Three chipped, worn incisors.
Missing right lateral incisor.
When patient closes on his back teeth, he must shift his lower jaw forward slightly, causing the upper front teeth to be hidden behind the lower front teeth. It is the rubbing of the upper anteriors against the back of the lower anteriors that caused this wear.

Two left incisors were restored by direct bonding of composite resin. Then, using the same material, reinforced by Ribbond, a false tooth was created in the space, while also restoring right central incisor.
Then the lingual surfaces of the lower anteriors were reduced to allow for comfortable,complete closure on back teeth.

Existing restorations from previous dentists are serving well.
There is a lower anterior porcelain-on-metal bridge.

Lingual porcelain of the lower bridge and enamel of right cuspid were reduced to allow complete closure.

Anterior Crossbite
Upper Teeth Are Hiding Behind Lower Teeth

Patient did not want jaw surgery and orthodontic treatment that could be done to correct this. He wanted simple, painless treatment of the upper front teeth to improve appearance.

The four photos below show technique. Teeth 1.1 & 1.3 were prepared. Old restorations were removed. Rubber dam was placed. Double thickness of Ribbond was used as the scaffolding for creating the false tooth 1.2 with composite resin.

Contouring & shaping has yet to be done.

Missing 1.2, worn & chipped 1.1, 2.1, 2.2 are all in lingual crossbite, after mandible shifts anteriorly to achieve maximum closure. There is end-to-end incisal contact at centric relation position of mandible. I attempted with temporary posterior occlusal splints (see photo below) to open the bite, but patient did not tolerate this.

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Photo shows two clear acrylic temporary splints on posterior teeth
Made By TALISMAN DENTAL LABORATORY

Direct bonding of 2.2 & 2.1 lengthened them. Then direct bonded bridge was made to lengthen 1.1 and create pontic 1.2, using double thickness of Ribbond reinforcement. Lingual surfaces of 4.3 & 4.2 were reduced to accommodate the upper restorations, within the pre-existing occlusion. Patient is pleased with the result.

This case involved much compromise. The best appearance and long-term result probably would start with a combination of Orthognathic surgery to reposition the jaw and Orthodontic tooth movement. Create a bite that does not involve an anterior shift of the mandible, and has the upper incisors anterior to the lower incisors,After that, incisors 1.1, 2.1, 2.2 could be restored with porcelain veneers. Missing tooth 1.2 could be replaced with an implant and crown. Patient did not want jaw surgery or orthodontics.