Which way to go?

[Berkshirelad]

I am a 28 year old male who has always disliked his smile.

I have a full completement of teeth, including all my wisdom teeth which are fairly crowded at the front of my mouth. My bite has never been great and I feel like I don't have a particular "set bite". Teeth are also darker than I would like and I have approximately 6 small restorations (combination of amalgam and composite). In addition I have a small amount of recession around several teeth (regular dentist suggested due to over zealous brushing) which has largely been halted for several years now and the sensitivty is 95% controlled with sensitive tooth paste. My two upper front teeth have small injuries (a star crack on one and a chip on the other) but these have never worsened or stained.

My question is what would be the best treatments to improve my smile? I could afford up to £5000 over a the next year, so am guessing Orthodontics and whitening would be the most conservative and natural option within my budger. However I am concerned about receeded my gums any further with this treatment. In addition I would like to consider gum grafting to address the receeded gums but this does not seem to be readily available in the UK.

Any ideas guys?

I am due to see an local orthodontist and a london cosmetic dentist over the next fews weeks - over a £120 just to get an idea of options and prices!

[Dr Sepehrara]

Hi

Of course it is impossible to give you a treatment plan without looking at the mouth, but I would suggest orthodontic treatment as the first option and then teeth whitening. As you said this would be the less invasive procedure, especially because you are 28.

You should be able to find many good periodontists in London who would be able to carry out soft tissue grafting procedures.

If required , this would be indicated after the orthodontics is completed , if that is what you wished to be done.

[prosman]

I agree with Dr Raha, have the ortho treatment first and whitening and then see about the gum surgery. It is important that the underlying causes of the recession are dealt with before the surgery. Gum surgery is also not that pleasant if gum is harvested from the roof of the mouth.

[davidbloom]

Your options are basically

1/Braces to move the teeth - Options include a removable Inamn alligner, Invisalign and fixed braces on the outside ( metal or tooth coloured ) or on the inside of your teeth. After the braces you could consider whitening . This option will move the teeth but not change their shape. If minor shape change is required of there are small areas of wear this could be achieved with composite bonding

2/Porcelain veneers - can change shape and arrangement . May involve some sort of orthodontics to pre allign the teeth and keep things conservative . This option would usually involve some degree of tooth preparation but this should be kept very minimal

The options depend on you ,what you want to achieve and obvioulsy upon your teeth

Gum grafting is an option if you want to replace the missing gum tissue but may not be required if the sensitivity is managed. If this is to be done it should be done before any tooth preparation is done (if you chose this path)

Regards

David Bloom
Past President BACD
Accredited member BACD