Patient Cases

Potential Solutions

1. We first discussed veneers, as this would take care of the black triangle between her front teeth, change the color of the teeth, and deal with the wear and cracking. Also, the root surfaces would be covered up. An advantage of this plan is that we can do this relatively quickly and the white color will last for a long time. The disadvantages are that I believe we would need to do much more than 6 front teeth to get a uniform matching smile. Also, Kathy did not like the idea of cutting down perfectly good teeth in order to change the color.
2. A second option was to use KOR Ultra-T whitening to whiten the teeth, followed by gingival grafting to cover the root surfaces. Veneers would then be placed on the upper front 2 teeth to fill in the black triangle, give length to the teeth and cover the visible cracks. This treatment plan is conservative in that teeth do not need to be cut down and less expensive than veneers. Also, all teeth will have a uniform color throughout the mouth. The main disadvantage is time. KOR whitening is the best material I have found for tetracycline stains, but it takes several months to do it right. Sensitivity can also be a problem, but I have found the KOR desensitizer to be helpful for many patients.
3. The most conservative option would be KOR Ultra-T whitening followed by composite fillings to fill in the black triangle and the cracks. Composite often requires replacement more frequently than veneers but is conservative and esthetic.

OUR SOLUTION

Kathy decided on option 2. We started with custom bleach trays and the KOR Ultra-T system. After 4 weeks we started to see considerable improvement.

At this point, Kathy felt her gingival recession was not as much of a concern to her. So she decided against gingival grafting. The gingiva is healthy, so we supported this decision. Although the crack lines in the front teeth were less noticeable, she still wanted to fix these. We therefore decided on 2 veneers on the front teeth.