Unravelling Upper Anteriors Prior to Placing Veneers

How often have you had patients come in and ask if you could just straighten one tooth to give them a better-looking smile? It’s a fact that most adults are unwilling to undergo complete orthodontic care. Yet, many of them would love you to do something to improve the way their teeth look. Fortunately, there are many minor tooth movement procedures that you can do that will give your patients the esthetic result they are looking to achieve. In this, and succeeding issues of Aurum Ceramic/Classic News, we will explore some of the more common orthodontic procedures used every day to help you give your patients the beautiful smile they want.

A typical example of adult minor tooth movement is illustrated here (see Figures 1 - 8). This patient has overlapping centrals and two peg laterals that are lingually placed. After a diagnostic wax up was completed, it became clear that the patient had two choices. He could either have his teeth prepared for four crowns and possibly have to have intentional root canal therapy, or he could undergo some minor tooth movement to realign and evenly space out the anteriors prior to placing some veneers. The patient chose the less invasive orthodontic approach.

In this case, using a simple Hawley retainer with distal kickers to move the centrals distally and finger springs to move the laterals labially was enough to complete the orthodontics. The total treatment time prior to placing the veneers was less than three months. After the veneers were completed, a Dual-Flex™ splint was used as a final retainer. This type of retention was chosen because the patient had a previous bruxism problem. The Dual-Flex™ splint was used because its internal layer is made from a soft thermoplastic material. This material protects against the possibility of an abnormal acrylic pressure point being placed on the porcelain veneers by the splint.

Facial view of overlapping centrals and peg laterals prior to treatment.		Occlusal view showing the labial position of the central.
An intraoral camera can give the patient an idea of the expected esthetic results.		Mesial kicker springs and recurved springs were used to reposition the teeth.
Facial view post orthodontics but prior to veneer placement.		Occlusal view post orthodontics but prior to veneer placement.
Occlusal view after veneer placement.		Facial view after minor tooth movement and veneer placement.