Case Study: A Prosthodontist Restores A Damaged Smile

As a prosthodontist, my primary goal is to restore teeth using prosthetics, focusing on achieving both functional and aesthetically pleasing results. In my daily practice in downtown Los Angeles, I work on a range of cases that require the precise design and implementation of dental restorations. Today, I invite you to join me in exploring a recent case that exemplifies the core of my profession.

Prosthodontics is the art and science of rebuilding smiles, and my role often involves collaborating with other dental specialists to provide comprehensive care to our patients. This case offers a glimpse into prosthodontics, shedding light on the steps, techniques, and considerations that go into restoring a patient’s dental health and confidence.

In the following case study, I’ll walk you through this typical case, highlighting the intricacies of my work and, ultimately, demonstrating how prosthodontics can make a significant difference in the lives of those seeking to regain their dental function and radiant smile.

The Problem

The patient’s initial presentation was relatively common in prosthodontic practice, but it highlighted a significant issue. They sought my expertise with a concern: two chipped porcelain veneers on their upper front teeth. However, upon closer examination, it became apparent that the problem extended beyond the veneers. See figure 1.

The gum tissue adjacent to these veneers appeared red and inflamed, signaling potential underlying issues. To get a comprehensive view of the situation, I decided to remove the veneers and perform a thorough examination. What I discovered was contamination within the root canals of the affected teeth.

The root canals, situated in the innermost part of a tooth, contain the nerve and pulp. In this case the canals had already been previously filled, but were contaminated with bacteria. It is critical that the canals are clean and sealed before proceeding to the final restoration.

The Solution

Before we could restore the patient’s teeth with new restorations, a crucial step was to collaborate with a respected endodontist who also practices in downtown Los Angeles.

An endodontist is a dentist who specializes in treating problems related to tooth pulp. In this case, their expertise was invaluable. The endodontist performed a meticulous retreatment of the patient’s root canals. This procedure involved removing the old root canal fillings, disinfecting and sealing the canals with a new biocompatible material. This helps to prevent future infections and ensures a healthy foundation for the new restorations.

After the canals were retreated, I then carefully created the necessary space within the canals to accommodate new custom posts. These posts are casted by my laboratory technician in gold alloy. Figure 3 shows the X-rays during the treatment. The X-ray on the left shows the pre-treatment image of the root canals and the chipped veneers. The middle X-ray shows the re-treatment of the canals with space created for the posts. The X-ray on the right shows the gold posts cemented into the canals.

Figures 4 shows the red acrylic pattern made for the posts. Figure 5 shows the custom gold posts in position after casting by the laboratory. These posts are retained by the canals and are critical for stabilizing the new crowns.

This cooperation between myself as the prosthodontist, the endodontist and the laboratory technician illustrates a fundamental aspect of our roles. As prosthodontists, we often serve as the “quarterback” of a patient’s dental team. We chart the course of treatment, coordinating procedures with specialists to optimize the patient’s oral health and deliver the best possible outcome.

The End Result

The culmination of this comprehensive treatment was nothing short of stunning, as depicted in these final photographs. The transformation is not only remarkable but also profoundly gratifying for both the patient and our dental team.

One key aspect contributing to the aesthetic success of the treatment is the meticulous design of the crowns. See figure 6 below. They were crafted with precision, with particular attention given to blocking the gold color of the underlying support posts. This attention to detail ensured the teeth did not appear unnaturally dark or discolored. Instead, the crowns seamlessly blend with the surrounding natural teeth, achieving a harmonious and visually pleasing result.

The porcelain layer meticulously applied over the zirconia crowns plays a pivotal role in mimicking the light-reflecting qualities of natural tooth enamel. This characteristic is crucial in achieving a result that not only looks natural but also exudes the radiance and vitality of a genuine smile. See figures 7 and 8 below.

With this successful treatment, the patient has regained more than just their dental function; they have reclaimed their confidence and a beautiful smile. The ability to comfortably enjoy everyday activities, from speaking and chewing to sharing a confident smile, is a testament to the transformative power of prosthodontics.

Could You Benefit from a Visit to a Prosthodontist?

If you’ve been inspired by this case and the transformative power of prosthodontics and wish to explore how it can restore your smile, we encourage you to connect with our dedicated team at Geach Dental. With locations in downtown Los Angeles and Laguna Niguel in Orange County, we are ready to provide personalized solutions tailored to your needs.

Don’t let dental concerns hold you back from a confident, radiant smile! Reach out to us, and let’s embark on a journey to rediscover your best smile.

Your path to dental health and renewed confidence begins with a simple conversation. Contact us today at (213) 622-3339, or click here and take the first step towards your dental transformation.

ABOUT THE AUTHOR: Meet Dr. Adam Geach, distinguished prosthodontics specialist and owner of Geach Dental. His dental education includes Harvard School of Dental Medicine and the University of Connecticut, where he earned a D.M.D. and an M.D.Sc. in Prosthodontics, respectively. Dr. Geach holds Diplomate status with the American Board of Prosthodontics, underscoring his exceptional expertise in dental care.

At his clinics in Los Angeles and Laguna Niguel, Dr. Geach offers a wide range of services, from cosmetic treatments to full-mouth reconstructions, all delivered with a focus on personalized patient care.Take the first step toward your ideal smile and improved oral health by clicking here.

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Meet Dr. Adam Geach, distinguished prosthodontics specialist and owner of Geach Dental.

His dental education includes Harvard School of Dental Medicine and the University of Connecticut, where he earned a D.M.D. and an M.D.Sc. in Prosthodontics, respectively. Dr. Geach holds Diplomate status with the American Board of Prosthodontics, underscoring his exceptional expertise in dental care. At his clinics in Los Angeles and Laguna Niguel, Dr. Geach offers a wide range of services, from cosmetic treatments to full-mouth reconstructions, all delivered with a focus on personalized patient care.Take the first step toward your ideal smile and improved oral health by clicking here.

When Old Veneers Make Your Smile Look Older

A Prosthodontic Approach to Replacing Aging Cosmetic Dentistry with Natural-Looking Restorations If you had veneers or crowns placed 10, 15, or even 20 years ago, you may have loved your smile when they were first completed. But smiles change—and so does cosmetic dentistry. Older veneers can look bulky, square, opaque, worn, or simply outdated compared with today’s more natural-looking ceramic restorations. Sometimes patients don’t want an entirely new smile. They just want their smile to look natural again. That was the goal for this patient. The Problem: Old Veneers That No Longer Looked Natural This patient was referred to Geach Dental because she was unhappy with the appearance of her four upper front teeth. Her existing veneers had several characteristics that made them stand out from her surrounding natural teeth. The front teeth appeared very square, all four restorations slanted slightly to one side, and the porcelain was relatively opaque rather than having the subtle translucency of natural enamel. See picture below. The veneers weren’t simply “old.” They looked like dental work. Our goal was to change that. We wanted to replace the aging restorations with teeth that blended naturally into her smile—without creating an artificial or overly perfect appearance. Good Cosmetic Dentistry Shouldn’t Look Like Dental Work One of the misconceptions about cosmetic dentistry is that improving a smile simply means making teeth whiter. For us, natural-looking cosmetic dentistry is much more about the details. The shape, proportions, contours, translucency, alignment, and color of the teeth all need to work together. For this patient, our goals were to: Ultimately, people should notice your smile—not your dental work. Designing the New Smile Before Making the Final Teeth Before fabricating the final restorations, we created a digital diagnostic design for the four front teeth. This allowed us to establish the new tooth shapes and proportions before completing the final crowns. After removing the existing veneers, the teeth were conservatively prepared and custom temporary crowns were made from our new digital design. This is an important part of our approach to complex cosmetic dentistry. Rather than simply removing the old restorations and hoping the patient likes the final result, the temporary crowns allow us to test-drive the new smile first. The Patient Gets a Say in the Final Smile With the temporary restorations in place, the patient can see the proposed changes directly in her own mouth. We can evaluate: Most importantly, the patient can give us feedback. If we want a tooth slightly shorter, longer, softer, or more rounded, those changes can be made before the final restorations are fabricated. Once the temporary restorations look and feel right, they become the blueprint for the final teeth. That patient feedback and refinement process was an important part of this case. Why Replacing Only Four Front Teeth Can Be So Challenging You might assume that replacing four veneers is easier than restoring an entire smile. Esthetically, the opposite can sometimes be true. When we replace only a few front teeth, the new restorations must blend with the patient’s remaining natural teeth. The shade can’t simply be “white.” Natural teeth have subtle variations in color, translucency, texture, and brightness. Reproducing those characteristics is what helps a ceramic restoration look like a tooth rather than a crown. The goal is not to make four beautiful crowns. The goal is to make it difficult to tell which four teeth are crowns. The Advantage of Our In-Office Dental Laboratory At Geach Dental, we work closely with our in-office laboratory technician when creating highly esthetic restorations. This allows us to carefully control details such as: In this case, the final restorations were designed, milled, characterized, and finished in close collaboration with our technician, using the refined temporary crowns as the guide for the final result. For front teeth, these small details can make an enormous difference. The Result: A More Natural-Looking Smile The objective wasn’t to give this patient a completely different smile. It was to make her existing smile look more natural, balanced, and current. The new front teeth have softer contours, improved alignment, and a more natural relationship with the surrounding teeth. The final crowns were made from zirconia, selected to provide a combination of esthetics and durability. The improvement is noticeable. But ideally, the dentistry isn’t. That’s exactly what we want. Before After Is It Time to Replace Your Old Veneers or Crowns? Many patients assume they should only replace veneers or crowns when something breaks. That’s not necessarily the case. You may want to consider replacing older cosmetic dental work if your restorations have become: You may also simply feel that your dental work makes your smile look older than you feel. In some cases, replacing just a few aging restorations can refresh the appearance of the entire smile. Why See a Prosthodontist for Replacing Old Dental Work? Replacing existing cosmetic dentistry presents different challenges than starting with untouched teeth. The dentist needs to evaluate the existing restorations, the teeth underneath them, the bite, the surrounding natural teeth, and the patient’s overall smile before determining what should—and just as importantly, what should not—be changed. A prosthodontist receives advanced specialty training in restorative, cosmetic, implant, and reconstructive dentistry. At Geach Dental, we routinely treat patients with existing veneers, crowns, dental implants, and complex restorative dentistry. Our approach isn’t simply about making teeth look prettier. We want the final restorations to look natural, function properly, and integrate with the rest of the patient’s smile. Ready to Update Your Smile? If you had cosmetic dentistry completed years ago and your veneers, crowns, or implant restorations no longer look the way you want, you may not need to start over. Sometimes the right approach is simply to replace aging dental work with modern, natural-looking restorations. Dr. Adam Geach, DMD, MDSc, is a prosthodontist providing advanced cosmetic, restorative, and implant dentistry at Geach Dental, serving patients in Downtown Los Angeles and Orange County. If you’re unhappy with old veneers, crowns, or other cosmetic dental work, schedule a consultation

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Replacing Old Crowns, Veneers and Dental Implant Restorations for a Natural, Younger Smile

When Old Dental Work Makes Your Smile Look Older Even the highest-quality dental work doesn’t last forever. Over time, crowns, veneers and implant restorations can begin to show their age. They may chip, stain, or no longer match your surrounding teeth. As your gums naturally change over the years, restorations that once looked beautiful can begin to appear uneven or unnatural. Many patients tell us: This patient came to Geach Dental looking for exactly that. The Challenge This patient had several cosmetic concerns affecting the upper front teeth: Because the implant could not simply be moved, restoring this smile required careful planning and advanced prosthodontic expertise rather than simply replacing the crowns. Why Replacing Old Dental Work Isn’t Always Simple Many people assume replacing an old crown or veneer is straightforward. Unfortunately, that’s not always the case. When dental implants, veneers, crowns and natural teeth all need to work together, every small detail matters: These complex cases are exactly why prosthodontists receive years of additional specialty training after dental school. Our Treatment Process Rather than immediately making new crowns, we first removed the existing restorations to evaluate the health of the underlying teeth and assess the position of the dental implant. Using digital smile design principles, we created custom provisional (temporary) restorations that allowed us to: These temporary restorations became the blueprint for the final result. Precision Craftsmanship Makes the Difference One advantage unique to Geach Dental is our in-office dental laboratory. Instead of sending everything to an outside lab, Dr. Adam Geach works directly with an experienced laboratory ceramist to customize: This close collaboration allows us to achieve an exceptional level of detail that is especially important in the highly visible front teeth. The Final Result Although the original implant position limited how much the gum line could be changed, nearly every other esthetic concern was corrected. The new restorations provided: The result is a smile that looks healthier, more balanced and significantly more natural. Healthy implant and tooth structure formed first: Final Restorations Placed: Do You Have Old Crowns, Veneers or Dental Implant Restorations? You may be an excellent candidate for replacing your existing dental work if you notice: Many patients are surprised how dramatically replacing aging dental work can refresh their entire appearance. Why Choose a Prosthodontist? Replacing cosmetic dental work is about much more than making new crowns. A prosthodontist is a dental specialist trained in complex restorative, cosmetic and implant dentistry. This advanced training is especially valuable when treating challenging cases involving: At Geach Dental, every smile is carefully planned with the goal of creating results that are beautiful, functional and built to last. Schedule a Smile Consultation If your crowns, veneers or dental implant restorations are beginning to look worn, stained or outdated, we can help you achieve a natural-looking smile that looks healthy—not like dental work. Dr. Adam Geach, DMD, MDSc is a board-certified prosthodontist providing advanced cosmetic dentistry, smile makeovers and dental implant restoration in Downtown Los Angeles and Laguna Niguel, serving patients throughout Los Angeles County and Orange County. Contact Geach Dental today to schedule your personalized smile consultation.

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