It's early in June but we could not wait to post our case of the month. As you may be aware, we believe in the least invasive techniques to create stunning smiles which look natural and healthy. After all, it is pretty obvious when a smile is false- just look at various celebrities on TV (no names mentioned!) 

Our patient requested a drastic improvement on his smile using lingual braces as he did not want the brace to be visible for work reasons. The treatment was a great success and the improvement as profound. We discussed the need for teeth whitening and cosmetic bonding after treatment to enhance symmetry. Often, teeth are asymmetrical due to tooth wear, grinding at night, genetic reasons or past treatments. 

Pre treatment:
 

Our case of the month for May involves a stunning smile transformation with a combination treatment involving lingual braces, teeth whitening and porcelain veneers. Here is a photograph of the initial appearance:
 

Some of you may have noticed that we missed the Case of the Month for March. However, our case today is worth the wait. Sometimes the end result is so spectacular that it completely transforms the smile, overall aesthetics, confidence and outlook on life. Modern dental orthodontic treatment means that treatment times are often far less than in the past which is a huge bonus. Our case underwent conventional full mouth orthodontics using good old metal brackets, which often are still the best method of treatment. The reasons being are:
 

1. Metal brackets are robust and will not break
2. Metal brackets are highly polished and offer less friction for quicker movements
3. Metal brackets can be removed and re bonded with ease for adjustments
4. Metal brackets are far cheaper than ceramic or lingual brackets
5. Metal brackets allow the placement of elastics with ease

We appreciate that conventional orthodontic treatment is not for everyone, but for those of you who want the best results in the shortest time span and are not bothered about how they look- this is the option for you. Our case initially:
 

Our case of the month for February involves the replacement of a single front tooth crown. Although this may seem a simple process, the technical skill involved in achieving a great match to the adjacent teeth is incredibly high. 

A dental crown is often needed if a tooth is badly broken, decayed or has had root canal treatment. Heavily damaged teeth will not be able to withstand the everyday forces of eating, chewing or grinding and may split or fracture. If the fracture is below the gum level or between the roots, the only option will then be removal of the tooth. 

The process involved with a crown has changed now that we use a fully digital approach. The only physical impression we need is a small one of the tooth to be able to make a temporary crown. The tooth in question will be prepared to approximately 0.8mm-1.2mm all around with a taper of 6-12 degrees. A vital aspect is something called a 'ferule'. This is where the preparation ends on tooth surface rather than a filling material. If a ferule of 1-3mm can be achieved, the retention and resistance form is very high leading to a long lasting treatment. Your dentist will be able to tell you if this has been achieved. 

Once the tooth has been prepared, it is usual for some level of gum 'retraction' using either pastes, cord or a combination of both. This is important so that the margin of the preparation is clear. This is where the crown will sit and hence if the margin is clear, a good fit will be the end result. We will then take a digital scan of the tooth and surrounding areas including how you bite. There is no need for messy, sticky impressions! On the software we can check that there is enough space, check the margin, shade test the adjacent teeth and check the angulation/ taper. 

Then it is time to make the temporary crown. This is usually from a bis acryl composite material and seated with a soft cement. Our labs will ask for 10 working days in most cases where the scans will be printed and the new crown designed, milled, characterised and glazed ready for fitting. The fitting appointment is usually straight forward with perhaps a slight adjustment. Once fitted, the crown will take a few days to get used to. After that, it will feel part of your mouth. Here are the photos of our case:
 

We are a bit late for the January case but it is well worth waiting for. The case involves one of our favourite treatments; ABC. As you may well, we believe in minimally invasive dentistry. We can create stunning smiles without having to drill away your teeth; we simply enhance what you already have.

Our case involves teeth straightening initially using full mouth lingual braces. Lingual braces are the only braces that can be said to be 'invisible'. They are placed behind the teeth so that no one will know that you are having your teeth straightened. Of course, we can use alternative systems such as conventional outside braces or Invisalign also. There are many choices available, long gone are the days of metal train tracks as the only option. 

After we achieved a beautiful straight smile, tooth whitening was done using our in chair Phillips ZOOM whitening and take home kit. 

This was followed by cosmetic bonding to create symmetry of otherwise uneven and asymmetrical teeth. The results are simply awesome and this is a case of a true smile transformation. Please take a look at the before and after photos:
 

Our case of the month for December 2018 involves one of our favourite techniques: ABC A is for alignment. Straightening teeth using a discreet treatment method, usually in a short space of time. B is for bleaching. Whitening teeth to brighten your smile. C is for cosmetic bonding. Enhancing the overall shape and symmetry of teeth by adding to teeth rather than cutting away healthy tooth enamel. Our case presented with quite severely crooked lower front teeth which bothering him a great deal. They were rotated, overlapping and worn down from years of tooth grinding. Initially, they front 4 teeth were straightened using the Social 6 lingual brace. Aligning the front teeth means that any future cosmetic dental procedure such as composite bonding or porcelain veneers requires minimal tooth preparation if any at all. After alignment, the teeth were whitened using a take home kit with Phillips ZOOM gel 6% hydrogen peroxide, which lifted the overall shade by 4-5 levels. Cosmetic bonding was then performed on the front 4 teeth to level the edges. Not only does this enhance the overall aesthetics but this will also improve the bite. Having even edges on the front teeth allows a smooth guidance when eating and chewing. In turn, this will protect the back teeth also. Before and after photos:
 

Our case of the months for November is a simple yet effective teeth straightening case involving the lower front teeth. Straightening lower front teeth has a number of benefits which include:
 

1. Improved aesthetics
2. Improved access for cleaning
3. Improved anterior guidance (bite)
4. Reduces damaging forces on the edges and reducing tooth wear
5. Improved contact

For those of you who are not dentally trained, point 3 is how the lower teeth move up against the upper teeth forwards, right and left movements. The smoother the guidance the better. Teeth that are very crooked cannot, by nature, have smooth contacts with the upper and often one or two teeth take the force and are damaged as a result. A simple test is to stand in front of the mirror and bring your teeth edge to edge. Do they meet evenly? Does one tooth make most of the contact? Are your lower/ upper teeth worn and uneven? If so, it is worth considering treatment. Here are the before and after photos for our case:
 

Our case of the month for October 2018 is one which involves a fully customised crown. What is this, you may ask. Well, we mainly advise a fully customised crown for single front teeth where the aesthetics are incredibly important. Essentially, this technique is the very best we can offer in terms of aesthetic dentistry. The process involves:


1. Full planning and diagnostic wax up if required.

2. Initial shade testing at the laboratory to ensure the base shades are all correct

3. Preparation of the front tooth and records. We now use intra oral scanning which eliminates the need for messy dental impressions.

4. Placing a temporary crown made from a mixture of acrylic and a resin.

5. Trying in the crown prior to any final customisation to ensure that the fit, margins, emergence profile, embrasure spaces, contact points and bite is all fine.

6. Placing the temporary with a soft cement and then a journey to the laboratory straight after the try in.

7. Full customisation of the crown until you are 100% happy with the overall aesthetics.

8. Straight back to the practice for fitting.


Although this may seem a long winded approach for one single tooth, we can assure you it well worth the effort. After all, it is your front tooth! Here are some photos of a recent case:
 

Our case of the month for September involves a dental implant to replace a missing molar tooth. Initially, the tooth was lost due to extensive tooth decay that was not treatable. This resulted in a space which affected eating. Although back teeth are not particularly visible, it is important to replace them for a number of reasons:
 

1. Restore the bite
2. Prevent movement of the adjacent teeth
3. Prevent movement of the opposite teeth
4. Preserve the jaw bone
5. Aesthetics if visible on smiling

In our case, the missing tooth was on the upper right side: