Invisalign & Porcelan Veneers

As we progress with more difficult cosmetic cases, we need to have more tools in our belt. Often we are challenged by patients who are capable and willing to proceed with treatment, but have dental conditions that make treatment more complex.

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Just like fine home builders who have to get a raw piece of land ready for a home with a solid foundation, dentists must be able to setup a patient for long term restorative success.

This case presentation article will showcase a combination cosmetic case that utilized Invisalign to setup the patient for long term restorative success.

Case History

This executive came to our office for initial consultation after reading one of our cosmetic article advertisements. His work often requires him to be in front of television and newspaper reporters and he was beginning to feel that his smile didn’t represent him appropriately.

His chief complaints was the general color of this teeth, the spacing and crossbite of the right canine, and the unnatural appearance of his old porcelain work present on teeth ##7-10. Note that #8 and #9 PFM crowns were splinted together.

To accomplish these goals we had many options. My initial thought was pure restorative treatment. However, I quickly noted and was concerned about his obvious wear patterns, less than ideal occlusal harmony, and gingival discrepencies. I was especially hesitant to attempt correcting the crossbite on #6 with purely restorative treatment.

My desire for long term success and establishing a more harmonized occlusal scheme led to the determination that the case would need to be setup with orthodontic therapy followed by restorative treatment. I discussed this with the patient and he agreed. However, due to his high profile position he was not comfortable with traditional metallic braces. Luckily, I was able to offer him the option of Invisalign to replace traditional braces.

Please note that our goal was not comprehensive orthodontic treatment, but instead orthodontic treatment that would setup the case for restorative treatment.

Our final plan was to perform limited Invisalign Treatment with concurren whitening followed by 8 porcelain restorations to provide the patient with a more pleasing smile.

Invisalign orthodontic treatment was completed in approximately 6-7 months. The invisalign treatment accomplished our goals allowing us to use conservative preparations and more harmonized occlusal scheme. Below are side by side photos of before and after Invisalign treatment. We were unable to completely correct #6, but felt comfortable restoring it without additional refinement.

After completing Invisalign treatment the patient was instructed to continue wearing the aligners for an additional 2-3 months for stabilization and continuation of final lower aligner as a retainer.

The final stage was restorative treatment of maxillary smile with porcelain restorations. Our plan was to place all ceramic crowns on #8 and #9 and conservative porcelain veneers on teeth ##5-7 and ##10-12. Please note that #8 and #9 would not be splinted in final plan. Additionally, minor gingival modifications would be accomplished with diode laser.

Final side by side pictures showing preoperative condition with final ortho-restorative outcome. Special thanks to Ultimate Styles for the natural porcelain ceramics.

Final treatment outcome was completed as planned with confidence of long term stability. Retention is accomplished using aligner for lower teeth and patient was fitted with custom NTI nightime appliance.

It should be our goal as ‘cosmetic’ dentists to have our patients best interests in mind when formulating a treatment plan. This patient would have happily avoided Invisalign treatment, but I know that the use of orthodontic as a pre-restorative setup was better treatment. The Invisalign treatment allowed me to be conservative with my preparations, corrected arch alignment issues, and allowed me to setup a more ideal occlusal scheme by adjusting overbite/overjet. I encourage and recommend the use of Invisalign prior to veneers when appropriate.