Dr Nosheen Chowdhary presents a case involving aligner therapy and porcelain veneers.
A female patient presented at the practice in August 2022 with concerns about her crooked teeth and ongoing periodontal disease. The patient was determined to reclaim her confidence following a difficult personal life, having admitted to hiding her smile behind her hand when laughing or speaking.
A previous dentist had been unable to help improve her smile, but there were options available – the patient was informed that any actions would be part of an 18-month to two-year treatment. She had considered travelling abroad for a quick-fix but it was advised that, due to her existing periodontal disease and the current position of the teeth, a solution must address these issues to avoid a more invasive treatment and potential health risks.
Assessing treatment options
A detailed consultation occurred where the patient identified her specific smile goals. It was agreed that orthodontic treatment would be required but this alone would not change the shape of the teeth. Options were fully discussed and the patient opted for minimal prep veneers due to their longevity and superior aesthetics. However, as a comprehensive dental examination found unstable periodontal disease and several cavities at the UR3 distal palatal, UR4 distal occlusal and LL8 occlusal, treatment could not begin until they were addressed. This meant fillings for the caries, an appointment with a periodontist for treatment, as well as a dental hygienist visits every three months for periodontal disease management long-term. The treatment plan was seen as affordable and long-lasting, with life-changing benefits for the patient.
Stable and able
By January 2024, the Periodontal disease was stable and the orthodontic phase could begin. By this point, the patient was already more confident with her smile. The position of the teeth was improved with approximately 30 trays of Invisalign, enabling a minimally invasive restorative treatment. It was insisted that the patient continue with periodontal treatment every three months alongside the orthodontics to avoid relapse.
Patient compliance throughout this process was excellent, and she was ready for the restorative phase of the treatment in January 2025. This started with a home whitening system. The smile design was planned on a tablet, allowing the patient to see the vision for the final restorations – she was also able to confirm how many teeth she wanted treated with veneers, settling on eight.
Final touches
The veneer treatment was carried out using minimal preparation to better preserve the tooth structure. By building on the teeth in an additive way, the length and volume was adjusted before preparation through this additive mock-up. The final tooth structure removed was minimal, with no prep required in some instances on the premolar teeth.
It was a 4-week process to manage the veneer treatment. To help the patient, a trial smile was produced using an impression of the initial build-up. She could then test drive the veneers before the technician fabricated the final prostheses. A week later the patient returned for a review appointment. Nothing had chipped or cracked, so no modifications were needed. Satisfied, the porcelain veneers were ordered and the dental technician asked to copy the trial design. The final veneers were then fitted three weeks later.
Reflections
The patient was immensely pleased with her new smile and expectations were met. Having attended every appointment and adhered to the advice of both myself, the periodontist and the dental hygienist, the patient kept their periodontal health at an optimal standard for successful treatment.
As the patient’s journey lasted over two years, the challenge was highlighting that the time spent would be worth it, especially as the patient had considered the quick-fix of going abroad. By detailing the drawbacks of this, such as shaving the natural dentition down to pegs and failing to address the oral diseases that were present, the patient understood the long-term value of the proposed treatment plan and developed a strong level of trust in the process. Her growing confidence throughout the two+ years reflected the notable changes in the smile aesthetics – a smile that marks a new chapter in the patient’s life.
For further information and enquiries about the British Academy of Cosmetic Dentistry visit www.bacd.com
Bio: Dr Nosheen Chowdhary graduated from the University of Manchester in 2010 and also qualified in Pharmacology from Kings College London University. She later went on to complete postgraduate training in MFDS, Pg Dip Aligner Therapy and Pg Dip Occlusion and veneers. Based at Bupa Dental Care Hornchurch, Dr Nosheen has a special interest in cosmetic dentistry and has been an Invisalign provider since 2019, delivering minimally invasive restorative treatments that patients leave smiling about.
