This young gentleman in his early 30's presented with upper crowding as we can see from the images below. The lateral incisors were buccally placed and the central incisors were retroclined (angled backwards).
All the pressure when biting was purely on the front teeth. The patient struggled to eat using his molars as they didn't meet.
We can see from the images below that the patient's occlusal scheme has caused severe wear to the lower incisors. The enamel has been worn away and he was now into the dentine layer, further wear could cause pain and sensitivity.
A treatment plan of adult orthodontics followed by composite bonding to the lower anterior teeth was recommended. The orthodontics would aim to align the upper anterior teeth and create a more harmonious occlusion. With the upper anterior teeth in an improved position, this should allow for sufficient space to then restore the lower anterior teeth.
Following 9months of fixed orthodontics using clear ceramic brackets, the upper anterior teeth were in a much better position. They were no longer directly occluding with the lower anterior incisors and there was more than 2mm of space to now provide some good composite restorations. For the first time the patient could bite on his premolar and molar teeth. This had a profound impact on the patient's masticatory function as well as improved confidence and comfort whilst eating.
After completion of the orthodontics, we proceeded to plan the lower teeth. A digital scan shown below was used fo a wax up and trial smile.
Once the final wax up was confirmed, composite was used to build up the worn down teeth and the patient was delighted with the final results.
It was only when the patient realised he could now eat and chew his food using his back molar teeth that he realised how difficult this aspect of his life had been, Not only is the result aesthetically pleasing but more importantly it has improved this gentleman's chewing function and confidence.
If you would like to explore how adult orthodontics, invisalign and/or composite bonding can help transform your smile then please get in touch!
Andrew Farr
Practice Principal @Broad Street Dental Surgery