How We Restored One Patient’s Smile After Veneers: Part 1

Why She Was Dissatisfied and How Our Team at My Gilroy Dentist, Amy N. Tran, D.D.S. Helped

I’ve encountered some cases that forge an indelible place in my memory, and make me feel incredibly grateful to be able to create positive, transformative change in my patients’ lives through the practice of dentistry.

Recently, I had a young female patient in her 30s who was new to my office and had a concern about the esthetics of her smile after recently having veneers and one anterior (front) implant crown placed on her six front teeth. She felt self-conscious about smiling because of the appearance of the restorations, as she did not feel that it was “her” smile and that the teeth looked “fake.”

Dental esthetics can be a tricky thing. Truly, the veneers that this patient came in with were objectively nice. By assessing the restorations, I could see that her previous dentist had used quality techniques and materials in the placement, design, and fabrication of the veneers and implants.

The problems with beauty lie partly in its subjectivity -- what is beautiful according to one paradigm may not work for another. Thankfully, cosmetic dentistry also utilizes scientific principles and guidelines which, along with subjective ideas of an individualized “ideal” smile, can produce incredible results.

In the case of my patient, the issues I noticed immediately during her preliminary consultation, which she was already aware of for the most part, were the following:

  • Restoration opacity

In brief, the porcelains used to make dental restorations are not all created equally. Some are opaque, preventing penetration of light through the material, while others are more translucent.

As my patient’s veneers were designed to replace enamel, which has a natural translucency, my goal became to replace them with a similarly translucent porcelain for the most natural appearance.

  • Restoration shape

Another observation important to the design of an esthetic smile is whether or not the shape of the restorations match the face of the patient.

As my patient has delicate, feminine features, it became important to create the appearance of teeth that match her youth and femininity. Rather than the squarish teeth she first presented with, I planned for a more rounded appearance for her incisors (the four front teeth), especially around the corners of the restorations.

  • Relatively small lateral incisors (the two teeth to the side of the two front teeth)

In cosmetic dentistry, proportions RULE. Specifically, the Golden Proportion, which relates parts of a whole to the ratio of 1:1.618.

This will be further explored in future blogs, but to summarize, there is a science to the size relationship of teeth for the best esthetic results (See picture below for a representation of how teeth may be measured according to ratios).

  • Restoration color

Teeth color may be the first thought that comes to mind when considering cosmetic dentistry. As we know, color is the result of light reflected by an object, and can be qualified and quantified through hue, saturation, and brightness.

In dentistry, we have a wide array of tools and equipment available to gauge and closely match “color” so that tooth-colored restorations can blend in as naturally as possible with existing teeth. I use the “Vita Classical Shade Guide” frequently to assist in assessing the best “color match” when planning for esthetic restorations. In the case of my patient, her front restorations appeared bright compared to her other teeth, which made the teeth appear to stand out more when she smiled.

  • Smile design

Smile design is complex, as it necessarily should be. I could go on for pages in a thorough discussion of this topic, but to simplify and focus on this patient, one thing that stood out was the “transition” from her existing front restorations to her back teeth. The thickness of the restorations on her front teeth made them appear more prominent and casted shadows on her posterior (back) teeth, thereby creating the look of “bulky teeth” in the front. Although the veneers themselves are beautiful, I wanted to change their relationship to her remaining natural teeth.

With these observations and considerations, what did we do next? Find out what happens for my patient in the next blog.

Click here to view our Before + After Gallery!

If you have questions about veneers, don’t hesitate to make an appointment with our team! You can call us at (408) 317-7300 or contact us online.