Is the center of your smile off to one side?
Redesigning the width of the teeth rather than moving them can sometimes correct a midline that sits off center, a matter of weeks instead of a year or more in orthodontics. Whether it is possible depends on how much width there is to redistribute. Send us a photo of your smile and we will tell you which answer applies to you.
- A call within two hours during office hours.
- A written cost from us, before you commit to anything.
- No obligation. Many patients take weeks to decide. That is normal.
What this case cost
$335/month
144 payments at 9.99% APR, on approved credit.
Total: $28,000 for the measurement and design, whitening of the lower teeth, the provisional phase and ten porcelain veneers.
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Treatment Plan by Dr. Mehdizadeh
- Measurement of the midline against the face and of the width available across the upper anterior teeth.
- Smile design redistributing that width so the center line fell where it belonged.
- Whitening of the lower natural teeth, with the shade allowed to stabilize.
- Provisional restorations on the upper arch, revised in the mouth.
- Ten porcelain veneers in e.max on the upper arch.
- The lower teeth left natural, whitened rather than restored.
The Patient's Journey
This patient had disliked her smile for years, and she was specific about the underlying reason. The line between her two front teeth sat off center, which tilted the appearance of the entire smile and made her persistently self-conscious about it. She had assumed the correction required orthodontics and a year or more of appliances.
There was a dark interproximal space between the central incisors as well, and the teeth on either side of the midline showed discoloration and irregular edges. The photographs display all three problems simultaneously, which is part of why the tilt had been difficult for her to describe to anyone.
Understanding the Challenge
There are two ways to correct a midline discrepancy. Orthodontics repositions the teeth themselves; alternatively, the design redistributes the width of the teeth so the center line falls where it belongs without any movement. The restorative approach requires weeks rather than a year, and it is not available in every case.
What determines it is how much width is available across the upper anterior teeth. A midline sitting off center means the widths on one side of it do not correspond to the widths on the opposite side, and correcting it in ceramic means redistributing width from the teeth carrying too much to the teeth carrying too little.
Where the total available width is sufficient, the design absorbs the discrepancy across ten restorations and the correction becomes undetectable. Where it is insufficient, orthodontics has to reposition the teeth, and we say so rather than attempt a correction the arch cannot accommodate. Hers had sufficient width.
The second difficulty was the one she cared about most. A midline correction changes the position of the most conspicuous feature of a smile, and if the restorations carrying it look manufactured, the change announces itself.
Establish whether the width available allowed a restorative correction. Move the center line without moving any teeth. Close the dark space between the central incisors. Match ten new restorations to the natural lower teeth. Keep the surface texture and translucency convincing at close range.
How We Approached Treatment
Dr. Mehdizadeh measured the midline against her face rather than against the teeth, because the reference that matters is the center of the face and not the center of the existing arch. He then measured the available width across the upper anterior teeth, and the design redistributed that width so the center line fell on the facial midline rather than on the center of the arch she had arrived with.
We whitened the lower teeth next and let the shade stabilize. We did not restore them: the ten veneers on the upper arch had to match natural teeth below them, and natural teeth have to reach their final color before we match anything to them, because ceramic does not respond to peroxide afterwards.
We placed provisional restorations on the upper arch, revised them in the mouth and confirmed the midline correction there, in her own face, before our laboratory made any definitive ceramic.
Our master ceramist reproduced the approved provisional shapes as ten porcelain veneers in e.max, designed and made in our own laboratory. We specified surface texture and translucency deliberately rather than leaving them to a standard finish, because at conversational distance those two properties are what distinguish restored teeth from manufactured ones.
The Result After Six Weeks
The center line falls on the center of her face, the dark interproximal space between the central incisors has closed, and the incisal edges run evenly across the arch, which together eliminate the tilt she had been unable to describe for years. Five appointments across six weeks covered the measurement and design, the whitening, the provisional phase and the final cementation of the restorations. No tooth moved, and she wore no orthodontic appliances.
Only the upper teeth carry restorations. The lower teeth are her own, whitened rather than covered with ceramic, and natural teeth gradually accumulate stain again while porcelain does not. The match between the two arches is therefore something she maintains with hygiene and occasional re-whitening rather than something we completed in September.
Frequently Asked Questions About Midline Correction and Porcelain Veneers
What is a tilted or off-center midline?
The line between the two upper front teeth sitting to one side of the center of the face. It tilts the appearance of the whole smile, which is why it is often noticed as a general impression rather than identified as a specific problem.
Can a midline be corrected without braces?
Sometimes. We can redistribute the width of the teeth in the design so the center line falls where it belongs without any tooth moving. Whether that is possible depends on how much width is available across the upper anterior teeth.
How do you know whether it is possible in my case?
By measuring the midline against the face and the available width across the upper teeth. Where the total width is sufficient, the restorations can absorb the discrepancy. Where it is not, orthodontics is the correct answer and we say so.
Why measure the midline against the face rather than the teeth?
Because the center of the face is the reference a viewer uses. An arch can be internally consistent and still sit off center in the face, which is exactly the situation that produces a smile that looks tilted for no obvious reason.
How long does a restorative midline correction take?
This case was six weeks across five appointments. Orthodontic correction of the same problem typically takes months to years, which is the main reason patients ask whether the restorative route is available.
Why were the lower teeth whitened instead of restored?
Because they did not need restoring. Whitening them brought them to a color we could match the upper restorations to, which is a considerably more conservative approach than covering sound teeth in order to control their shade.
Why was the whitening done before the veneers were made?
Ceramic does not lighten. The natural teeth have to reach their final color and the shade has to stabilize before our laboratory makes restorations that must match them.
Will the veneers look obviously different from my natural teeth?
Not when we specify surface texture and translucency rather than leave them to a standard finish. At conversational distance those two properties are what separate restored teeth from manufactured ones, and we designed them deliberately in this case.
Will the upper and lower teeth stay matched?
The porcelain holds its color. The natural lower teeth gradually take up stain again, so you keep the match with hygiene and occasional re-whitening rather than finishing it at cementation.
How much does a midline correction with veneers cost?
This case was $28,000, covering the measurement and design, whitening of the lower teeth, the provisional phase and ten porcelain veneers. $335/month: 144 payments at 9.99% APR, on approved credit.
