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Kunal Rai presents a case report of a smile makeover using an align, bleach and contour approach.

A patient in her mid-twenties presented unhappy with her gummy smile.

She said she didn’t like her front teeth pointing outward and the shade/shape of her top teeth, which were affecting her self-confidence. No acute pain was reported.

She wanted to have her teeth treated but was unprepared to have fixed braces at her age. She sought to have braces that were invisible and did not regress her confidence further.

Furthermore, she wanted to have composite bonding to improve the edges of the teeth.

Case Assessment

The patient’s last dental visit was more than 12 months prior due to the Covid-19 pandemic. She was referred to the practice through a friend.

As part of any assessment, we started by discussing the patient’s main concerns, which helps build a rapport with her so she felt at ease. We then moved on to discussing her medical and social history.

The patient was generally fit and well, taking no medication and no known allergies. Alcohol consumption was moderate and she was a social smoker.

Her oral hygiene was good, reporting that she brushed twice daily with an electric toothbrush and flossed occasionally.

The preoperative photographs are shown in Figure 1 and Figure 2. The results of the extraoral and intraoral examination are summarised in Table 1.

Table 1: Assessment summary

Face

Normal lower face height

Upper midline coincident; lower midline shifted to the right class II skeletal base

Lip catch present

Smile

High smile line

Deficient buccal corridor

Mesial of upper canines are prominent

Function

Canine guidance in excursive movements

Healthy and asymptomatic TMJ

Dentition

Multiple restoration on the LLQ

Attrition and worn incisal edge of the anterior teeth

Wisdom teeth: PE UR8, UL8, LL8 [distoangular], LR8 [distoangular]

Periodontal status

Fair oral hygiene: minor inflammation and calculus present, thick gingival biotype

Occlusion
Sagittal Right Left
Incisal Class II div II
Molar CL II sub-unit [25] CL II sub-unit [25]
Canine CL II sub-unit [50] CL II sub-unit [50]
Overjet 1mm [UR1 and LR1]
Vertical
Overbite Increased approx 50%
Transverse
Crossbite UR6
Space analysis
Upper arch Mild/moderate crowding
Lower arch Mild crowding
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CLIENT TESTIMONIALS

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As a result of an accident I had as a child my front tooth suffered some trauma and became discoloured over time. The tooth eventually broke last year which led to it being removed. I was referred to Kunal who took me through the various options I had. As functionality was the most important aspect...

Andrea B

stars 1

As a child, I was given a fixed brace by a practice who showed very little care. These were removed after 9 months due to them being "unable to straighten anymore" leaving me unhappy with my teeth and a major open bite. As years went on, I became less and less confident with my teeth,...

Imogen O

stars 1

Thank you for your hard work and I hope this testimonial reflects just how happy I am with my smile. The care and attention which I received during my smile makeover was far better than any I have previously experienced. Kunal and his team were amazing throughout the entire process. I had regular check-ups throughout,...

Matthew G

stars 1

Kunal is a very approachable, informative and meticulous dentist. From the beginning of my last Invisalign journey, Kunal explained the procedure very clearly and thoroughly. He showed me a 3D image and how my teeth would change throughout the treatment, the length of the treatment and the possible cons of it, such as black triangles...

Charanprite D

stars 1

I was never conscious of my teeth much but over the years my teeth became more overcrowded, in particular my bottom teeth. I found myself smiling in photos with my mouth closed as I didn’t like the way my teeth looked this was something that over time I got even more conscious of and so...

Eve

stars 1

Kunal and his team gave me the best experience throughout my transformation. Everything was explained all the way through the process and he even accommodated my lunch time appointments every 4 weeks! He always gave his honest opinions and made me feel at ease. He is such a perfectionist and wouldn’t let me leave my...

Happy Patient

stars 1
VIEW ALL TESTIMONIALS

CLIENT TESTIMONIALS

reviews icon

As a result of an accident I had as a child my front tooth suffered some trauma and became discoloured over time. The tooth eventually broke last year which led to it being removed. I was referred to Kunal who took me through the various options I had. As functionality was the most important aspect for a replacement for me we agreed an implant was the route to go. The tooth removal however left an element of damage to the natural bone so I had to undergo a bone graft to repair this. One year after the extraction (as 2 bone grafts were needed in the end) I'm now fitted with my implant and I can honestly say I have never been as proud to smile as I am today. From start to finish Kunal...

Andrea B

stars 1

As a child, I was given a fixed brace by a practice who showed very little care. These were removed after 9 months due to them being "unable to straighten anymore" leaving me unhappy with my teeth and a major open bite. As years went on, I became less and less confident with my teeth, until I came across Kunal. From the first moment I walked into the practice, Kunal was very welcoming and talked me through every possible stage that would happen if I was to go ahead with treatment with zoom calls to show the perceived results and ensure I was happy to go ahead with treatment Kunal gave me a diagnosis of my open bite, which was behavioural, therefore instantly this behavioural trait was worked upon to receive the best results from...

Imogen O

stars 1

Thank you for your hard work and I hope this testimonial reflects just how happy I am with my smile. The care and attention which I received during my smile makeover was far better than any I have previously experienced. Kunal and his team were amazing throughout the entire process. I had regular check-ups throughout, and each time Kunal would make sure I was happy, not just with the work that had already taken place, but with the direction my smile was headed. Kunal engaged in discussion with me about each aspect making sure I fully understood what would happen and giving me the chance to have my own input. This combined with his vast knowledge and incredible skill left me feeling fully relaxed and in safe hands. Each step was performed in meticulous detail,...

Matthew G

stars 1

Kunal is a very approachable, informative and meticulous dentist. From the beginning of my last Invisalign journey, Kunal explained the procedure very clearly and thoroughly. He showed me a 3D image and how my teeth would change throughout the treatment, the length of the treatment and the possible cons of it, such as black triangles and what can be done to minimize them. Kunal made it clear from the beginning that as a dentist his interest was the function of the teeth, better oral hygiene, the bite etc. I learned so much from him regarding my own teeth, that it was my bottom teeth that was causing the misalignment on my top teeth, l have gum recession due to excess brushing and l was in danger of losing two teeth due to it! Things my...

Charanprite D

stars 1
VIEW ALL TESTIMONIALS

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