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!

Please feel free to ask ques­tions or post a com­ment below, or to share with your friends!  If you’re inter­ested in a Com­pli­men­tary Con­sul­ta­tion in our office, please call 704–364-7069 or Request an Appoint­ment Online.