Treating the Teeth Without Fighting the Bite

The Patient's Journey

This patient presented with chipping along the edges of his upper front teeth and a noticeable forward flare to those teeth. Both were consequences of an underbite. In an underbite the lower anterior teeth close in front of the upper anterior teeth rather than behind them, a relationship described as a Class III occlusion. It changes how the upper teeth are loaded whenever the jaws come together.

The upper incisal edges were meeting the lower teeth at an angle they had never been shaped for. Over a period of years that produced two visible effects. The incisal edges chipped where the contact was heaviest. The upper teeth were also pushed forward over time, by forces arriving from behind them.

Understanding the Challenge

The obvious-sounding objective, correcting the underbite, belongs to a different category of treatment. A skeletal Class III relationship is addressed with orthodontics, orthognathic surgery, or both, over a period measured in years rather than weeks. This patient wanted the damage repaired and the appearance improved, which is a restorative objective rather than an orthodontic one.

That reframed the clinical question considerably. The teeth had to be rebuilt to appear straight and undamaged while continuing to function inside an unchanged occlusion. This meant designing for the relationship that existed rather than an idealized one. In a Class III bite the envelope in which an incisal edge can sit without being struck is narrower than usual and differently shaped. It is not apparent from looking at the teeth.

How Dr. Mehdizadeh Approached Treatment

Occlusal analysis came first, mapping where the upper and lower teeth actually made contact and identifying which contacts had produced the chipping. The smile design was then drawn inside what that mapping permitted, rather than drawn first and checked afterwards. Reversing that order produces a design that photographs well and fails within a year.

The temptation with flared teeth is to bring the incisal edges back and down, that is what makes a smile look straight in a photograph. In a Class III occlusion that places new porcelain directly into the excursive path of the lower teeth, and porcelain in a heavy contact behaves much as the natural enamel did. The incisal edges were instead positioned to restore the lost length and rebalance the visual line, while remaining clear of the excursive contact that had caused the original damage.

The natural lower teeth were sound and required no restoration, they were whitened first and allowed to stabilize in shade before the veneer selection was made. Porcelain does not respond to whitening, and a natural tooth not brought to its final color beforehand remains darker than the restorations permanently. Ten upper porcelain veneers were then delivered.

The Result After Six Weeks

The chipping has been restored and the flare is visually corrected, with the incisal edges positioned where they can achieve both without being struck by the opposing teeth. The upper shade meets the whitened lower teeth rather than outrunning them.

There was no surgical healing period in this case, which is why treatment moved considerably faster than cases involving gum surgery. The underbite remains an underbite, which was never the objective, but it is no longer damaging the teeth in front of it and it is no longer the first thing his smile communicates.