Crowded, Worn Teeth and an Uneven Smile: Restored in a Single Visit
What a Pleasing Smile Should Show
- Even, symmetrical arch form
- Balanced tooth display and gum show
- Natural tooth colour and shape across the arch
- Smooth, harmonious smile line
What We Saw Instead
- Upper arch crowding
- Uneven, accelerated tooth wear
- Asymmetry and a narrow maxillary arch
- A worn smile line affecting overall aesthetics
Chief Complaint
Crowded upper arch, worn smile line and discoloured, uneven teeth.
Initial Presentation
Ms C presented with upper arch crowding and uneven tooth wear, both affecting the aesthetic appearance of her smile – colour, tooth shape and overall arch form. Orthodontic treatment wasn’t an option for her at this stage, so restoring function and aesthetics called for a different approach.
Initial presentation showed:
- Unacceptable tooth and gum displa
- Asymmetry across the upper arch
- A narrow maxillary arch, creating aesthetic disturbance
- Worn, uneven tooth colour and shape
This lovely, socially active patient wanted to smile with confidence again, understanding the complexity and precision the case would require.
Diagnostic Mock-Up: Real Smile Design™
Before any treatment began, we carried out a diagnostic mock-up and full assessment – a process Dr Sarkis Nalbandian developed as Real Smile Design™.
This step allowed us to:
- Finalise how much gum and tooth would show during smile and speech
- Assess the ideal maxillary arch form and smile width
- Close the spaces in the upper arch using natural tooth formation
- Test the proposed design for Ms C’s acceptance before committing to treatment
We assessed smile dynamics, speech dynamics, and Ms C’s functional envelope throughout. This mock-up stage guided the final aesthetic outcome, meaning treatment could proceed with confidence, minimal discomfort, and no unnecessary tooth intervention.
Complexity of this kind is exactly why specialist intervention matters – a precise outcome in a case with this much asymmetry and wear isn’t something general treatment alone can safely deliver.
Treatment: Composite Veneers Smile Lift™
Following discussion of all risks and treatment options with Ms C, together we considered:
- No treatment – not viable, as her main concern (spacing and wear) directly affected her confidence and appearance
- Composite additions alone – only a temporary measure, and not what Ms C wanted long-term
- Orthodontic space closure – risked narrowing the upper arch further, complicating rather than improving aesthetics
- Composite veneers – the best long-term solution for Ms C’s goals, and the option she chose to proceed with
Ten direct composite veneers were placed across Ms C’s upper arch – improving tooth shape, colour, display, length and symmetry, and restoring a harmonious smile line. This was achieved with minimal discomfort and no unnecessary tooth intervention, keeping her natural enamel intact throughout. The entire treatment was completed in a single visit.
Final Presentation
Ms C’s upper arch now showed restored symmetry and harmony, with ten composite veneers giving her a natural change in tooth colour, length and shape. Her aesthetics were restored – but most importantly, the result complemented her natural facial aesthetics as a whole.
Five years post-op
Results remained stable and aesthetically consistent.
Nine Years Later: Time for a Change
By this stage, Ms C returned requesting orthodontic correction for her lower arch (mandible). The original composite veneers on the upper arch were combined with orthodontic treatment on the lower arch, creating balance across her full smile.
Ten Years On
2017 Outcome: A decade on, the results have stood the test of time – a testament to both the durability of the original composite veneers and the accuracy of the initial diagnostic planning. Harmony and balance between the dentition and surrounding soft tissue have been maintained throughout.
Final Treatment Outcome
Aesthetics, comfort and function were restored and maintained across all three stages of treatment, with a meaningful complement to Ms C’s facial aesthetics throughout – what Dr Nalbandian describes as dentofacial rejuvenation. Most importantly, the result was a confident, happy patient over a decade of care.
Registered Specialist
Prosthodontist & Implant Surgeon
B.D.S. (Hons), Dip. Clin. Dent. (Oral Implants) Uni Syd, M. Clin. Dent (Prosth) King’s College, Uni London D. Clin. Dent (Prosth) Uni Syd, FRACDS, MRACD (Prosth)
What Our Patients Say
Here are just a few reflections from patients featured in our case studies. Every story is different, but each one speaks to the power of feeling proud of your smile again.
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