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Tiny teeth…some people were just born with teeth that are very small. Andrea was just such a person. Her teeth measured in the smallest 2% of the population and hated the way she smile looked. She told us that it actually affected her image in the workplace. Although she had graduated with honors from college, her co-workers and clients treated her like she was still in high school. As a results of her very young look she felt that she wasn’t taken as serious as she should have been by her co-workers and customers.
What she wanted was a mature, adult-looking smile. Braces weren’t the answer, she needed larger teeth. And she didn’t want to show as much of her gums either, could that be fixed? Fortunately for Andrea her problems could be corrected with cosmetic dentistry. First, we used a gum laser to remove some of the excess gums around her teeth. That made her teeth look a little longer. Then we placed porcelain veneers on her upper teeth, making them longer and in normal proportion to her face and mouth. Also, we made her veneers whiter and with a more natural unworn feminine shape. The results were fantastic for Andrea! She loved her new smile and reports that she get compliments everywhere she goes.
Clearly, what we achieved for Andrea is a beautiful, adult-like smile and she was incredibly pleased with the results of our cosmetic dentistry and porcelain veneers.
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA
March 18th, 2009
Kathleen had misaligned, misshaped, discolored teeth and wanted a nice smile. As an adult in her late 40s, she didn’t want to have to go through years of braces. Is there another way, she asked? Would cosmetic dentistry correct her problem and give her a great smile?
BEFORE
The answer for her was “yes”, we could correct her tooth problems with porcelain veneers on both her upper and lower teeth. Kathleen was excited as her entire treatment was completed in less than two months! See the photo below for her final results! Straight, white, beautiful teeth and smile without braces.
AFTER
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA
June 25th, 2008
One of the most frequent questions we get from new patients wanting to improve their smile is “how many visits will it take?” Here is a brief description of the process and number of appointments for a smile makeover with porcelain veneers or porcelain crowns:
1. The first appointment for new porcelain veneers is a diagnosis and treatment planning visit, about 1 hr. 15 minutes. This consists of a full examination with x-rays, models of your teeth, photographs of your face and teeth, gum length and facial analysis, and smile design analysis. No local anesthetic is needed or given at this appointment.
2. Tooth preparation and “trial smile” (temporary veneers) appointment, about 2-3 ½ hrs. A gentle local anesthetic is given to numb the teeth. Sometimes a tranquilizing medicine in the form of a pill is given to make the patient more relaxed and comfortable. The patient leaves that visit with their “trial smile”, the “test drive” of the new smile with temporary veneers. During the next few days the patient evaluates the shape, length, contour and color of the trial smile for esthetics, comfort and phonetics (how the teeth might effect speech, especially the letters “f”, “v” and “s”).
3. “Trial Smile” approval for the final shade, length, contour and color. This visit is done 2-4 days after the tooth preparation visit and lasts about 45 minutes. No local anesthetic or tooth drilling is done at this appointment. Patient and doctor finalize all aspects of the smile design, especially the color and length of the porcelain veneers. Approved smile design is photographed, teeth measured for length and models are taken for the master ceramist to use in fabrication of the final porcelain veneers. Patient signs written approval of smile design and their final choice in porcelain veneer shade.
4. Porcelain Veneer placement appointment, about 2-3 hrs. Local anesthetic is given, the temporary veneers (“trial smile”) are removed, permanent porcelain veneers are placed for the patient to preview and approve. Patient sees veneers on their teeth in three lighting conditions (fluorescent, incandescent and natural sunlight) as part of the approval process. Patient signs written approval accepting final porcelain veneers prior to final placement (bonding the porcelain veneers onto the teeth with laser).
5. Porcelain veneer check appointment, about ½ hr, 2-5 days after placement. No local anesthetic needed or given at this appointment. Veneers and bite are checked and any adjustments indicated are done.
6. Portrait appointment (optional, no fee for this appointment), 1-4 weeks after placement. Dr. Huefner, gold medal winning portrait photographer, takes your portraits of his porcelain veneer patients as part of “the celebration of your new smile”. A DVD or CD is given to the patient that included all photographs taken.
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA
May 22nd, 2008
Jenny hated her excessively gummy smile and was desperate for some way to reduce the amount of gums she showed, and make her teeth appear larger.
BEFORE
Actually Jenny had more than just an over gummy smile, she had a short upper lip and long upper jaw bone (excess vertical maxillary height). We discussed that ideal treatment for her was to see an orthodontist and a maxillofacial surgeon. However, like many people, Jenny said that she would never consider having braces or jaw surgery. Was there anything at all that I could do to help her? My answer is that I could use a very safe, effective and relatively non-invasive technique called “laser gum recontouring”. She understood that by doing this I couldn’t fix her other problems, but that I could reduce the amount of her gums that she showed when she smiled, and by doing this that her teeth would then look longer and more normal in length. The procedure with laser took less than half an hour, required a little local anesthetic, had no bleeding and very little post treatment discomfort. Look at this photo below, which is her post operative photo taken just TWO DAYS LATER! 
TWO DAYS AFTER LASER GUM RECONTOURING
Needless to say, Jenny was ecstatic with the improvement. Note how she shows considerably less of her upper gums and how much longer and more normal her upper teeth now appear. For many people with “excessive gums”, short appearing teeth and not willing to go through extensive surgery or treatment, laser gum recontouring (”gum lifts”) are a great conservative way to get an almost immediate improvement in the way the smile appears!
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA
May 2nd, 2008
Many people get porcelain veneers on their teeth because their natural teeth became worn, shortened and chipped over the years. So, how does a cosmetic dentist know how long to make the new teeth? Cosmetic dentistry is an art and there is no absolute rule, but there are many guidelines and generalities that I use in determining the length of the teeth. One thing is how much of the teeth show when smiling? When the upper lip is at rest and the mouth is slightly opened so that the back teeth are not hitting, we usually like 1-2 millimeters of the upper front teeth to be showing. That would be consistent with unworn teeth on a person in their 20s or 30s. Even patients in their 40s or 50s usually want to look a little younger, so that is a good guideline. Another thing is if a person smiles, do they show the gum line of the upper teeth and the entire length of the four front teeth? If so, then another thing comes into play – the length to width ratio of the front teeth. Studies have shown that both dentists and patients like the appearance of the upper front teeth most often if their length is 1.29 times longer than the tooth width. Or, said another way, if the width of the front teeth is 75-80% of the length of the front teeth. The lower lip gives us another guide, as when the patient smiles the teeth generally look very good if they follow the curve of the lower lip, which dentists call “the smile line”. Here is a photo of my patient Jill Frick (who was previously Mrs. U.S.Globe). Note how her teeth beautifully follow her lower lip.
The above are just some guides, but the ultimate guide is “does the patient like it” and “do they look good with that length of teeth?” In our cosmetic practice in Laguna Niguel, CA, we always verify that the patient likes and approves of the length of the front teeth BEFORE we tell our ceramist how long to make them. Our patients wear temporary veneers, called “the trial smile”, for several days and then comes back to us for verification. This gives our patients an opportunity to actually function with the length of the new teeth before making them. It’s important that they like the length, and also have no speech challenges with the new length. If they are too long, sometimes patients will have challenges with the “f” sounds (like “fire truck” or “fifty-five”) or if they are too thick on the back challenges with the “s” sounds (like “sixty-six”). The “trial smile” is a beautiful way for our patients to preview and sample the length of the new veneers and solves many of our challenges. If the patient says that they are too long, then the trial smile teeth can be shortened to the patient’s liking and then measured for the lab. If they are too short, the trial smile teeth can be lengthened as well. What is extremely important is that the length of the front teeth be a decision made by both the patient and the cosmetic dentist together, and not made solely by the ceramist (who probably has never seen the patient in the flesh). Unfortunately, there are many dentists who do veneers and have their ceramist do all of the designing, including the decision of how long to make them.
Dr. Norman Huefner, General and Cosmetic Dentistry, Laguna Niguel, CA
March 12th, 2008
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