Cosmetic Dentistry – A modern approach
Historically dentistry has been about treating oral disease, saving teeth and maintaining the chewing function. However with the explosion of media and the movie industry in the past 50 years., there is today a greater emphasis placed on looking good and feeling confident about our smiles.
Cosmetic Dentistry – A modern approach
So now most dentists are asked by their clients “How can I make my teeth and smile look really great”!
Cosmetic dentistry is that part of dentistry concerned with improving the appearance and function of teeth and the smile. So when a client consults me about their smile and appearance of their teeth. I need to know” what is the main thing that is bugging the patient about their smile”.
Is it just the colour of the teeth? Perhaps ugly old fillings that can be easily replaced? Is it the smile that is uneven, with dark teeth from root fillings; or is the alignment of the teeth out of whack with the face and the lips.
An easy way to work this out is to say” if I had a magic wand what would I like to change”
Improving the appearance of teeth then may be as easy as whitening the teeth with a bleaching kit; (2 ) Using bonded veneers to improve the colour and shape;(3) for a longer lasting more permanent look porcelain veneers; and (5) finally for major cosmetic make overs porcelain crowns.
Professional Tooth whitening:
This procedure can be divided into the In Surgery Whitening; and Home whitening kits.
Tooth whitening uses either Carbamine Peroxide which converts slowly into Hydrogen Peroxide in the mouth or Concentrated Hydrogen Peroxide which is the active agent
The stronger the bleach the more tooth sensitivity the patient may encounter.
The In surgery whitening is a more controlled situation where 3 or more applications are placed on the teeth in 75minutes. This bleach has a light sensitivity accelerator which activates the bleach on exposure to white or blue light.
Mostly, but not always the result is 4-6 shades of lightness..
Bleaching of teeth is not a permanent solution, as we lose about 1 shade of whiteness every 3-6months…..so we have to always be redoing it to maintain the colour.
Bonding and Bonded direct veneers:
The tooth coloured resins that all dentists use today for fillings, can be used on front teeth to improve the shape, lengthen and cover up otherwise ugly teeth. This is a quick fix and the appearance looks great initially; but as the years go by, the resins stain and lift around the edges becoming more unsightly. It is however a relatively inexpensive method of improving the smile and can be easily removed and replaced.
Bonding is used to repair fractures and broken teeth in the teenagers where more than 60 % sustain some injury to their front teeth, thanks to contact sports, skate boards and the like. The permanent incisors continue to erupt as the roots form until the patient is about 20 years old, so if we placed a porcelain crown on these teeth early , as the tooth erupts the crown margins become exposed and look very unsightly.
Porcelain Laminate veneers:
The problem with the composite resin fillings is the granular nature of the surface. It is made of a resin matrix with silica particles that give it the strength and tooth like appearance. It is a bit like the concrete floor of your garage…..from a distance it looks smooth, but look at it closely, and you can see the granules of sand between the depressions. If you spill oil on that floor, it is very difficult to wipe clean.
The composite resins at a microscopic level are similar, in that the stains collect in the micro pores between the silica particles, which make the filling discolour over time. So resins look great when new but become more yellowish and stained with time.
The ceramic surfaces of crowns and veneers provide a glass like surface very like tooth enamel, which does not stain or discolour with time, hence a better long term appearance for the tooth.
Porcelain veneers are a shell of porcelain shaped like the tooth and bonded directly to the front of the tooth to restore the perfect contour and appearance much in the same way an acrylic fingernail is attached to your fingers.
Veneers are used for small to moderate repairs on teeth.
Crowns are used to restore a moderate to severely damaged tooth, to mask discolouration, or where strength is the most important factor, as with a tooth clencher or bruxor. Unlike the veneer where the porcelain is perhaps 0.5mm thick, the porcelain crown is 1mm thick is all dimensions. The skilled dentist and ceramist can exactly match the colour of the crown to the adjacent teeth so that no one would know that the crown was not your real tooth.
Facial Harmony and Smile design:
When a dentists is planning a full make-over of the teeth and smile it is important that the teeth are in harmony with the general facial features. The midline of the Central incisors need to be in the centre of the face, the plane of the teeth needs to be parallel to a line between the pupils of the eyes, and the tooth display appropriate to the sex, age and nature of the person. In general women show much more of their upper teeth than males, younger women more than older women.