Do you have more than one thing you want fixed?
Color, proportions and missing teeth are three different problems, and treating any one of them first makes the other two more obvious. The order they are done in is most of the plan. Send us a photo of your smile and we will tell you what would have to happen in what sequence, and what it would cost.
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What this case cost
$526/month
144 payments at 9.99% APR, on approved credit.
Total: $44,000 for hygiene therapy, whitening, two implants, sixteen porcelain veneers and two implant crowns.
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Treatment Plan by Dr. Mehdizadeh
- Hygiene therapy to establish healthy gingival tissue before any restorative work.
- Whitening of the natural dentition, with the shade allowed to stabilize.
- Two implants placed, at teeth twenty-three and twenty-six.
- Healing and osseointegration.
- Sixteen porcelain veneers, ten upper and six lower.
- Two lower implant crowns, matched to the veneers made alongside them.
The Patient's Journey
This patient arrived with several complaints and wanted all of them addressed. Her teeth were yellow. They were also mismatched in size, with an asymmetry across the arch that made the proportions look wrong even when the color did not. And she was missing two lower teeth, which she had been managing with a removable partial denture.
Treating any one of those in isolation would have made the other two more obvious. Whitening alone would have sharpened the contrast between teeth of different widths. Restoring the proportions alone would have set new ceramics against a discolored background. Replacing the missing teeth alone would have left both of the visible problems untouched.
Understanding the Challenge
The sequence was the whole of the plan, and it is governed by two constraints that cannot be worked around. The first is that ceramic does not respond to peroxide, so whitening precedes any shade being recorded. The second is that gingival health precedes restorative work, because margins placed against inflamed tissue sit in a position that changes once the inflammation resolves.
Hygiene therefore came before whitening, and whitening before ceramics. That ordering is not a preference. A restoration bonded to a tooth whose gingival margin is still receding to its healthy position will show a line at the join within months, and no amount of ceramic quality compensates for it.
The lower arch raised a separate question. Only the upper teeth are prominent in most of her expressions, and restoring the lower arch as well adds cost. It was restored anyway, for two reasons that have nothing to do with appearance from the front.
Establish gingival health before any restoration is bonded. Whiten, then record the shade against the whitened teeth. Replace two missing lower teeth with implants rather than an appliance. Correct the width asymmetry across the upper arch. Match the lower arch to the upper in color and in function.
How We Approached Treatment
Hygiene therapy was completed first and the tissue allowed to settle. Whitening followed, and the shade was left to stabilize afterwards, because tooth color rebounds for a period following any peroxide course and a shade recorded during that window is not the shade the patient keeps.
Two implants were placed at teeth twenty-three and twenty-six and left to osseointegrate. Replacing lower incisors with implants rather than continuing with a partial denture matters structurally as well as practically. A removable appliance rests on the mucosa and transmits no load into the alveolar bone, so the ridge beneath it continues to resorb; an implant loads the bone and maintains it.
Sixteen veneers were then fabricated, ten upper and six lower, together with two crowns on the implants. Treating both arches together is what resolves the width asymmetry, because tooth proportions are read in relation to the teeth above and below as well as beside them. It is also what fixes the color, since a whitened lower arch beside restored upper teeth would have diverged again within a year or two as the natural teeth took up stain and the ceramics did not.
The second reason for restoring the lower arch is occlusal. Designing sixteen restorations across two arches allows the contacts between them to be established deliberately rather than inherited from a bite that had been compensating for missing teeth. That is the part of this case a photograph does not show.
The Result After Five Months
Eighteen units span both arches: sixteen veneers and two implant crowns. The gaps are closed, the widths are even across the arch, and the color is uniform because every visible surface was either whitened or made to match the whitened result.
The partial denture is gone, and the two implants beneath the lower incisors are loading bone that had been resorbing under an appliance. The bite was established across the finished restorations rather than around the missing teeth she arrived with.
Frequently Asked Questions About Combining Implants, Whitening and Veneers
Why does the order of treatment matter so much?
Two constraints govern it. Ceramic does not respond to peroxide, so whitening has to precede any shade being recorded. And gingival health has to precede restorative work, because margins placed against inflamed tissue sit in a position that changes once the inflammation resolves.
What happens if veneers are placed before the gums are healthy?
The gingival margin recedes to its healthy position after treatment, and a restoration bonded at the earlier position shows a line at the join within months. No amount of ceramic quality compensates for a margin in the wrong place.
Why whiten if the teeth are going to be veneered?
Because not every tooth is being veneered. Any natural tooth still visible has to match the restorations, and it is the natural teeth that have to move, since ceramic will not lighten later.
Why restore the lower arch when only the upper teeth show?
For color and for the bite. A whitened lower arch beside restored upper teeth diverges again within a year or two, because natural teeth take up stain and ceramics do not. And treating both arches lets the contacts between them be designed deliberately rather than inherited from a bite that had been compensating for missing teeth.
Why implants instead of continuing with a partial denture?
A removable appliance rests on the mucosa and transmits no load into the alveolar bone, so the ridge underneath it keeps resorbing. An implant loads the bone and maintains it, as well as removing the appliance.
Can tooth width asymmetry be corrected with veneers alone?
Usually yes, where the teeth are in acceptable positions to begin with. Proportions are read in relation to the teeth above and below as well as beside them, so treating both arches gives more control over the result than treating one.
How long does a case like this take?
This one ran five months. Most of the interval is hygiene therapy, whitening stabilization and implant osseointegration, none of which can be compressed. The restorative phase itself is a small part of the elapsed time.
How long do porcelain veneers last?
Fifteen to twenty years with proper care is the usual expectation. They do not stain, and the main determinants of their lifespan are the bite and whether a night guard is worn where grinding is present.
Will the veneers and the implant crowns match each other?
They were fabricated at the same time, by the same technician, against the same shade reference. Making the ceramics for both arches together is what allows the color, translucency and surface character to agree across all eighteen units.
How much does a case like this cost?
This case was $44,000, covering hygiene therapy, whitening, two implants, sixteen porcelain veneers and two implant crowns. $526/month: 144 payments at 9.99% APR, on approved credit.
