The Inside Out Smile

Heavily Restored and Failing Dentition

The Inside Out Smile

Problem: an older patient presented with what we describe as a heavily restored and failing dentition, i.e. that his teeth were severely worn down, restorations (e.g. fillings and crowns) broken and/or decayed and his bite overall having totally collapsed causing a forward re-positioning of his jaw. All this effectively left his teeth with an ‘inside-out’ appearance.

Solution: the photographs demonstrate the degree of this breakdown – for us, the immediate challenge is ‘space’ for there was none when the patient bit together. Given the collapsed and reversed nature of his extreme bite (developed over many years), it would be a considered process of undoing the damage and then re-programming and setting him up with a new one. Such was the level of ‘dysfunction’ that in these cases we carry out additional dynamic tracking of jaw movements in order to design a new bite well before anything permanent goes in, so that there are never any unwanted surprises. These complicated additional levels of diagnostics and planning are the only way to safely and predictably reconstruct such a jigsaw puzzle of a case. Gum surgery and root canal treatments were also part of a comprehensive treatment plan that included splint therapy, crowns, bridges, dentures as well as some elements of composite sculpting.

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Discussion Points: the patient was of senior years but given his own background in first class engineering, he was acutely perceptive to the multi-staged approach and the degree to which prosthodontics is obsessed with precision and control of both biology and the mechanics of a new smile and bite. Once again the remit for smile aesthetics was one where the fit was age sensitive and we were all thrilled at the outcome of a tremendous undertaking. In our opinion successful aesthetics should leave the observer wondering what is natural and what isn’t! Additionally in such cases, in order to protect the new teeth/bite, we always recommend the use of a splint (i.e. biteguard) to be worn at night.