Monique's Smile Story

Cosmetic Dentistry - Smile Makeover

This is Monique's story... 

A dental professional told me "You have to go to Royal York Dental. They're the very best at cosmetic dentistry."

I had very high expectations when I came in for the consultation. Everything got top marks from the amazing customer service to the modern equipment and techniques. And of course the unmatched expertise coupled with the relentless effort to reach perfection for the customer.

I've been so impressed at each visit and that's saying a lot for having spent well over 20 hours in the chair to complete all the work for my smile.

I LOVE my new smile and I can't tell you how many positive comments I've received to date. Thank you so much for all your help and care. You're a wonderful team! ~ Monique Patenaude ~ Jan 2010

Watch the 4 video segments to hear Monique tell her story. Her responses during this interview were completely unscripted. She was happy to share details of her experience, knowing she would help others understand more about the benefits of Advanced Cosmetic Dentistry.

Recapturing Beauty & Longevity

Monique first  came to see us in February 2009. She was referred by one of her friends who worked in the dental field.  She came to us to explore how she could improve her smile.

Monique worked in healthcare and knew quite a bit about aesthetic dentistry. She had been already spoken to a few dentists about her cosmetic options, and was skeptical at this point.

Having a healthy dose of skepticism was a good thing. Before taking that first step, she wanted to make sure she was choosing the right path and the right professionals.

Our first goal was to simply help Monique by sharing a bird’s eye view of the possibilities for her smile.

Dr Joe Bulger states, "The journey to a beautiful smile always starts from our guest's point of view. What concerns them about their smile and what changes would they like to see? Our first role is to serve as trusted advisors - as guides on their journey."

After our initial interview, we moved over to a dental operatory so we could determine Monique’s current situation and explore the aesthetic potential for her smile.

Monique's Situation:

Monique's smile on the first day she first came to see us

Remember that TV show called Extreme Makeover? The best cases were those delivering the biggest transformation. 

Dr. Joe Bulger states, "I get excited by the aesthetic potential of a smile. When I see someone's smile that can be dramically improved, I'm eager to help make that happen. Of course, I have to contain my excitement until I can be sure that person is ready to hear about the possibilities. It's a delicate subject and people may take suggestions the wrong way. Fortunately, Monique was ready to hear everything and that was a huge help."

The following list represents the issues we found with Monique's smile that day. We've attempted to translate those findings into general terms for you.

Right side of smile before treatment

Excellent periodontal status and terrific oral hygiene. It's our philosophy that health precedes beauty. Monique's gums were in excellent shape and she took care of her dental health. This meant that any investment she made in her smile would likely be sustainable for years to come.

Attractive full lips and a large smile display. Monique's smile was very prominent. That meant any enhancements we made would probably have a big impact on her overall appearance. It also meant that most of her teeth were "on-stage performers" in her smile.

High upper lip line. Monique showed all of her upper teeth when she smiled. This meant that Monique's upper gums become a factor in designing her smile and the aesthetic demands of this case would be more challenging.

Heavily restored dentition on both arches. There was lots of previous dentistry done on Monique's teeth. Some of the work was old and looked a little worse for wear. This meant that any new restorations would be more oriented towards maximum coverage and protection.

Multi-colored teeth. Monique had extensive bonding and crown coverage. There wasn't a consitent color to her teeth - some were light and some were dark.

Dark-colored teeth. Over time, Monique's teeth had faded in color. Her smile looked aged. This meant Monique was a great candidate for Teeth Whitening.

V-shaped upper arch. This led to excessive dominance of the upper central incisors. Monique's teeth on the sides were squeezed inwards, making the front teeth look more "bucky" in appearance. This meant that restoring Monique's smile would be more complicated and involve expanding the sides outwards.

Upper arch before treatment

Erosion damage to teeth. Most of Monique's remaining teeth showed considerable erosion damage from acid exposure (see Special Report on Acid Attack to learn more). This meant the restorations for Monique's teeth were not just aesthetic in nature. They would be restoring and protecting her damaged teeth.

Moderate overclosure. Monique's bite had slightly collapsed in height due to extensive erosion and wear. When the bite collapses, the lower part of the face begins to collapse. Restoring Monique's bite would give her more support for her lips and cheeks.

Moderate bicuspid drop-off on the lower arch. Monique's bottom front teeth looked long, while the ones on the side looked short. Changes to her smile would need to address this imbalance.

Finding so many issues with Monique's teeth meant that there was greater potential in transforming her smile. Imagine a smile that starts at a 4 and jumps all the way to a 9  or 10. That's a far bigger jump than a smile that start out at 8.

Treatment Goals:

Our goals address the compromises we found in Monique's smile.

These were our 5 main goals for Monique's Smile Enhancement:

1. Improve the color and contour of her teeth.

2. Restore and protect all the erosion-damaged teeth.

3. Expand the buccal segment to fill out the buccal corridor and improve the proportions of her front teeth.

4. Prop open the bite to restore the lost vertical height and allow clearance for restoring the upper front teeth.

5. Reduce the sloping curve (bicuspid drop-off) on the lower teeth.

Recommended Treatment:

Step #1 – Contouring. Straighten lower front teeth with selective trimming.

Step #2 – Teeth Whitening. Improve color of upper and lower teeth.

Step #3 - Diagnostic Waxup. Provide a simulation of final result in a slightly opened vertical position.

Step #4 – Aesthetic Previews. Transfer the waxup into Monique's mouth. The se "Bonded No-Prep Aesthetic Previews" are worn for a minimum of 60 days to ensure acceptible aesthetics, occlusion (bite) and phonetics (speech sounds).

Step #5 – Restore lower arch. Use E-max Porcelain Restorations on lower second bicuspids, composite restorations on the lower first bicuspids. Replace crown on lower left cuspid.

Step #6 – Restore upper arch. Use E-max Porcelain Restorations on 12 teeth (from the upper right first molar to the upper left first molar).

Results:

We didn't push Monique to go for the full reconstruction right from the beginning.  We knew she could get quite an improvement just from those first 2 steps of Contouring and Whitening. So that's where we started.

New smile after treatment

The Contouring was done in under 20 minutes with no anaesthetic. Impressions were taken to fabricate custom Whitening trays and Monique was soon whitening her teeth at home while she slept. 

Within a few weeks Monique's teeth were considerably whiter and more even in color. She was very pleased with those early results. She also knew there was far more that could be done, and was ready to press on to fully restore her smile.   

We went ahead and made the Diagnostic Waxup.

Monique was amazed by how good the teeth looked on the model, but that was nothing compared to how thrilled she felt when she had the Aesthetic Previews inside her own mouth. The change was dramatic.

Upper arch after treatment

Monique was ecstatic about her new smile at this preview stage. She was surprised by how much extra support she gained for her lips and face. It took very little time for her to get used to the new bite.

Left side of smile after treatment

Next, we restored Monique's lower teeth to repair the damage and replace the old restorations. This corrected her excessive lower arch curve.

After waiting 2 months, we had Monique back in to restore all the upper teeth in 3 stages - right side, left side and front. This was the most time-consuming stage of the work.

The results of Monique's makeover were spectacular. As good as the previews looked, the real thing was far better.

Monique's photos were taken one week after her final insert, and we presented her with a gift to celebrate her new look!

Left side of smile after treatment