Chief Complaints: Headaches & Small Teeth

By Rhys Spoor, DDS, FAGD
Accredited Member of the American Academy of Cosmetic Dentistry
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This case shows an example of using a conservative restorative approach to get a big change in the function and aesthetics for this patient. Her chief complaint was two-fold: daily headaches and small teeth. Clinically she exhibited significant wear, especially in the anterior area, a compressed vertical opening, multiple diastemata anteriorly, chipped incisal edges, a darker shade and one less than adequate restoration on #19. Additionally, she was fearful of the whole dental process from when she had #19 placed years before and extremely self-conscious of the appearance of her teeth.

Patient Goal: A Nice-Looking Smile
At first, all we did was replace #19 with a bonded ceramic crown with a little triazolam and local anesthesia. The experience allowed her to begin to trust she would be OK to get through the rest of a process to get what she really wanted which was a nice-looking smile. Using the concept of form follows function, the need to gain more vertical height became apparent and meant the amount of tooth reduction to restoratively treat this case would be minimal. We established a final occlusal position using TENS (trans electronic neuro stimulation) and did an intraoral mock-up from a diagnostic wax-up at that position.

No More Headaches and Happy Patient
The maxillary arch was prepared first and an acrylic overlay was placed on the lower arch during the transition. While the final maxillary restorations were fabricated, we had time to access and correct any negative functional issues. The time to fine-tune the occlusion and the aesthetic acceptance is during this phase because it is a lot easier to adjust acrylic than it is to adjust the final ceramic.

We found that her daily headaches ceased, and she really liked the aesthetics. During her first night home with the provisionals, she sent us an email that said, “When I looked in the mirror, for the first time in my life, I thought of myself as pretty.” That is always very satisfying to hear from any patient.

Second Phase Goes Smoothly
We seated the final restorations in the maxillary arch against the mandibular overlay and, one week later, prepared the mandibular arch. Since most of the functional and aesthetic issues were resolved during the first provisional phase, the second phase went smoothly.

Met Goals of ImprovedFunction & Aesthetics
with Conservative Solution
The final result accomplished our mutual goals of improved function and aesthetics with a very conservative restorative solution.

Dr. Rhys Spoor is a 1983 graduate of the University of Washington where he was an Affiliate Assistant Professor in the Department of Restorative Dentistry for 10 years. He is an Accredited Member of the American Academy of Cosmetic Dentistry, a Fellow of the Academy of General Dentistry, the American Dental Implant Association and the Pierre Fauchard Society. He is also an Editorial Reviewer for the Journal of Cosmetic Dentistry. Dr. Spoor maintains a private practice in Seattle in aesthetic, implant and restorative dentistry. He may be contacted at

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