Treating the Teeth Without Fighting the Bite

What an underbite does to the front teeth over time

In an underbite the lower front teeth close in front of the upper front teeth instead of behind them, a relationship also described as Class III. The consequence for the upper teeth is that their edges meet the lower teeth at an angle they were not shaped for. Over years that produces two visible effects: chipping along the edges where the contact is hardest, and flaring, as the upper teeth are pushed forward by forces arriving from in front of them rather than behind. Both were present here.

Why straightening the teeth was not the goal

The obvious-sounding aim, correct the underbite, is a different treatment in a different category. A skeletal Class III relationship is addressed with orthodontics, jaw surgery, or both, over a period measured in years. What this patient wanted was the damage repaired and the appearance improved. So the question became a restorative one: can the teeth be rebuilt to look straight and undamaged while continuing to function inside a bite that is not going to change? Answering yes to that requires designing for the bite that exists rather than the one that would be ideal.

How the veneers were shaped to work with the underbite rather than against it

The temptation with flared teeth is to bring the edges back and down, which is what makes a smile look straight in a photograph. In a Class III bite that puts new porcelain directly into the path of the lower teeth, and porcelain placed into a heavy contact does exactly what the natural enamel did before it: it chips. The edges were instead positioned to restore the lost length and rebalance the visual line while staying clear of the contact that caused the original damage. The teeth read as straight from the front while the function underneath them is unchanged.

Why the bite was analysed before the shape was drawn

This is the sequence the case depends on, and it is the opposite of the usual order of interest. A smile design is a drawing of what the teeth should look like. In a normal bite it can largely be drawn first and verified afterwards. In a Class III bite the available envelope, where a tooth edge can sit without being struck, is narrower and differently shaped, and it is not obvious by looking. Mapping where the teeth actually contact came first, and the design was then drawn inside what that mapping allowed. Reversing the order produces a design that photographs well and fails within a year.

How the colour was matched to the natural lower teeth

Only the upper arch was being restored, which makes shade a question of matching rather than choosing. Natural teeth cannot be brightened after adjacent porcelain has been made, because porcelain does not respond to whitening. The lower teeth were therefore whitened first, allowed to stabilise, and the veneer shade selected to meet them. Doing it in that order is what prevents the common outcome of a bright upper arch sitting above a noticeably darker lower one.

The result after six weeks

The chipping is restored and the flare is visually corrected, with the edges sitting where they can do that without being struck by the lower teeth. The upper shade meets the whitened lower teeth rather than outrunning them. The underbite is still an underbite, which was never the target, but it is no longer damaging the teeth in front of it, and it is no longer the first thing the smile communicates.