Smile Design Cases
Case 75
Full Mouth Reconstruction After Multiple Failed Veneer and Crown Treatments in Toronto Smile Design - Yorkville Dental
Initial smile before treatment—uneven, uncomfortable, and lacking harmony.
When Aesthetics Mask Dysfunction
The patient arrived at our Toronto clinic following a long history of restorative dental treatments. She had undergone three separate veneer and crown procedures across different provinces and clinics. Despite the effort and investment, she continued to experience functional discomfort and was never satisfied with the esthetic outcome.
At her first visit, she presented with newly placed restorations on her lower arch that were significantly over-contoured and bulky, impairing speech, mastication, and esthetics. The upper arch featured temporary crowns from canine to canine—a segment she described as aesthetically “acceptable,” but still far from her desired outcome.
Her main request was straightforward: she wanted brighter, whiter teeth. Specifically, she sought an ultra-white smile without natural gradation, incisal translucency, or anatomical texture. While the color preference was clear, the underlying dysfunction told a deeper story that had yet to be properly addressed.
Our 2D smile design preview customized for facial harmony and symmetry.
Clinical Evaluation: A Case of Structural Breakdown
During comprehensive examination, the following issues were identified:
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Excessive Vertical Dimension of Occlusion (VDO): The patient’s bite was noticeably over-opened. This created strain in the temporomandibular joints (TMJ) and led to muscle fatigue in the masseter and temporalis regions.
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Improper Occlusal Contacts: The distribution of contacts across the occlusal surfaces was uneven. Posterior teeth were not engaging in centric occlusion, while the anterior teeth bore excessive contact, leading to discomfort and premature wear.
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Poor Crown and Veneer Contours: The existing restorations—particularly in the lower arch—were over-contoured, impinging on tongue space and affecting both speech and comfort. There was inadequate cusp anatomy and guidance pathways, impairing functional movements.
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Restoration Instability: The temporary crowns had already shown signs of debonding and chipping, and the patient was visibly anxious about the durability of future treatments.
The patient also reported long-standing symptoms:
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Severe tooth sensitivity, particularly to thermal stimuli, making even mildly warm or cold foods painful.
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Clenching and grinding, which she attributed to stress but were actually related to an unstable bite.
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Dietary restriction, with an exclusive reliance on soft foods like smoothies and soup.
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Sleep disturbances due to jaw tension and discomfort.
At the time of arrival, she had undergone a full-mouth reconstruction in California that she described as a failure. A subsequent dentist in Vancouver attempted to restore only the upper six anterior teeth by removing prior crowns and placing temporaries, but this partial correction further exacerbated the lack of posterior support and balance. The result: pain, esthetic dissatisfaction, and psychological fatigue from years of incomplete solutions.
Front view of severe open bite from an overbuilt bite.
Left side showing bite imbalance and poor alignment causing sensitivity.
Right side view showing no contact between teeth and bulky old restorations.
Digital bite scan shows excessive pressure on the second molars, leading to clenching and discomfort.
Smile analysis showing flared vs. properly angulated teeth—highlighting the need for full smile correction.
Preview of the smile design planning process using advanced digital tools.
Treatment Philosophy: Addressing the Foundation First
This case exemplifies the risks of treating cosmetic goals without addressing functional stability. Aesthetic outcomes—whether through porcelain veneers, dental crowns, or full reconstructions—cannot be sustained without a stable occlusal foundation.
Our approach prioritized the correction of bite mechanics and joint balance first. By establishing proper vertical dimension and centric relation, we created a foundation upon which long-lasting, beautiful results could be built.
Key Steps in Diagnostic Planning:
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Kois Deprogrammer Therapy
We began with a Kois deprogrammer—an orthotic device used to relax the musculature and identify the true centric relation of the mandible. This allowed us to confirm that the patient’s existing occlusion was pathologically altered and that her symptoms were mechanically driven. -
Digital Documentation and Functional Design
Full photographic documentation, facial scanning, intraoral scans, and radiographs were taken. Using this data, a functional and esthetic mock-up was created digitally and shared with RDT Dental Lab, a premier partner in fabricating high-quality dental restorations. -
PMMA Temporary Restorations
We fabricated full-arch PMMA (polymethyl methacrylate) temporaries for both arches. These were not just placeholders—they were functional prototypes of the final porcelain crowns and veneers. Their purpose was to test esthetics, function, phonetics, and occlusal balance in real-world conditions.
Center view showing how the final restorations will look after reducing the vertical bite height.
Left-side view of the digital plan showing the bite correction zones and final smile projection.
Right-side view of smile design showing planned corrections to lower the bite and improve alignment.
Treatment Process: Full-Arch Rehabilitation
The treatment unfolded in two comprehensive appointments:
Phase 1: Removal and Preparation
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All existing restorations—flawed crowns and veneers—were removed carefully.
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Teeth were prepped for full-coverage restorations, with careful attention to ferrule effect, biologic width, and soft tissue management.
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PMMA temporaries were delivered for both the upper and lower arches.
These temporary restorations featured carefully planned incisal edges, functional posterior anatomy, and idealized occlusion. Importantly, they were fabricated to allow real-time feedback from the patient regarding speech, bite, and appearance.
Phase 2: Finalization and Delivery
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After a few weeks of wearing the temporaries, the patient reported:
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No discomfort or muscle soreness.
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Dramatic improvement in chewing ability.
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Complete resolution of tooth sensitivity.
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No recurrence of clenching or grinding symptoms.
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With the patient’s approval of the design, we proceeded to deliver the final porcelain restorations—a combination of porcelain veneers and full-coverage crowns, fabricated using layered ceramics for strength and beauty. The shade selected was an ultra-bright tone consistent with the patient’s initial request, yet harmonized with facial proportions and lip dynamics.
Digital preview of the patient’s new smile design—tailored for natural balance and symmetry.
Left-side view of the smile simulation, showing how the new teeth will complement facial structure.
Center view: before and after placement of long-term PMMA temporaries—showing dramatic functional and esthetic improvements.
Left side: transformation with PMMA temporaries shows improved angulation and smile balance.
Right side: improved alignment and bite correction with customized PMMA temporaries.
Center view of digitally designed PMMA temporaries on the model, showcasing proposed smile form and symmetry.
Left view of the model with PMMA temporaries, displaying detailed tooth anatomy and bite correction.
Right view of PMMA restorations on the model, showing improved occlusion and side profile esthetics.
Watch how we digitally design the final restorations for a precise, customized smile transformation.
Final upper restorations on the model—showcasing detailed design and esthetic harmony.
Upper restorations from the front—balanced, symmetrical, and designed for a natural smile curve.
Final lower restorations spinning—designed for both beauty and functional precision.
Lower restorations from the front—restoring balance and precise incisal edge design.
Left upper arch—customized tooth shape and ideal angulation for natural function.
Right-side view of upper teeth—beautiful contouring and improved functional angulation.
Top-down center view of upper ceramic restorations—showing perfect arch form and symmetry.
Left occlusal view of upper teeth—balanced anatomy and seamless ceramic finish.
Upper arch from the right—highlighting precision contact points and natural tooth form.
Left view of lower teeth—designed for comfort, symmetry, and optimal function.
Right side of lower arch—refined bite plane and seamless tooth contours.
Lower arch, center view—showing balanced bite design and restored arch shape.
Left view of lower occlusal surface—digitally perfected bite and seamless transitions.
Right occlusal view of lower jaw—precision-crafted contacts and posterior anatomy.
Opening and closing jaw motion—tracking real-time function and bite closure.
Right-side jaw motion—used to evaluate chewing balance and lateral guidance.
Left lateral jaw movement—visualizing bite function and joint performance.
Forward jaw motion (protrusion)—used to guide precise anterior restoration design.
Before treatment: Overbuilt, uneven bite with bulky restorations causing discomfort and clenching.
After treatment: Restored bite with balanced, natural-looking ceramic restorations designed for comfort and esthetics.
After treatment: Restored bite with balanced, natural-looking ceramic restorations designed for comfort and esthetics.
Post-Treatment Results: Predictable and Life-Changing
The difference was felt almost immediately.
Pain Elimination: The patient ate solid food—including steak—the very next day without any temperature sensitivity. For someone who had been limited to a liquid diet for weeks, this was a transformative experience.
Occlusal Harmony: For the first time in years, the bite was balanced, with ideal posterior support and anterior guidance. Clenching ceased entirely. A nightguard was deemed unnecessary.
Aesthetic Satisfaction: The final result aligned with the patient's desire for a bright, uniform smile. Every crown and veneer was fabricated with ideal length, proportion, and surface texture to create a pristine, high-impact result.
Lifestyle Impact: She described the smile as “the one I always dreamed of,” and emphasized the importance of finally being free from daily dental discomfort. Sleep improved, confidence returned, and routine activities like eating and speaking became effortless again.
Left-side view: From flared, uneven teeth to a refined and balanced smile with natural flow.
Right-side view: A dramatic smile improvement—from flared and unbalanced to smooth, confident, and perfectly aligned.
Conclusion: Function-Driven Aesthetic Dentistry That Lasts
This case underscores a critical principle: aesthetic success depends on functional health. The best-looking porcelain veneers or dental crowns will fail if placed on a faulty occlusal foundation. Temporary improvement in color or shape cannot outweigh the consequences of poor joint mechanics, uneven forces, and overbuilt restorations.
By starting with diagnostics—including Kois deprogrammer therapy—and leveraging digital design and PMMA temporaries, we offered the patient a preview of her final smile in both function and esthetics. Only once that design was proven in daily life did we proceed to the definitive ceramics.
In modern dentistry, patients deserve more than superficial fixes. They deserve precision, predictability, and personalization. With digital workflows, skilled lab partnerships, and a commitment to comprehensive diagnosis, we can deliver full mouth reconstruction results that restore more than just teeth—they restore quality of life.
Final interview: Hear how our patient found relief, confidence, and the smile she always dreamed of after years of discomfort.
Patient Testimonial: "It Changed Everything"
“Before coming to Dr. Johnson, I had been through years of failed dental work. I had a full set of porcelain veneers placed years ago that eventually needed to be replaced. I sought help from a well-known dentist in California for a full mouth reconstruction, but unfortunately, the outcome was devastating. I ended up with a severe overbite, and soon after, I began clenching and grinding worse than ever before—something I had never experienced to that extent.
I assumed the problem was me—stress, maybe anxiety from work—but I now understand that the real issue was the mechanical dysfunction of my bite. It was affecting how I chewed, how I breathed, how I functioned. I adapted to living in discomfort without even realizing how much pain I was carrying. At one point, my teeth were so sensitive that I couldn’t eat anything remotely warm or cold. I lived on soups and smoothies for weeks. Chewing was out of the question.
Eventually, I saw another dentist in Vancouver who was hesitant about the complexity of the case. They started with only six teeth—breaking off a few of the previous dental crowns—but I was still left with flared, uncomfortable restorations and temporary teeth. When I came to Dr. Johnson, I was honestly losing hope.
What impressed me immediately was that his first concern wasn’t just the aesthetics—it was bite correction. He understood that without restoring proper function, no cosmetic result would last. He wasn’t intimidated by the scale of the treatment I needed. He developed a clear plan, and in just two treatment visits, we removed all the failing restorations—upper and lower crowns—and replaced them with perfectly designed PMMA temporaries.
And they weren’t just placeholders. These temporaries were durable, beautifully shaped, and functionally accurate. They didn’t fall out while I was traveling. They were so good, we actually joked that I might never come back for the final ceramics.
But of course, I did—and when the final porcelain restorations were cemented, I ate steak the very next day. That might sound small, but for someone who hadn’t been able to chew anything properly for weeks, it was everything. The bite felt right. The pain was gone. I’ve had no sensitivity. I haven’t even needed a night guard since—because the clenching stopped entirely.
Now, I’m sleeping well. I’m not in pain. And I have the smile I’ve always dreamed of. Dr. Johnson is intuitive, thoughtful, and precise. He asked me what I didn’t like about my smile and what I really wanted—and he made sure every detail was considered.
This treatment changed everything. The difference in how I feel every day, and the confidence I have now, is beyond words. For the first time in years, I’m living without discomfort—and I have a beautiful smile to show for it.
”
Left side before treatment: Poor bite contact, flared crowns, and visible discomfort in occlusion.
Left side after treatment: Stable bite, corrected alignment, and natural tooth anatomy.
Right side before treatment: Uneven bite, bulky restorations, and heavy molar contact.
Before (center view): Uneven edges and unnatural embrasure shapes before esthetic correction.
Right side after treatment: Balanced contact, ideal function, and smooth ceramic finish.
After (center view): Balanced, natural-looking incisal shapes with improved esthetic proportions.
Before (left view): Unnatural tooth edges and crowding before restoration.
After (left view): Smooth incisal embrasures and natural transitions after smile correction.
Before (right view): Flared teeth with poor incisal contour and esthetic imbalance.
After (right view): Clean, well-shaped embrasures and refined tooth angulation.
“In an era of rapid change, standing still is the most dangerous course of action.”
— Brian Tracy
Comprehensive Smile Rehabilitation After Failed Veneers and Crowns: A Digital Dentistry Success Story at Toronto Smile Design—Yorkville Dental
At Toronto Smile Design—Yorkville Dental, we believe that every smile should not only look beautiful but also feel comfortable and function properly. Dr. Johnson Ozgur’s expertise in full-mouth rehabilitation blends cutting-edge digital technology with individualized care to deliver predictable, long-lasting results—even in the most complex cases.
One such case involved a patient who had undergone multiple rounds of dental work over several years, including three sets of porcelain veneers and a full-mouth reconstruction that unfortunately resulted in an unstable bite, severe overbite, and chronic discomfort. She arrived at our clinic with painful sensitivity, poorly designed lower crowns, and temporary upper restorations, unable to chew properly or enjoy daily life.
Rather than beginning with esthetics alone, we took a function-first approach to rebuild her bite from the ground up. Comprehensive documentation and diagnostics were performed using our advanced digital workflow, which included facial scanning, CBCT imaging, and a Kois deprogrammer, to identify her true centric relation and ideal vertical dimension of occlusion.
We partnered with RDT Dental Lab to fabricate high-quality PMMA temporaries that served as functional prototypes. These restorations enabled the patient to experience life with her new bite, testing her speech, chewing, and aesthetic appearance in real-time. The temporaries were so stable and comfortable that she was able to travel with ease and, for the first time in years, enjoy meals without pain or worry.
After validating the bite, shape, and smile design, we proceeded to deliver permanent porcelain veneers and crowns tailored to her vision of a bright, clean, and harmonious smile. The results were transformative—not only did we resolve the clenching and eliminate the need for a night guard, but we also restored her ability to sleep comfortably, eat confidently, and smile freely.
This case highlights our commitment to restoring both form and function with precision and care. At Toronto Smile Design—Yorkville Dental, we don’t just fix smiles—we rebuild quality of life. Whether you're recovering from failed dental work or seeking a personalized full-mouth rehabilitation, our team is ready to guide you every step of the way using the most advanced tools in digital dentistry.
Book your consultation today and discover how modern dentistry can transform your experience.
