A Full-Mouth Smile Reconstruction
Quite some time ago, I showed this case as an example of how badly teeth can be damaged by grinding them, whether at night, in the daytime, or both, and why something as simple and inexpensive as a nightguard (my recommendation is a NTI-tss). It is especially inexpensive in comparison to the cost of rebuilding a smile that is so broken down. This gentleman came to us in 2008, looking for options to feel good about his smile again for various reasons. After plenty of discussion, we agreed that the only option that would truly give him the smile that he wanted was a Total Smile Makeover/Reconstruction with porcelain crowns. After showing the Before-After pictures of his smile, I’ll discuss some of the issues you need to consider if you are thinking about significant cosmetic dentistry for yourself.
Frequently Asked Questions about Smile Reconstruction
When rebuilding a smile such as this, it is crucial to establish a proper bite relationship of the top and bottom teeth. Sometimes this can take a little while to figure out, because – when the teeth are so worn, the patient has long since adapted to a very bad bite relationship. The muscles have to be relaxed, accurate records taken, and excellent communication is necessary among the patient, the doctor, and the lab, to ensure that the crowns are made to look good, feel good, and last a long time. However, in severe wear cases, we always remind the patient that s/he already did a pretty good job destroying their natural set of teeth, so a nightguard is an absolute requirement as “insurance” to protect their investment, and even then they are more likely to break or chip the porcelain than others who don’t have that history. Simply put, these cases are far more complicated and require a great deal of time to get right, so you need to be absolutely committed to proceeding and working closely with your dentist to get a good result.
How Much Does a Smile Reconstruction Cost?
It’s not unusual for a patient to ask why it costs so much to do a Smile Reconstruction like this; it often seems like there should be a “volume discount,” so-to-speak, when doing a lot of crowns instead of just 1 or 2. The difference between such scenarios is the amount of time involved, the skill, training and experience required to successfully diagnose, complete, and treat, and that your dentist will have to work with a highly knowledgeable lab to make the crowns to not just look good, but fit properly and work smoothly in eating motions. Your dentist will likely spend at least a couple hours just in the planning stages! It’s usually a case of “You get what you pay for.” IOW – if you want a cheap smile makeover, you should reasonably expect a cheap outcome. To get excellence……it won’t come cheap. Depending on various factors, a case such as this will be the equivalent of buying a fairly nice car. The main difference, of course, is that you should expect to be “driving” your smile for a lot longer than most people keep a car!
- How Long Will This Take to Finish?
When doing so many teeth, you need to plan on a minimum of several appointments that could take 1/2-day to a full day each, as well as several other appointments to refine, modify if needed, polish, etc. From beginning to end, if everything goes perfectly, you might be done in as little as 1 month. That would be somewhat rare; more likely, you should plan on the entire process taking at least 2 months, and maybe many more. Extremely complex cases that involve implants, different specialists, and very complicated lab work may take a year or more due to the time needed for healing, verifying each stage is correct, and even just the time needed for lab technicians to do the custom work.
- What kind of Crowns will/should you get?
Due to improving materials and with the right techniques, in most cases nowadays you can have all-porcelain crowns made to rebuild a smile. The crowns used in this case are made of E.max porcelain, which is extremely strong and resistant to breakage. Numerous studies now show that this type of porcelain will likely last for 15-20 years, and quite possibly longer. For certain cases, though, and for patients who are even worse grinders than this gentleman was, gold crowns might still be necessary for the back teeth, simply because they are the strongest, longest-lasting crowns available. They can also take more abuse than any other material. Porcelain-to-metal crowns are also an option and have a long track record, but it is very important for the lab to be highly skilled so that you don’t see dark grey lines at the gum from the metal showing through.
- How Do I Choose the Right Dentist?
This is one of the trickiest questions, because the public doesn’t usually know enough about the training necessary beyond dental school that trains dentists to handle complex full-mouth reconstructions with skill and confidence. But here’s my recommendation: ask to see pictures of their other cases that might be similar to yours. That’s one of the reasons digital photography is such an instrumental and daily part of our dental practice – you will be able to see similar cases and know how the outcome will be before ever committing. The large majority of dentists who are well-trained in these cases also use digital photography, both for communicating with you as well as for documenting and tracking their own work over time. If you meet a dentist who can show you pictures of cases that were completed 5-10 (or longer) years ago AND s/he has recent follow-up pictures to show how well it has held up, THEN you should feel very confident that your dentist can take good care of you.
And then start imagining how much better you’ll feel when you can smile like Wayne does now!
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