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Prior to having your full mouth reconstruction, it would have been highly advisable to have orthodontics dental treatment first, prior to placing full mouth crowns. You are trying to correct the skeletal discrepancy of under developed upper jaw bone with fabrication of crowns, in which the teeth will look long, flared and angled. There are some cosmetic dentistry illusions we as cosmetic dentist can use to make it a pleasing smile, but not perfect. Orthodontic, or orthognathic surgery options must have been discussed with you, and also the looks of the final outcome prior to starting full mouth crowns.I am guessing that you had a pseudo class 3 bite in which the dentist tried jumping all your upper teeth over the lower teeth, and as the result of that you have flared, long upper teeth.At this point if you are not happy, you still need to consult an orthodontist and a maxillofacial surgeon, for solution and possibly redo most of your porcelain crowns after their treatment.In cases of full mouth crowns with bite issues, in my practice, it is a must that I would do a full wax-up of the final result, so you as the patient would know what you will be getting, all your questions and concerns must be answered to your satisfaction and you sign off on what I can achieve for you. For cases with bite issue, I would have referred you for consult and treatment with orthodontist prior to starting any full cosmetic dentistry.
You have received a prosthetic solution to an orthopedic problem. I would have suggested growing your jaws orthopedically as a first step and then finding a correct bite. It is hard to diagnose with a single photo but the deep nasal labial lines are due to narrow maxilla and overclosure as are the depressed angular lines of the lower lips.Patient is cross-bites often posture their jaws forward while opening of the bite allows the lower jaw to roate back. Even with the porcelain built outward you still have dark buccal corridors.Ideally a DNA expansion appliance would have been a good start.Ira L Shapira DDS, D,ABDSM, D,AAPM, FICCMOChair, Alliance of TMD OrganizationsDiplomat, American Academy of Pain ManagementDiplomat, American Board of Dental Sleep MedicineRegent & Fellow, International College of CranioMandibular OrthopedicsBoard Eligible, American Academy of CranioFacial PainDental Section Editor, Sleep & Health JournalMember, American Equilibration SocietyMember, Academy of Applied Myofunctional Sciences
