Very White Teeth That Still Look Like Teeth

The Patient's Journey

This patient came in wanting a significantly brighter smile. That was the whole of her stated complaint. The examination added something she had not come in about: one upper tooth toward the back had decayed beyond the point where a restoration would retain anything, and it required extraction.

The photographs show the appearance problem. The upper teeth were crowded, darkened and rotated, and the smile was narrow in relation to her face. A brighter shade on its own would not have corrected any of that.

Understanding the Challenge

Very white restorations have a reputation for looking artificial, and the reputation is deserved in the cases that earn it. The reason is rarely the shade itself. A tooth looks natural because of its proportions, its surface texture and the way light enters it and scatters before leaving. A tooth that is flat, uniform and mechanically even will look manufactured at any shade whatsoever.

That is why the brightness she asked for was never the difficult part of this case. The difficult part was designing twenty-one restorations that retained enough individual variation to remain convincing while carrying a shade considerably lighter than the teeth she arrived with.

The extraction introduced a second consideration. An implant crown and a veneer are made differently and supported differently. Where both appear in the same arch, the crown has to belong to the same set rather than resemble it approximately.

How Dr. Mehdizadeh Approached Treatment

The decayed tooth was extracted and an implant was placed in the upper right posterior region. The restorative design proceeded while that site healed, because the proportions of the anterior restorations could be established from the records independently of the implant's readiness, so none of the design work had to wait on the bone.

The design specified shape before anything else. Proportions, the contours of each surface, the texture across the facial aspect and the way each unit was intended to handle light were all determined before any conversation about shade took place. Shade was selected afterwards, against approved shapes, which is the reverse of the order most patients expect.

She wore provisional restorations and had them revised in the mouth to her own specification. Provisionals are where a patient's preferences are expressed against something they can see and feel, rather than described in advance to a laboratory that has never met them.

The approved provisionals were reproduced as twenty porcelain veneers and one implant crown in e.max, ten veneers in the upper arch and ten in the lower. Every unit was designed and fabricated in the practice's own laboratory by its master ceramist, which is how twenty-one restorations carrying deliberate individual variation stay recognizably one set.

The Result After Ten Weeks

The shade is substantially lighter than the teeth she arrived with. The proportions are even, the smile fills the width of her face, and the individual variation in shape and surface texture is what keeps a shade this bright looking like enamel rather than ceramic. Seven appointments across ten weeks covered the extraction, the implant, the design, the provisional phase and the final cementation.

There is no outstanding treatment. The implant does not decay, but the tissue surrounding it requires the same attention as the tissue around a natural tooth, which is what the routine examinations and cleanings provide.