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Look for a Dawson Academy dentist

Hello Dr. Hall, My dental condition is short teeth, all of them as they have worn, seemingly of inferior enamel consistency. The incisor and bicuspid enamel has worn down to expose dentin interior. The upper jaw incisors are perhaps 6 mm shorter than when the adult teeth were new. Indeed, I looked like “Bucky Beaver” (of 1950’s Ipana commercials). The lower jaw molars are shorter than the incisors by over 2 mm. The edge of the lower jaw incisor is concave into the dentin resulting in sharp enamel edges. The look of my face with mouth closed and teeth clenched looks similar to a person with full upper and lower dentures (without the dentures in place). “Open up the bite” with a crown cap on every lower molar seems appropriate. The upper jaw incisors would need thin veneer over the existing tooth combined with thick tooth extension (4 mm) and veneer lapping over the back of the incisors (due to wear from impact of lower jaw incisors). The result of wear has resulted in a knife edge sharp edge to the upper jaw incisor bite. With this upper jaw incisor tooth extension, “open up the bite” with a crown cap on every upper molar seems appropriate. What cosmetic dentistry technology is capable of solving all of these? I look forward to you reply. Happy New Year to you and yours, Connor

I’m only going to be able to reply in generalities which may or may not be proper treatment for your specific case. Your situation is rather complex, and would need careful diagnostic work in order to accomplish it.

I would start by being sure that you are seeing a highly competent dentist. Graduation from dental school isn’t enough training to do complex full-mouth reconstruction, which is the treatment you’re talking about. Look for a dentist who has graduated from the Dawon Academy, the Pankey Institute, or the Las Vegas Institute for Advanced Dental Education. These programs teach the subtlties of occlusion and complex restoration for taking on a case such as yours.

Dr. Newkirk is on the faculty of the Dawson Academy for Advanced Dental Study, so we know how much we teach there and how important that postgraduation instruction is for getting these things right.

What you’re describing definitely sounds like occlusal collapse – you’ve ground down your natural teeth so they are shorter now. Yes, the usual treatment would be to restore all the teeth and make them their original height. One of the tricks is to get your lower face to be the correct height – high enough but not too high – or you could be aggravating your TMJ disorder condition. We usually find the correct height by having you wear a snap-on smile or some other temporary appliance to test the proposed new vertical dimension of your lower face. After wearing the longer teeth, we can evaluate whether or not this is a comfortable chewing position for you.

Then, yes, porcelain veneers in the front could be an excellent choice, and, if done beautifully, would finish off the case with a beautiful smile.

I’d get two or three opinions, if I were you, and then turn on your intuitive “radar” to try to feel if the dentist is being straight with you about your needs and his or her credentials. Look for graduation from one of those post-graduation dental education institutes I mentioned above. And then, if you want a beautiful smile afterward, make sure that the dentist is an artist. A good source for finding out that information is the cosmetic dentistry information website mynewsmile.com.

As far as the technology for doing all this, there isn’t just one way. On the back teeth, porcelain fused to metal crowns would be fine. But on premolars and incisors, most excellent cosmetic dentists would strongly lean toward pure porcelain or ceramic crowns. If your dentist suggests porcelain fused to metal in a prominent position in your smile, that’s an indication that you are in the wrong office. Now that dentist, when they find that you want all porcelain crowns in those places, he or she may backtrack and say, “Oh, I know, I can do that.” That’s not good enough. You’re trying to test the dentist’s artistic instincts, and if they first suggest porcelain fused to metal on say, a canine tooth, which always shows prominently when you smile, I’d be very suspicious that they aren’t very passionate about cosmetic dentistry.

I hope this is helpful.

Links: For more information about Dr. Newkirk’s credentials, please see our Best Dentist in Naperville page. This blog sponsored by Dr. David Newkirk, Naperville dentist.