, bone and gum structure, and actual teeth. First, we determined how
her teeth actually functioned:
• Did her teeth meet in an optimal way?
• Did she experience clicking at her jaw joint or experience jaw pain?

Then, we determined how well her bone and gums supported her teeth. If she was
experiencing some bone loss and/or gum disease, her newly shaped teeth could shift and
create more imbalances, which could cause her teeth to fracture.In addition, we looked for
areas of decay, which could lead to a chipped or broken tooth. Analyzing x-rays and clinically
evaluating the biologic integrity of each tooth is key in identifying and preventing future
problems.

Because we followed these three steps, the aesthetic result we achieved was exactly what
she wanted. And she will enjoy her smile for many years to come!

Treatment Time Commitment
Within two months, this woman could flash her ideal smile.