Restoring Youth to Teeth Worn by Time

The Patient's Journey

This patient wanted to look more youthful. She had arrived at that conclusion by noticing two specific changes. Her teeth had become discolored, and they had become visibly shorter. She had also accumulated restorations over the years, placed at different times and by different hands, which no longer matched anything surrounding them.

The photographs show the wear most clearly from the side. The biting edges have flattened and the posterior teeth have darkened. From the front the effect is subtler and harder to attribute, which is the reason patients frequently describe this presentation as looking tired rather than as having worn teeth.

Understanding the Challenge

Wear removes length, and shortened teeth account for a considerable proportion of what makes a smile appear older than the person wearing it. The teeth become squarer, the edges flatten, the smile line loses its curve and progressively less enamel displays when the lips part. Restoring the length is what addresses all four of those consequences simultaneously.

How much length can be restored is determined by the bite rather than by preference. Lengthened teeth have to meet the opposing arch somewhere, and length added beyond what the bite will accommodate is length that fractures or interferes with function. The design therefore proposed an amount and the provisional stage established whether it was tolerable.

The second consideration was the character of the shapes rather than their dimensions. Fuller, brighter teeth on a patient in her sixties can be made to appear conspicuously reconstructed, which is the opposite of looking youthful. The brief was softness and femininity in the outlines, at proportions appropriate to her age rather than borrowed from someone thirty years younger.

There was also one failing tooth. A lower posterior tooth carried a root canal that had failed, and it required replacement before any restorative work above it could be considered finished.

How Dr. Mehdizadeh Approached Treatment

The design established the shapes before any preparation. It corrected the outlines of the worn teeth rather than simply rebuilding them larger. Softer edges, a restored curve to the smile line and proportions consistent with her age were specified deliberately, because fuller and brighter teeth designed without those constraints look reconstructed rather than younger.

The failing lower tooth was removed and replaced with a single implant, which is the appropriate treatment for a tooth carrying a root canal that has already failed rather than a further attempt at restoration. That site healed while the restorative design continued, since the proportions of the remaining twenty-one units could be established from the records without waiting on the bone.

Provisional restorations went onto both arches. She wore them while the new length was tested in ordinary use. This is the stage that decides how much length the case can carry, because a proposed length either functions in speech and eating or announces itself within days. The provisionals were revised, adjusted and reassessed until the shapes and the proportions were approved.

Twenty-two units were then fabricated in e.max: nine porcelain veneers and two crowns in the upper arch, and ten veneers and one implant crown in the lower. The two crowns replaced the mismatched restorations she had accumulated previously, so the older work became part of the new set rather than a visible exception within it. Everything was designed and fabricated in the practice's own laboratory by its master ceramist.

The Result After Fourteen Weeks

The teeth have their length back. The smile line has recovered its curve and the shade is consistent across both arches. Eight appointments across fourteen weeks covered the assessment, the extraction and the implant, the design, the provisional phase and the cementation of all twenty-two units, which is a longer schedule than a veneer case because the implant had to integrate first. The outlines are softer than the worn teeth she arrived with, and appreciably fuller, rather than merely longer.

There is no outstanding treatment. The restorations are ceramic, and how long they last depends on how the bite loads them, so her routine examinations review the bite alongside the gums. That is the same reason the length was tested in provisionals before any of it was made definitive.