Pasha Nasirzadeh

05/08/2026

Creating Harmony: A Multidisciplinary Case Treating Undersized Lateral Incisors

Sometimes our patients' concerns are a result of multiple problems over time which create an unpleasant aesthetic result. And sometimes the underlying cause for aesthetic disharmony may not always be identifiable at first glance.

In this patient's case, she thought her problem was with her two front teeth. She felt that they were "too large" for her smile. In many instances the two front teeth are actually an ideal size and the problem is due to other areas of the smile that can create disharmony.

Our patient was concerned because she felt her front teeth were too large and thus too prominent for her smile, however upon closer inspection, she actually had a narrow upper arch and undersized lateral incisors. Her anatomy caused her front teeth to appear larger than normal and she was uncomfortable with her appearance.

The narrow arch and the tooth alignment were corrected by orthodontic treatment by . Once the teeth were aligned, some spaces were left around the lateral incisors due to their size. This spacing issue was then corrected with 2 porcelain veneers fabricated by .

The arch alignment and the narrow jaw will require orthodontic treatment (braces) in the future and her undersized lateral incisors will require restorative treatment (porcelain veneers) as well to achieve her preferred best results.

05/01/2026

Before Your Next Sip... Watch This!

I'm often asked if sparkling water is bad for your teeth so I thought I'd share this video. Feel free to ask any questions if you have any.

04/24/2026

A Four Year Follow Up On A Cracked Tooth

This lovely patient saw me for pain on a lower tooth just over 4 years ago. She was experiencing sharp pain when biting on the lower right.

After a thorough examination, the tooth was vital and the diagnosis was a coronal fracture. The old amalgam restoration was removed and we discovered two cracks in the tooth.

One oblique/horizontal crack extending under the wall with symptoms. The second, a vertical crack originating from the same area as the first crack but extending through the middle of the tooth over the nerve. In my experience, the vertical cracks are much harder to manage and more detrimental to the tooth long term. I knew I had to try to mitigate the forces on the tooth to reduce the risk of the crack extending beyond its existing location. Removal of cracks like these aren't always possible and may lead to more damage to the tooth than we want.

The horizontal cracks can be easier to manage as the wall above them can be removed/replaced. This usually leads to immediate resolution to the symptoms and chances of recurrence, if treated properly with a well bonded restoration, become very minimal.

In this case, the horizontal crack was removed. The vertical crack was left and reinforced.
An overlay was fabricated to connect the cusps in a cohesive manner. The mesial and distal
contact points were preserved to prevent unnecessary removal of tooth structure. We only
remove tooth structure if it's compromised or if space is needed for the ceramic.

A Lithium Disilicate overlay was fabricated by to protect the tooth.

On the four year follow up the tooth is vital with no pathology and no symptoms.

04/17/2026

It's hard to believe it has been 6 years. 

I joined the executive board of the Toronto Crown and Bridge Study Club 6 years ago.

Before the pandemic.

Before knowing our family was going to grow.

Before knowing how this experience would change my professional life.

There were ups and downs as the uncertainties of the lockdowns and lack of travel made it difficult to perform the tasks we needed to finish. Yet despite the challenges we were faced, the past 6 years have brought unimaginable changes to my career and personal life. I've met so many friends and mentors on the board. I've developed lifelong friendships. I've met mentors who have over time become friends, people I turn to for questions and guidance. I have met professionals around the world who share the same passion for dentistry that I do. 

I spent entire weekends with some of the most impressive educators and clinicians who are pushing our profession to heights previously unknown to me. The most impressive part is learning how humble, kind and selfless they are. I have become a much much better clincian as a result. 

My friend and mentor, Abdi Sameni (), deserves a VERY special thank you. Abdi has had tremendous influence and impact on my professional career.  He showed me a lot of doors to open and peek through, and I will continue to do so throughout my career. 

The Toronto Crown and Bridge Study Club () is a very special organization that I am proud to be a part of for many years, and to help organize for the last 6. And while my tenure for the Toronto Crown and Bridge Study Club is now complete, I will still be happily around to help this incredible group of dentists I now call family.

04/10/2026

Life Is A Highway

Sometimes a patient's smile journey starts well before they find us.

This lovely patient of our's had such an experience. Prior to visiting us, she experienced a long and challenging orthodontic and surgical phase. Once she completed orthodontic treatment an implant was placed for a missing front tooth while she also had a smaller lateral incisor (sometimes referred to as a "peg lateral") on the right side. The surgical phase was challenging due to some complications that lead to multiple surgeries. Ideally my team and I want to be involved in the planning stages for our patients' smiles, but unfortunately this isn't always possible.

From a patient's perspective, the restorative process can sometimes be challenging as it is the final stage of a long treatment period. In this patient's case, the entire process from the start of her orthodontic treatment until we met with her spanned over 5 years.

As a health practitioner, it is important to have empathy to understand each patient's story. This is where my team comes in. It is our job to ensure each and every one of our patients are heard. It is our responsibility to ensure our patients' needs are fully understood to curate an ideal treatment plan that meets (and hopefully surpasses) those needs. If we anticipate challenges, we need to discuss and review them with the patient. And finally, every person on our team has to excel at what they do to achieve an exceptional result that will withstand over time.

There are many different ways to solve this patient's problem, but after many discussions and gaining a deep understanding of her expectations and objectives, this was the path taken. It is impossible to achieve a perfect result when you begin the process with compromise. In her case, we weren't involved in the initial planning stages of her prior dental team. However despite the challenges we were faced, I am proud that my team and I were able to provide her with a new smile that exceeded her expectations. She was over the moon with her new smile and that is our ultimate goal.

Beautiful ceramics by

02/19/2026

Cloudy White Spots

Here is an example of white spots caused by fluorosis.

Our lovely patient inquired about treatment options for her two front teeth. For many years her smile had an unsightly combination of cloudy/brown spots on her teeth. She had seeked prior medical advice elsewhere that ranged from observation to porcelain veneers. 

While these treatment options were valid, they didn't meet specific criteria our patient was seeking. She wasn't interested in changing the shape of her teeth, she only wished to treat her two front teeth (despite her other teeth showing less evident white spots), and she was searching for a solution that was less invasive to avoid any removal of tooth structure. Additionally our patient had a small chip in a corner of one of her teeth, yet despite its condition, she did not want the tooth restored.

After a thorough discussion and review of various treatment options, our patient decided to start with initiating a whitening treatment to lighten the color of her teeth and attempt treating the brown spots. Our goal was to evaluate how the teeth respond to determine if any further treatment was necessary.

After two whitening treatments in the comfort of her own home (overnight trays) we were able to achieve a desirable result. The brown spots were nearly gone!

And while the white spots were still prominent, we knew that no further treatment was necessary to change the shape of the teeth. At this point our patient decided to undergo resin infiltration to target removal of the white spots. Roll over or click on the images below to see the transformation.

You can see in the final results that the opaque spots on the teeth are gone. A very small, thin layer of composite resin was placed on the middle part of the tooth to cover the mottled nature of the enamel in the area of the white spots.

Our patient is absolutely ecstatic about the result! We couldn't be happier and we are thrilled to have treated her smile in a microinvasive manner without removal of any tooth structure.

Questions? Let me know in the comments.

12/09/2025

WE DID IT!!!

Thank you to everyone who helped make our first annual Polished Punchlines Comedy Gala a successful one!

With your help, we managed to raise OVER $5000 for the Canadian Mental Health Association (CMHA).

Special shout outs to our host, and our comedians, and , for keeping the laughs coming all night long. All of them made the evening a memorable one.

I can't wait until next year!

11/18/2025

Smile Upgrade

I saw this lovely patient for the first time with the concern of a missing tooth due to a fracture. There were some failing veneers that were completed only a couple of years before, and she was not happy with the shape and size of the teeth.

To replace the missing tooth, we have to match the size and shape to the rest of the teeth, and if our patient is unhappy with the existing restorations, we need to address them.

Part of the issue was the relationship between the upper and lower teeth and the traumatic forces that were placed on the upper teeth due to this issue. Orthodontic treatment was completed by Dr. Shojaei to fix this issue.

Once the bite was corrected, new ceramic restorations were fabricated by .

This proved to be a challenging case, but our team and our patient are very happy with the end result-- a beautiful smile upgrade!

11/13/2025

11/05/2025

A Multidisciplinary Case. Music to my ears!

I am very proud to have helped this amazing patient of ours. It required a lot of dedication on the part of the patient, but she knew that the end result would be well worth it. 

She had been a part of our practice for some time and had mentioned to us about her concerns with her smile. More importantly, she was concerned about the wear on her teeth and the long-term effects it was having on her bite. But there is one thing that she was adamant about since day one: she wanted to be as conservative as possible with her teeth– music to my ears!

Sometimes, the most minimally invasive treatments take the most effort and time. She started her orthodontics with to help correct the relationship between the teeth, align teeth in the correct position for the veneers, and to create restorative space for me to be able to restore the back of the upper front teeth without removing any more tooth structure than she had already lost. 

Once the orthodontics work was completed (IMAGE 02), I was able to restore the back of the upper teeth with CAD CAM restorations in an additive manner so her teeth were kept intact. There are a few different ways to do this. We had a very long discussion about different options, including the pros and cons of each, which is something that is a part of every decision-making process with all of our treatments. There are different materials, techniques, and designs to consider. Eventually, a decision was made that fit the needs of our patient. 

Crown lengthening (gum lift) was then completed by at to improve the length of teeth and provide better aesthetics.

Finally, minimal preparation porcelain veneers were fabricated by based on a design that was approved and test-driven by our patient. 

Everything we do in dentistry will one day need to be repaired, replaced, or adjusted. We need to make sure that our work for patients lasts as long as possible. We also want to ensure sustainability in the future so that the next practitioner has a better chance of helping our patients with teeth that aren't compromised.