Case Study

Below is a summary of Dr. Sweet’s publication in the January 2025 edition of Compendium, a peer-reviewed scientific journal for dental professionals.

For further reading, Please see Dr. Sweet’s full publication here.

Restoring a Smile in a Patient Who Has Bite Problems and Esthetic Concerns

Overview

Before any major dental work, a dentist needs to check that your teeth come together properly when you bite and chew. This patient, who faced multiple problems with previous dental treatments, came to our office looking for a solution. The issue was an undiagnosed problem with her bite, which was causing the failure of her dental restorations. By using a specialized bite appliance to understand her bite, we created a plan that helped improve both the function and appearance of her smile.

Patient’s Concerns

A 68-year-old woman came to our office with broken teeth and a damaged veneer. She wanted her teeth to look longer, whiter, and prevent further chipping. She was also unhappy with the shape and colour of her front teeth. She had been experiencing bite issues, including jaw discomfort and tooth sensitivity, and had several previous failed dental treatments.

Diagnosis and Evaluation

• Periodontal Health: The patient had some gum issues with a few teeth, but most were in good health.
• Tooth Condition: Several of her teeth had decay or were broken beyond repair, while others had large fillings or root canals that were weakening the teeth. Some teeth were deemed irreparable.
• Bite Problems: She experienced discomfort when biting because her front teeth touched first, which caused her jaw to be pushed into an uncomfortable position. This led to continued chipping of her anterior teeth.
• Esthetic Concerns: The patient wanted a more attractive smile, but her gums and teeth were not in the right shape or height to give her the desired look.

Treatment Plan

Our goal was to create a comfortable bite and improve the esthetics of her smile by:

1. Adjusting her bite so that her jaw joint and teeth fit together harmoniously without causing friction.
2. Correcting the shape, length, and colour of her teeth with crowns.
3. Protecting weakened teeth from further damage.

Steps Taken

1. Disease Control: We started with a cleaning and improved at-home care to address gum issues and prevent further decay. We also treated some of her more damaged teeth with temporary solutions to stabilize them.
2. Bite Adjustment: We opened and corrected her bite by using a Kois Deprogrammer (a device that helps relax the jaw muscles) to find the most comfortable position for her teeth and jaw joint. This helped eliminate uneven contacts when
   biting.
3. Temporary Changes: We used bonding on her teeth to change the bite and give her teeth a more comfortable jaw joint position. This temporary solution allowed her to get used to the new bite before we created permanent restorations.
4. Restoration and Surgery: After her bite was corrected, we performed gum surgery to improve the length of her teeth, and dental implants were placed to replace missing teeth.
5. Final Restorations: Once healing was complete, we placed the final crowns to restore and protect the patient’s teeth. These were custom-designed to her new comfortable bite and also improved the look of her smile.

Results

The patient was very happy with the results, both in terms of the comfort of her bite and the appearance of her teeth. By fixing her bite and making sure her teeth and jaw joint were in the correct position, we were able to create a functional and beautiful smile that met her expectations. Her risk for future dental issues was reduced, and she left our office feeling confident in her smile and oral health.

Conclusion

This case shows how important it is to properly diagnose and treat bite issues before starting cosmetic dental work. With the right approach and tools, we were able to fix the functional problems that were causing the patient’s previous treatments to fail. This resulted in a long-lasting, beautiful smile that was both functional and esthetically pleasing.