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Designer Smiles Dentistry

Complex Aesthetics: Anterior Skeletal Class I/ III Open Bite

Examination, study models, photos and x-rays confirm the presence of general discolouration. There was also general canting of the tooth alignment and of the centreline. The smile line also canted to the left (lower). There is also canting of the midline and uneven gum line, where the premaxillary (upper front part of the jaw) segment has tipped upwards and maxilla normal growth downwards. Because the patient tends to grind on the back teeth, this can result in possible propagating crack, hence the suggestion of a night guard once treatment is completed to protect the teeth and the new restorations.

Complex Aesthetics: Anterior Skeletal Class I/ III Open Bite

Examination, study models, photos and x-rays confirm the presence of general discolouration. There was also general canting of the tooth alignment and of the centreline. The smile line also canted to the left (lower). There is also canting of the midline and uneven gum line, where the premaxillary (upper front part of the jaw) segment has tipped upwards and maxilla normal growth downwards. Because the patient tends to grind on the back teeth, this can result in possible propagating crack, hence the suggestion of a night guard once treatment is completed to protect the teeth and the new restorations.
Model

Complex Aesthetics: Anterior Skeletal Class I/ III Open Bite

Correcting bite problems and improving aesthetics.

This patient initially presented with:

  1. General tooth discolouration.
  2. Concerned about “The problem of having an uneven bite. The gap between my upper and lower teeth, uneven bite that is causing a lisp: Hoping to correct the bite and remove the lisp.” Due to anterior open bite “V” shaped upper arch, and the large negative spaces were present bilaterally. Presence of considerable lisp which may be related to an anterior open bite due to childhood thumb sucking. Residual tongue thrust is also present.
  3. The presence of uneven lower anterior teeth.
  4. Wish to improve her smile.

Examination, study models, photos and x-rays confirm the presence of general discolouration. There was also general canting of the tooth alignment and of the centreline. The smile line also canted to the left (lower). There is also canting of the midline and uneven gum line, where the premaxillary (upper front part of the jaw) segment has tipped upwards and maxilla normal growth downwards.
Because the patient tends to grind on the back teeth, this can result in possible propagating crack, hence the suggestion of a night guard once treatment is completed to protect the teeth and the new restorations.

Adequate periodontal (gum stability), normal craniomandibular (jaw) function. Skeletal class I/III anterior open bite.

TREATMENT PLAN

The aim of the treatment is to improve dental harmony to complement the facial appearance of this beautiful patient. We need to correct the jaw discrepancy, anterior open bite and midline deviation. How do we know if our proposed changes will work? It is a system developed by Dr Nalbandian that involves direct application of proposed tooth coloured material on teeth without bonding to assess speech, comfort, dental aesthetics and dentofacial aesthetics. This is where art meets science. Following composite mock-up, we assessed the speech, smile line and aesthetics in general. The speech was improved, with diminished residual lisp remaining. Comfort and aesthetics were also improved.

 

step
1
COMPOSITE MOCK UP

We discussed using composite or porcelain veneers as well as orthodontic/surgical correction, however due to time factors and the stage of the patient’s life, an orthodontic/surgical treatment was not an option.

Diagnosis:Direct composite mock-up restoring symmetry, complementing patient’s dentofacial aesthetics. The composite mock application allowed us to assess the effect of tooth alignment, future tooth colour, arch broadening and tooth emergence and arrangement across midline as well improving the smile line and general symmetry. Speech function was also satisfactory after the mock up.

 

step
2
CONSERVATIVE TREATMENT:

Using composite veneers is a conservative treatment, since there is minimal intervention to the teeth and a biologically favourable treatment. We also discussed no treatment and consideration of porcelain veneers, which we both agreed in this case would possibly be an invasive treatment. Considerable tooth preparation would be required, which is irreversible, and therefore opted for composite veneers on upper teeth: (14, 13,12,11,21,22,23 and 24). The lower front teeth (4 and 31) will be slightly built up and selective composite placed to improve general tooth alignment.

At this stage we decided to proceed with composite veneers, which are adequate from tooth conservation point of view and the fact that modification in shape contour, colour is easily achieved. Naturally some teeth will require slight recontouring (upper front teeth: 11, 21) as discussed to improve the emergence profile and tooth arrangement. Some period of habituation will be also required, which is usually transient. This will improve colour, broaden the smile line and aesthetics in general. Slight gum recontouring at 14 may also be required.

We need to regard this as a long term provisional measure to serve as a guide for future reconstructions: porcelain veneers if required. However we can from time to time extend the life of these restorations by resurfacing the veneers with new composite materials at a minimal cost.

We pride ourselves with the quality of dentistry we deliver however, there are always limitations placed on us by materials and oral environment. One can be reassured at the end of the treatment that all should be well, however if anything unexpected does show up or unusual symptoms occur we are always here to look after our patients. Regular 6-12 monthly check-up and maintenance visits help to enhance the longevity of the restorations and your oral health.

We always stress that bruxing/grinding habits will play important role in longevity of the restorations and dentitions as whole.

 

step
3
THE RECONSTRUCTIVE / RESTORATIVE PHASE

Composite veneers on teeth: teeth: 14, 13, 12, 11,21,22,23 and 24. The lower teeth (41 & 31 small built up), slight recontouring, any selective composite placement to improve general tooth alignment and night guard. The lower cervical erosive lesions (teeth: 34, 36, 33, 43, 44 & 45) would also be restored with composites.

Aesthetic Dentistry is ‘imitation’, derived from the Greek word “mimesis” defined by Aristotle. What we are doing is imitating nature.

Specialised knowledge and experience is required to create this beautiful smile.

Dentofacial aesthetics: imitating nature with composite technology, developed at Designer Smiles by Dr Sarkis Nalbandian.

Composite veneers on teeth: (14, 13, 12, 11,21,22,23 and 24). The lower teeth (41 & 31 small built up), slight recontouring, any selective composite placement to improve general tooth alignment and night guard. The lower cervical erosive lesions (teeth: 34, 36, 33, 43, 44 & 45) would also be restored with composites.

 

STEP
4
Aesthetic Effect

Should establish harmony and balance between dentition and surrounding soft tissues

This is aesthetic dentistry at its best. Remember no teeth were cut. Zero tooth invasion. Why?
Because the teeth underneath are intact!
One Smile says it all! It was a pleasure treating this charismatic patient!

Step
5
What our Clients Say!

I've been a customer of Designer Smiles for over 20 years and I cannot say enough good things about them! From the moment you walk into the office, you are greeted with a warm and friendly atmosphere that immediately puts you at ease. The staff is knowledgeable, professional, and caring. They use the latest technology and take the time to explain everything. I highly recommend them!

Ken Baumli

Dr Sarkis is the maestro of cosmetic dentistry….for years I suffered with 2 slightly darker front teeth due to a childhood accident. I’ve had composite veneers before but nothing compared to the composite veneers Dr Sarkis did……now I feel so confident smiling again……Dr Sarkis I can’t thank you enough…

Monica McKenzie

Quite literally the best dentist I’ve been to in a lifetime. Dr Natasha Koelmeyer specifically is just a wonderfully kind and gentle Doctor. Must also mention that the head specialist here is also second to none. Their knowledge (goodness they know their stuff) their approach, their kind and gentle manner - my daughter actually enjoys going to the dentist. They’ve got a really considered patient centric mentality. I wouldn’t go anywhere else, every single person there including the reception staff is a star. Thank you Designer Smiles!

Michelle Lacasse

My journey with Dr Sarkis began about 10 years ago. I did not realise that I had lacked self confidence and shone away from "my true smile". Dr Sarkis was honest, reassuring and professional throughout my process and not only was he able to achieve that perfect smile but achieve same without compromising the health of my teeth and gums.The ongoing care at Designer Smiles is 5 star whether it is a routine check, clean minor or major dentistry. Thank you Dr Sarkis and also your team.

Christina Vergotis

I found Designer Smiles from one of their YouTube videos showcasing the Icon treatment to fix white spots on teeth. Dr. Sarkis Nalbandian's consultation provided me with a thorough plan and showed me how their practise could give me predicable results for my concerns. I knew I was in safe hands. I had Kristy Gupta perform both of my procedures and she was very professional and so kind. I am very happy with my results!

Winsome Kain

I cannot express how grateful I am for Sarkis and the team at Designer Smiles. Around 11 years ago my life changed when Sarkis first transformed my smile with composite veneers. This month, with my original teeth in tact I returned to have my composite veneers upgraded to porcelain. I was amazed that Sarkis and his team could do this without an injections, no pain and whilst still keeping my original teeth in tact. I absolutely love the result and I would highly recommend that anyone that is unhappy with their smile in any way, must visit designer smiles

Matt Williams

Started my treatment with the team at Designer Smiles in 2019. Had other dental treatments including Maxillofacial, expanders, straightening and gum grafting but out of all the procedures and surgeries Dr. Sarkis was the key as he was applying the ‘finishing product’ which included composite veneers. I am gobsmacked by the incredible job done. He talks the talk and definitely walks the walk. And his support team there are simply incredible and make you feel part of a family not just another dental clinic to take your money. Can not recommend highly enough. Customer for life here!!

Shaun Meader
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