Patient Goals
My patient is a very successful business owner who, like many people running their own companies, had neglected his oral health for years. Eventually, his teeth started breaking, he had constant pain, and that’s when he decided it was finally time to fix everything.
He wanted a nicer smile, but even more than that, he wanted healthy teeth and gums that he could confidently chew and talk with every day. Because this was going to be such a big transformation, he wanted it to look completely natural — and he asked me to keep one thing about his old smile: his signature middle gap.
Comprehensive analysis
My patient had quite a few issues that needed to be addressed:
- Gum health: He had a lot of buildup and severely inflamed gums. Healthy gums and bone are the foundation of healthy teeth — without fixing this first, nothing else would last.
- Bite: He had an anterior crossbite, meaning his top and bottom front teeth hit edge to edge instead of overlapping naturally. This is a big problem because front teeth aren’t designed to handle heavy chewing forces — they have thinner enamel and are meant for cutting food, not grinding it. When the bite is off like this, every time you chew, those front teeth collide directly against each other. Over time, this constant stress causes the teeth to chip, flatten, and wear down prematurely. It can also overload the jaw joints and muscles, leading to discomfort and long-term damage if left untreated.
- Spaces: He had large gaps between many of his front teeth, which made cleaning difficult, trapped food, irritated his gums, and impacted how his smile looked.
- Decay and broken teeth: Multiple teeth were badly decayed and several old crowns had decay underneath.
- Missing teeth: He was missing four back teeth, which forced him to chew with his front teeth — accelerating the wear and flattening his bite.
- Aesthetics: Stained, small, and unevenly spaced teeth all contributed to an aged and unhealthy-looking smile.
Treatment Process
This was a multi-step, full-mouth rehabilitation that took months and multiple phases to complete:
- Step 1 – Gum health: We started with a thorough deep cleaning to remove buildup and calm the gum inflammation.
- Step 2 – Extractions and implant placement: I referred him to Dr. Chris Gurries, who extracted unrestorable teeth and placed implants to replace missing teeth.
- Step 3 – Full mouth reconstruction: Once his gums were healthy and the implants had healed, we restored every tooth:
- Designed a full mock-up to plan the bite, tooth length, and final smile design
- Removed all decay and failing restorations
- Conservatively prepped the teeth and placed temporary crowns and veneers
- He wore these temporaries to test the bite, speech, and aesthetics
- In one 5-hour appointment, we cemented the final crowns, veneers, and implant crowns
Design Details
- Bite: To fix his crossbite and lengthen his front teeth, I had to raise his bite. This meant increasing the height of his molars to open up his vertical dimension. When the bite is “collapsed”, which is what he had, the jaw over-closes and the front teeth crash into each other. By opening his bite, I can lengthen his teeth, ensure there is enough room to prevent the front teeth from breaking, and take stress off the jaw joints and muscles. This step was key for making sure the final crowns and veneers last long-term.
- Shade: We chose a shade that was brighter than his original teeth but still very natural.
- Translucency: To avoid the “porcelain look,” the veneers and crowns were designed to be highly translucent. You can see this especially at the edges, and because the preps were minimal, his natural tooth color shows through — making the restorations look like real teeth.
- Spaces: I had to close the spaces which requires excellent communication with the lab. We had to make sure that the teeth contact with each other properly to ensure the gum emergence stays natural. I also had to ensure the teeth were shaped and prepped in a way to keep the restorations thin enough to avoid food traps and allow for easy cleaning.
Keeping the gap: Per his request, we kept his signature midline gap — an important detail that made the transformation feel authentic to him.
Final Result
With 24 veneers, we were able to brighten her smile, soften the shade for a natural look, and give her a wider, more vibrant smile that truly reflected her personality.
The end result was a fresh, natural enhancement — not a drastic change — and a smile that felt beautifully “hers.”
The final restorations look very natural — it’s the perfect shade of white, and because his natural teeth show through behind the restorations, they look more like teeth than porcelain. I closed all his gaps, and you can see the natural contours of the gums. His bite is much better now; we raised his vertical dimension, and he no longer has a crossbite putting pressure on his jaw and front teeth.
I’m so happy for my extremely kind patient. He’s a very successful interior designer with his own firm, and during this whole process, I happened to be redecorating and renovating my office. He guided me and really took the time to help me choose new paint colors, flooring, light fixtures, and furniture. Even with his busy schedule, he made time to help me.
I love the technical aspect of dentistry, but what’s just as fulfilling is the relationships I get to build with such incredible people.
