Cosmetic Dentistry: Porcelain Veneer "Magic"

Every once in a while a cosmetic dentist has to reach deep into his “bag of tricks” to solve challenging esthetic problems, and I’m going to share with you just such a case that I treated not too long ago. This patient, a lovely lady in her 40s, was born without one of her front teeth, the upper right second tooth, which is her right lateral incisor ("her" right lateral incisor in the photo is on the left). Congenitally missing a permanent tooth occurs in about 5% of the population, but fortunately only about 20% of those are missing one or more front teeth (most often wisdom teeth or lower bicuspids are the teeth that are missing). In this lady’s situation, since she only had 5 of the normal 6 front teeth, it resulted in a generalized spacing of her teeth. She had a smile that showed a lot of her teeth, this quite embarrassed her.

I corrected her problem with 8 porcelain veneers, but with a special trick of “dental illusions”. I made all the porcelain veneers a bit wider to fill the spaces, but shaped each tooth in a way that made it look like she wasn’t missing any tooth at all.

How did I do that? I used special techniques called “cuspid lateralization” and “bicuspid cuspidization”. Since her right lateral incisor (or second tooth on her right) was missing, I made the shape of her right cuspid the shape of a right lateral incisor. Then I made her first bicuspid the shape of a right cuspid. So, even though she didn’t have the normal compliment of six upper front teeth, with porcelain veneers and a little creativity and ingenuity, we gave the illusion of having the normal compliment of teeth. Also, you’ll note that we did a little gum recontouring with laser to take away a little of the over gummy look that she had, and also reduced the length of the front teeth to reduce her overbite.

As you might imagine, she was absolutely thrilled with the result and we were extremely happy that we could provide “life changing cosmetic dentistry” for such a wonderful lady.