Most people think that they know what cosmetic dentistry is: making people’s smiles nicer. But do you really know what is involved in doing this?
Cosmetic dentistry may seem simple to many people, but in fact, it is really a very detailed process from the first to the last appointment. I want to take the time to explain both the techniques available and the process required for the execution of these techniques.
First, let’s list the different treatments that can help transform a smile:
1. Tooth Whitening
2. Orthodontic treatment
3. Porcelain Veneers/Crowns/Restorations
Of these different treatment options, the first four are used when the tooth that needs transformation is present. The last 3 treatments (Implants, bonding and dentures) are used to replace a single tooth or multiple missing teeth.
1. Tooth Whitening
The results of this treatment are self-explanatory. At the conclusion of this treatment, the patient has significantly whiter, brighter teeth. Tooth whitening can be achieved by several different treatment options.
These range from home treatments where the patient wears either clear plastic trays with bleaching gels or thin plastic strips coated with bleaching gel. With persistence, the patient can achieve great results with these home treatments. The problem with the home treatments is that most patients lack the motivation to continually wear the whitening system at home.
The other alternative is “In-Office” bleaching, which is done in the dental office by the dental hygienist. This form of treatment is often more effective because the bleaching agents are stronger than what is commercially available for home use. Requiring only a single appointment, the patient usually achieves their whitening goals much quicker.
2. Orthodontic Treatment
Quite simply put, orthodontic treatment means moving the crooked, shifted or rotated teeth into the correct position in the patient’s dental arch (jaw) so that they not only look better, but also function better. With orthodontics, the treatment can (rarely) be limited to a single tooth, or the whole mouth can be treated so that all the teeth are properly aligned. This movement of teeth is accomplished in a few different ways.
These are the traditional brackets and wires that have been in use for decades. They can be either silver colored or tooth colored. The silver ones are far easier for the dentist and the patient when the wires need to be changed, but the “porcelain” or “tooth colored” brackets may be more acceptable to some patients.
This is a revolutionary treatment option that requires no wires or brackets and is almost completely invisible. It consists of a series of clear aligners worn for just 2 weeks and then replaced with the next one in the series. With this treatment option, visits to the dentist are fewer, it is easier to keep the teeth clean, and there are no wires that may occasionally shift causing discomfort. Also, since each aligner moves the teeth just 0.2 mm, there tends to be less tooth tenderness when each new aligner is started.
These devices focus on addressing problems with the jaws and try to correct these issues prior to full braces or Invisalign. This movement is called “orthopedic” movement. Removable appliance can also be used to correct very simple tooth movements, such as correcting the position of a single tooth. While removable appliances play a very useful role in comprehensive orthodontics, they usually are not used by themselves to correct problems.
3. Porcelain Restorations
Porcelain restorations (crowns or veneers) are considered to be the “gold standard” when it comes to correcting a misshapen, broken or even discolored tooth. The difference between a crown and a veneer is simple: A veneer is like a false fingernail, covering the front surface of the tooth, while a crown is more like a sewing thimble, covering the whole of the tooth. Your dentist can best recommend which will meet your needs most effectively.
To make a crown or veneer, the dentist prepares the tooth with a drill to a shape that will support the restoration. Sometimes this means almost no drilling, and other times the tooth needs more preparation to allow for a greater thickness of porcelain.
Porcelain restorations are beautiful and most closely mimic natural teeth. The porcelain can easily be made whiter than the original tooth, or it can be made to match almost exactly the appearance of the tooth as nature intended (before being worn down, broken, decayed or discolored).
There are several different types of porcelains, and your dentist will usually specify which type of porcelain he or she wishes the lab to use. These choices are based on several factors, including the chewing stresses on the teeth, the underlying color (a different porcelain may be chosen if the original tooth is quite dark), or if it is in the front of the mouth where even subtle differences of shade will be noticed.
Bonding is the general term used by the public to describe the application of tooth colored “plastics” to the surface of the tooth. These materials are called “composite resin” by the dental profession and refer to a vast number of products that come in an equally vast array of shades. When these composite resins are “bonded” to the teeth, they can be used as fillings or to resurface discolored teeth. Composite resin restorations (fillings) are long lasting, but they do tend to be more brittle and can chip, flake and eventually discolor with time.
Esthetic bonding can be used as an intermediary step for patients who are considering porcelain veneers but are deterred by the increased cost. One major advantage bonding has over porcelain restorations is that they can be placed immediately by the dentist and requires no impressions or lab time, thus reducing the number of appointments required and reduced costs.
Now we are getting into replacing missing teeth. Implants are the greatest things since sliced bread (even better if you try to avoid carbs). Dental implants are placed by the dental surgeon directly into the site where the previous tooth was prior to being removed. With implants, the adjacent teeth are left alone and are not asked to do the work of helping to support the replacement tooth. (Read on to Bridges and Dentures to fully understand). Suffice to say, when done properly, they look far more natural than other restorations and are far more comfortable for the patients.
Bridges are made to replace, at most, one to two teeth. Bridges require strong teeth on either side of the gap (where the teeth are missing). These teeth are prepared for crowns, but instead of crowns, the dentist will take an impression (mould) of the prepared teeth and send the case to the lab. The lab then returns the bridge, which has two crowns with a false tooth in between holding the crowns together. The problem with bridges is that patients can’t floss with them because the teeth are joined together and they required extensive drilling to the teeth on either side of the gap supporting the bridge.
Dentures are made from acrylic. They are removable “teeth.” They can be either complete dentures, replacing all the teeth in the mouth, or “partial” dentures, replacing only a few teeth that may be missing. Problems with dentures are that they are frequently loosened with time as the support jaw bones shrink with age. Dentures also often put stress on the supporting teeth. In addition, if the denture is worn on the upper arch, the palate is usually covered with acrylic, which can reduce the sense of taste and change speech. If the denture is worn on the lower arch, the tongue and muscles of the lower jaw can often cause the dentures to slip off the tissues, leading to embarrassing moments for the patients.
Now you have a very basic understanding of the options available for remaking a smile. While it sounds simple, there are many steps the dentist must perform to get a great result.