Enamel Repair and Replacement

Our young patient pictured here had many complaints about certain cosmetic features of her overall teeth and smile.

An anterior crown was discolored, didn’t match in size and caused a very unattractive diastema (gap) between her two main front teeth. Several teeth on her upper arch had an angular appearance and, due to gingival overgrowth (hyperplasia), many of her teeth had a juvenile appearance which didn’t match her facial features or smile.


Cosmetic and restorative dentistry provides several choices, depending upon a dentist’s access to technologies, for repairing, modifying or replacing tooth structures.

Customized Treatment Combination Choices

Creating the correct combination of technologies can be critical for certain types of cosmetic or functional makeovers.

The physical properties of different types of restorative products usually influence cosmetic and functional characteristics of smiles and occlusion differently. By selecting products and treatments that are complementary (in terms of tooth structure changes and aesthetic characteristics), common problems of, for example, new crowns or veneers causing future uneven or painful bite problems, can be avoided.

Working with Mother Nature

Few people are fortunate to have perfect teeth. Genetic issues, developmental growth spurts, oral hygiene habits, treatment histories, physical trauma, oral infections, food preferences, and eating habits, to name just a few, influence how our teeth become formed and grow into their final positions as we enter adulthood.

Optimizing or normalizing a bite (dental function) and cosmetic appearance usually refers to creating or modifying what “should” exist for each patient. The functional ideal is based on the physical characteristics of facial features, jawbone positioning relationships (resting and open) between the maxilla and mandible, and the occlusal plane created by the upper and lower arch.

A reconstructive dentist focuses on these relationships and determines what requires modification or restoration so “natural” dental function is re-established or created for the first time, due to Mother Nature errors.

Education: Informed Decision Making

As our patient participated in her initial consult with Dr. Muslin, she quickly became aware of different aspects of her dentition and how it affected the development of the smile she felt was unattractive.

The angular appearance of her upper teeth, a common condition, played a role in why her smile was not as broad as she wanted. Uneven sizing, unusual wear patterns and more recently, gingival hyperplasia due to minor gingivitis was causing gum overgrowth…. making many tooth structures appear even smaller.

Mother Nature provided somewhat oversized front teeth which, over several years, caused unevenly and accelerated wear on other tooth structures, some of which were undersized. Previous treatment of an anterior crown was unsuccessful in that the sizing was not normalized, a diastema (gap between teeth) was not eliminated and the use of a metal post for securing the crown caused discoloration.

Minimally Invasive Treatment Choices

To arrest the overgrowth of gum tissue, the patient selected a non-invasive treatment for getting rid of the gingivitis. Gum lift and gum reshaping procedures (non-surgical) were used to create a harmonizing effect for all of the upper jaw tooth structures (LVI’s Rules of Golden Proportion).

To encourage the natural regrowth of gum tissue into natural positions, an optimal combination of tissue recontouring and custom no-prep porcelain veneers were fabricated to resurface each treated tooth into having a non-angular relationship with the lower jaw (veneered upper teeth become perpendicular). While height, width, and bulk were being modified for each tooth, Dr. Muslin monitored occlusal properties of all restorations to assure maintenance of proper bite characteristics.

A total of three (3) new crowns were used to replace the failed crown and to rebuild two (2) other compromised tooth structures. Dr. Muslin’s proprietary bonding process and the use of ceramic crown build up posts would eliminate the occurrence of crown discoloration that often occurs with metal posts.

Six (6) lower and seven (7) upper feldspathic veneer laminates were used to create the appearance of natural tooth enamel that would match her existing teeth and the new crowns. Specialized jacket veneers were used as needed, to prevent occlusal problems that, if not monitored closely, can cause veneers to crack, move or fall off …. a common failure with substandard veneer bonding.

Our after photo demonstrates the degree of change that is possible for creating a smile that best fits a person’s facial features. The upper arch is much broader, thereby producing a larger smile. Upper and lower lip positioning have also been altered.

Our patient is thrilled with her new smile that seems to fit “perfectly.” Her teeth and smile no longer have the juvenile appearance that is usually associated with small tooth structures.

Full face photos of the patient’s treatment are presented below for an easier review of the structural changes obtained on both arches.

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