Dental prosthetics with e.max crowns after orthodontic alignment

The patient came in complaining of chipped front teeth and an unaesthetic appearance of her smile. At first glance, it looked like a local problem — several damaged teeth in the smile area. But during diagnostics, it became clear that the cause was much deeper.

Computed tomography and examination showed that the teeth were positioned incorrectly, the bite was disrupted, and the load was distributed unevenly. Because of this, the front teeth were gradually overloaded and began to chip. In addition, we detected caries, inflammation in previously treated teeth (periodontitis — when the infection extends beyond the tooth root and maintains chronic inflammation in the bone), as well as the absence of tooth 36, which further disturbed the chewing balance.

Tooth 12 with a metal-ceramic crown was a separate problem. From the outside, it looked more or less stable, but under the crown the tooth was significantly destroyed.

This is a situation where “just placing veneers” or replacing several crowns does not provide a stable result. Without correcting the bite, any new restoration would work under improper conditions and would quickly lose its shape or function.

The patient was offered several treatment options — from faster approaches to comprehensive treatment. She chose the longer but more predictable path, which made it possible not just to improve the appearance of the teeth, but to completely rebuild the system and achieve a stable result. A team of doctors led by chief doctor Yevhen Makarenko began the treatment.

        STEP 1
        
Therapeutic preparationWe performed professional hygiene, treated caries, and also carried out root canal treatment in teeth with inflammation. This was necessary to remove the source of infection before the next stages. Tooth 12 was temporarily restored because it was needed as a support during orthodontic treatment.

        STEP 2
        
Teeth alignmentBefore placing the braces, the wisdom teeth were removed. This is not done “just in case,” but to create space and allow the teeth to move into the correct position without pressure from behind. In this clinical case, the wisdom teeth were removed before braces to create space for tooth movement and reduce the risk of complications. The need for such extraction is determined individually.

At the end of 2023, a metal self-ligating braces system was fixed. Self-ligating means that the archwire is held without additional elastics — this helps reduce friction and move the teeth in a more controlled way.

        STEP 3
        
Surgical stageTooth 12, which had previously been used as a support, was removed. Bone augmentation was performed in the area of teeth 12 and 36 — this restores bone volume when there is not enough bone for stable implant placement. After that, Alpha Dent implants were placed — a German implant system that allows stable fixation even in complex clinical conditions.

The very next day after implantation, temporary crowns were placed. This allows the patient not to remain without teeth and to maintain a familiar appearance during healing.

        STEP 4
        
Temporary tooth modelAfter the braces were removed, digital scanning was performed and a mock-up was made — a temporary model of the future teeth. It allows the patient to see the shape, length, and proportions of the teeth before prosthetic treatment begins and make changes if needed.

        STEP 5
        
Tooth preparationIn one visit, the teeth were prepared — minimal shaping of their surfaces for the future restorations — and temporary restorations were placed. This is important not only for aesthetics but also for adaptation: the patient gets used to the new tooth shape before the permanent restorations are placed.

        STEP 6
        
e.max crownsAfter 7 days, the permanent ceramic e.max crowns were fixed — 28 crowns in total. This was no longer local treatment, but a full smile reconstruction, restoring not only the color but also the anatomy of the teeth, their shape, and the contact between them. Individual zirconia abutments were used on the implants — these are intermediate components between the implant and the crown. They help avoid a gray shadow near the gums and make the result as natural as possible.

The treatment took several years and consisted of several stages — from preparation and orthodontics to implantation and full prosthetic rehabilitation.

As a result, we did not simply “renew” the teeth, but rebuilt the entire system: aligned the bite, restored chewing function, and created a stable, natural smile without overload.

Cases like this cannot be solved in one visit — but they provide a result that works for years. If you have a similar situation — chips, old crowns, an incorrect bite, or missing teeth — it is better not to postpone treatment. During the consultation, we will show what exactly is happening in your case and what treatment options are available. Carefully, step by step, and with a predictable result.

Post Author

Yevhen Makarenko

Dentist, surgeon. Clinical experience: 15 years.

Prosthetics with e.max crowns after teeth alignment

Yevhen Makarenko

Therapeutic preparation

Teeth alignment

Surgical stage

Temporary tooth model

Tooth preparation

e.max crowns

Summary

Yevhen Makarenko

From removable dentures to Straumann implants at age 73

Dental restoration: Neodent implant placement and crown prosthetics

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