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Whether we like it or not, personal appearance is rapidly becoming
one of the most important factors in our society today. Americans
spend billions of dollars on clothing, jewelry, hair, and other
items in an attempt to
"look good." With all of the hype given to these other products,
we often tend to overlook our most important asset of all, our SMILE!
A person's smile forms the basis of a first impression, and its importance
cannot be overstated in almost any line of business.
Because of this fact, smile enhancement through cosmetic dentistry
has become one of the most cost-effective means of achieving personal
attractiveness, and a great emphasis has been placed upon it in recent
years, in large part due to the myriad of technological advances which
have allowed for predictable and dramatic results.
Listed below are the most popular procedures done to give you a brighter,
healthier smile.
BLEACHING
Whitening of the teeth by bleaching is done by the application
of a peroxide based gel to the teeth. There are many over-the-counter
preparations available ranging from peroxide-containing toothpaste,
to actual bleaching kits. These methods are rarely successful,
mostly due to the very low concentration of peroxide provided,
and the limited time during which the peroxide is in actual contact
with the teeth.
In contrast, when bleaching is done under the supervision of a dentist,
one can usually expect significant results, because a dentist
may use much higher peroxide concentrations (usually carbamide
peroxide 10-25%) and of much higher product quality than those
available elsewhere, and will fabricate a bleaching tray which
will precisely fit your teeth. Additionally, the bleaching trays
in our practice are made with a reservoir to hold extra bleaching
gel on the outer surface of each tooth in order to maximize exposure
of the tooth to the peroxide.
PROCEDURE
First, your starting tooth shade is determined by comparing
your own teeth alongside standardized shade guides. Next, impressions
are taken of your teeth, from which a plaster model is made which
that is an exact duplicate of your teeth. Using this model, a
soft, thin, clear tray is made to precisely fit over the teeth,
similar to an athletic mouthguard. You will probably notice that
the tray material "bubbles out"
from each individual tooth, forming a reservior that will hold extra
bleaching gel against each tooth's outer surface. The fabrication
of bleaching trays is done in a laboratory, and usually takes several
days.
Once your bleaching tray has been made, you will be given dispensing-syringes
filled with bleaching gel, along with instructions for use. This
involves simply partially filling the tray with bleaching solution
and placing it in your mouth. Other specific instructions are tailored
to each patient, taking into account many factors. Generally, most
poeple can expect to see significant whitening within one or two
weeks, when wearing the bleaching trays for several hours each night.
Limitations and disadvantages of bleaching:
Bleaching only works on natural tooth structure, therefore
if you have bonded fillings or porcelain crowns, these will not
whiten along with your teeth. Your teeth will get whiter, but
these restorations which may now blend in with the rest of your
teeth will retain their original shade. This often necessitates
replacement of bonded (tooth-colored) fillings with new lighter-shaded
ones.
Severely stained teeth may take much longer a time frame to achieve
desired results, or a higher concentration of peroxide can be used.
Bleaching usually results in some temporary sensitivy, but higher
concentrations and longer courses of treatment can prolong or magnify
sensitivity.
White spots, or areas of "hypocalcification" on teeth
may be enhanced by bleaching, creating an undesirable result.
Bleaching of the teeth usually does not permanently whiten the teeth.
You may notice some fading after about a year, but this is easily
corrected by wearing the bleaching tray for a few days.
BONDING
Bonding is the process
by which a hard, tooth-colored, resin-based material called composite is
applied to the teeth. Composite fillings have been in existence
for more than thirty years, however, recent advances in adhesive
technology (hence the term "bonding") and composite
durability have greatly improved the predictability and long
term success for this material.
Composite material is generally used as a cosmetic
filling for cavities and chips in the front teeth, but
can also be applied as a direct veneer to the face
of a tooth.
Direct veneering of composite to teeth can be used to mask
discolation, to reshape broken down or worn teeth, close gaps
(called diastemas) between teeth, or can make twisted or malposed
teeth appear straight.
The results are instantaneous and often dramatic.
PROCEDURE
As direct veneering is a cosmetic procedure which is usually
done on multiple teeth together, you can usually expect the
visit to last form one to two hours, depending upon the number
of teeth to be veneered. Anesthetic is not required if composite
is only added to the outer surface of each tooth, but may be
beneficial if some reduction of tooth structure is necessary
as may be the case if the edge of a crooked tooth protrudes
outward too much.
Each tooth is prepared by etching with a mild acidic gel (to create
microscopic porosity), along with the application of a special adhesive.
The composite material, in the form of a thick putty-like consistency,
is then carefully layered over each tooth surface and cured to hardness
(using a high-intensity light) to create the desired result.
The veneered teeth are then carefully adjusted to proper shape and
contour, and then polished to a high gloss.
This process is extremely arduous , and requires a great deal
of expertise and manual dexterity on the part of the dentist,
as each tooth in the mouth has very specific anatomic form, and,
if not done correctly will result in the appearance of "chicklets",
rather than that of natural teeth.
Limitations and disadvantages of direct veneer composite bonding:
All of the disadvantages of cosmetic dentistry using composites
are related to limitations of the material itself. Although the
new generation of composites are considerably stronger and more
stain-resistant than their predecessors, they usually only carry
a life expectancy of about an average of three to five years
before they have to be touched-up or redone due to staining and/or
chipping. Although they often last much longer, it is important
that one has reasonable expectations regarding longevity. Factors
which may adversely affect long term success include smoking,
coffee, tea (staining), and hard chewing, nail biting, etc. (chipping).
PORCELAIN LAMINATES
Porcelain laminates are currently the "gold standard" in
cosmetic dentistry. Porcelain laminates, also called porcelain
veneers, are laboratory-fabricated facings which are bonded to
the outer surfaces of the teeth.
They are analogous, and similar in thickness to, false fingernails.
Each laminate, however, is custom-made to fit each individual
tooth, and made from very high-strength porcelain.
Porcelain laminates are used for the same puposes as direct
veneer composites; that is to mask discoloration, reshape broken
or worn teeth, close gaps, or make crooked teeth appear straight.
Porcelain laminates offer many advantages over direct composites
both in terms of durability (usually 10+ years, similar to
that of crowns) and esthetics. They can create beautiful, natural
smiles, and are the choice of many, if not most, Hollywood
stars.
The porcelain used to fabricate these veneers will not absorb
any stains, and is extremely fracture resistant. This porcelain
is so durable it is often used to reinforce teeth with stress-fractures
which may have become weakened due to trauma or age.
BEFORE
|
Canine
angled outward and down |
Diastema
(Gap) |
Cental
Incisors overlapped |
Chipped
tooth |
Improperly
angled tooth |
Abnormally
rotated canine tooth |
|
AFTER
|
PROCEDURE
The procedure consists
of two parts: Tooth Preparation; and Bonding.
Tooth Preparation: Typically, the Doctor will
set aside the better part of a morning or afternoon to complete
the preparation phase. As mentioned earlier, the porcelain
laminates are similar in thickness to false fingernails. In
order to accomodate this thickness of the veneers and avoid
a final appearance of bulbous teeth, some reduction of enamel
from the face of each tooth to be veneered is usually necessary.
This is typically done under local anesthetic. Once the outer
surfaces of the teeth have been prepared, a highly accurate
impression of the prepared teeth is made. This is sent to a
dental laboratory for use in fabricating the laminates, which
usually takes about one week. There is often some cold sensitivity
experienced during this time, however this rarely amounts to
anything more than a temporary minor inconvenience.
Bonding
In most cases, the laminates are completed by the laboratory
in exactly one week's time. At the bonding appointment, often
no anesthetic is necessary unless the teeth have not desensitized
enough during the week. Each laminate is tried on to the tooth
it was made for to check for proper fit, shape, and shade. The
tooth surfaces to be bonded are then treated and the veneers
are set in place with bonding adhesive, after which the bonding
is activated with a high-intensity light. Excess bonding adhesive
is then cleaned off of the teeth, and VOILA!! Beautiful Smile!
Disadvantages and limitations of porcelain laminates
There do not seem to be any absolute disadvantages to porcelain
laminates, however, in contrast to crowns and other types of
restorations, we do not know how well past 10-15 years they can
be expected to last. This is because most of the first porcelain
laminates were done about 10 to 15 years ago, and for the most
part seem to hold up well over time, but there is no definitive
data to prove this since not enough time has elapsed since they
were first introduced. Also during this period, there has been
an explosion of technology in both bonding and development of
high impact-resistant porcelains, which has most certainly enhanced
the life-expectancy of these restorations.
It is now generally believed that the longevity of porcelain
laminates will rival that of conventional crowns, which can
be anywhere from five years to a lifetime.
There are several limitations to placing porcelain laminates.
Since they are intended to serve as only a facing to a tooth
that will usually only wrap over the biting edge, severely
broken down teeth, or teeth with cavities are usually not
good candidates. For these situations, usually a crown, which
covers and protects the entire tooth will be recommended.
Crowns
A crown, often referred to as a "cap", is a tooth
restoration that fits over an entire tooth (the area above
the gumline, that is). Before the advent of bleaching, porcelain
laminates, and bonding, crowns were the only option for cosmetic
enhancement of the teeth, and remain the treatment of choice
whenever those more conservative approaches are deemed inappropriate.
Crowns are usually placed on teeth which are badly broken
down or weakened. Most crowns done today are either all-porcelain,
or porcelain fused to a metal substructure to add strength.
Invariably, the cosmetic results are excellent, especially
using the exceptional materials now available.
PROCEDURE
In order to fit a crown
over an existing tooth, the tooth must be prepared by reshaping
it into a form which will allow the crown to be seated onto
the tooth. This typically involves shaving down most of the
enamel covering of the tooth under local anesthetic. Once the
tooth is reshaped, an impression is taken from which a plaster
model of the tooth will be made for use in the dental laboratory.
A temporary crown will then be cemented onto the tooth, to
remain in place until the permanent crown or crowns are completed
by the laboratory.
Crowns typically require two to three weeks of lab time.
Once ready, your temporary crown is removed, and the permanent
one cemented in place, after checking for correct shade and
fit
Disadvantages and limitations of crowns:
As discussed earlier, crowns done primarily for cosmetic
purposes are usually only done if the tooth structure is
weak or broken down, therefore, the placement of the crown
will almost invariably strengthen the tooth. Occasionally,
the misalignment of the existing teeth is so severe that
the condition is best corrected by orthodontic treatment
(braces).
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