A Gap Between the Front Teeth and Mismatched Crowns: Hidden Decay Treated and a Customized Natural-Shade Bridge

A diastema and mismatched crowns rebuilt with a customized bridge

Esthetic rehabilitation of the upper smile in Washington, DC for a patient with a noticeable diastema, multiple spaces, and existing crowns that varied in shade and lacked natural shape. This documented case at Elite Prosthetic Dentistry treated the recurrent decay found beneath several of those crowns with root canal treatment and buildups, then replaced them with a customized natural-shade PFM bridge from the upper right canine to the upper left first molar. Treatment was planned and completed by Gerald Marlin, D.M.D., M.S.D., a prosthodontist focused on natural-looking restorative work.

The presenting condition

The patient’s concerns were the spaces between her teeth and the inconsistent look of her existing crowns. The diastema between the central incisors was the most visible, but there were multiple spaces across the upper smile, and the crowns varied in shade and color, so the teeth read as separate pieces rather than a cohesive smile. They also lacked natural anatomical shape. The comprehensive evaluation found that the problem was not only on the surface. Several teeth had recurrent decay underneath their restorations, and some required root canal treatment and buildup procedures to address the disease and preserve the remaining tooth structure before any new restoration could be placed.

Why closing the gaps started underneath the crowns

Changing the appearance of crowns is rarely the first step when the teeth beneath them are compromised. New crowns placed over recurrent decay fail from the inside, so the foundation had to be treated and confirmed before the esthetic work began. Root canal treatment and buildups allowed the affected teeth to be preserved and incorporated into the plan. The esthetic design then had its own discipline. Closing a diastema and multiple spaces is not simply a matter of making teeth wider; width, length, anatomy, contact areas, and facial proportions all determine whether the result looks natural or obviously restored. Treating the segment from the upper right canine to the upper left first molar as one customized restoration allowed each tooth to be shaped and proportioned to the patient’s face and the shade to be made consistent across the whole visible smile.

The treatment plan

The plan treated the disease first and then designed the smile as one coordinated restoration.

The outcome

The completed treatment transformed the visible portion of the patient’s upper smile. The previous crowns had varied in shade and lacked natural form, and the gap and spaces had further disrupted the appearance; underneath, recurrent decay had compromised several teeth. After the endodontic treatment and buildups, the teeth were incorporated into a customized natural-shade bridge in which each tooth was shaped to complement her face. The before and after views at the top of this page show the diastema and spaces closed, the shade made consistent, and the proportions corrected. The patient was extremely happy with the result and the renewed confidence it gave her.

Who this case may sound familiar to

This story tends to resonate with patients in a few recognizable situations:

• You have a gap between your front teeth or spaces across your smile and want them closed naturally.
• You have crowns that do not match each other in color or shape and the smile looks pieced together.
• You suspect, or have been told, that there is decay under older crowns.
• You want the teeth underneath treated properly before anything cosmetic is done.
• You want a result designed around your face rather than a standard set of wide, uniform teeth.

If any of those describe where you are, a consultation with Dr. Marlin can give you the diagnostic picture and the specific plan for your case.

Frequently asked questions

Can a diastema be closed with crowns or a bridge instead of orthodontics?

Yes, when the teeth involved already need restoration. The spaces are closed by redesigning the width and shape of the restorations. The challenge is keeping the proportions natural; the design distributes the space across several teeth so no single tooth looks too wide.

Why would decay be found under crowns that look fine?

Decay develops at the margin where the crown meets the tooth and advances underneath, where it cannot be seen. Radiographs and a careful examination detect it. Any new restoration placed without treating that decay would fail from the inside.

Why was a PFM bridge chosen for this case?

Porcelain-fused-to-metal restorations combine a strong framework with a porcelain surface that can be shaded and shaped for a natural appearance. Material selection depends on the teeth being restored, the bite, and the esthetic goals, and is decided case by case during planning.

What does designing restorations around facial esthetics involve?

Tooth width, length, incisal edge position, contact areas, and shade are chosen in relation to the lips, the smile line, and the proportions of the face rather than from a standard template. A prosthodontist plans those relationships before the restorations are fabricated so the finished smile looks like it belongs to the patient.

More about the work behind this case

This case uses a customized dental bridge to resolve crown problems and cosmetic concerns in one plan. The treat-the-foundation-first approach reflects the practice’s philosophy, and the bridge was fabricated with the in-house laboratory.

Elite Prosthetic Dentistry treats patients from across the DMV including Bethesda, Chevy Chase, McLean, Arlington, Potomac, and Great Falls, and from much further out for cases that warrant the trip.