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What exactly is "cosmetic dentistry"?
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Cosmetic dentistry is any form of dentistry that can enhance someone's
appearance. It can be as simple as whitening one's teeth to complex
procedures such as capping or even repositioning the gum. The popularity
of cosmetic dentistry has occured because of the advances in technology
that have allowed dentists to place life-like restorative materials
in the mouth and the desire for people to look and feel their best.
The primary areas of cosmetic dentistry include bonding, veneering,
capping, and bleaching the teeth.
What is "bonding"?
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In the early 1970's materials began to appear that could be attached
to the teeth with a process that minimized or eliminated the undercutting
of the tooth that was necessary for some restorative materials such
as amalgam (silver fillings). Up until this time, a dentist had to
make a hole in the tooth with undercuts, areas where the deepest part
of the hole was wider than the top, in order to get materials to hold.
Of course, this created a great disadvantage in front teeth where
the fillings were meant to be invisible. This is still the case with
common silver fillings today where there are two disadvantages to
this technique: first, this type of hole in the tooth weakens the
tooth leading to many fractured and broken teeth; and second, the
interface between the tooth and filling material always leaked and
broke because the material was thinnest at this point. -
- Enter bonding. Research had found that the enamel,
and later the underlying dentin layer could be "etched"
with the use of an acid that would create millions of microscopic
"pores" in the tooth. When new filling materials were placed
in or on the tooth, these pores would hold the material, eliminating
the need for undercutting the tooth. This created a bond that made
it almost impossible to tell where the filling material ended and
the tooth started. With the advances made by applying space age materials
to dentistry, the materials got more life-like and stronger as well
as allowing variances in colors.
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- Accordingly, bonding was first applied to fillings
of the front teeth. Later, it was employed in fillings of the back
teeth and also used for redoing entire fronts of the front teeth.
However, there were still some disadvantages, primarily the lack of
a permanent life-like appearance. While this was not particularly
important for the back teeth, when combined with the lass than adequate
wear of the material, front teeth that were bonded lost their lustre,
began to wear, and in general looked awful. While the materials have
gotten better, for much of the cosmetic work on the front teeth, veneering
is the technique of choice.
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What are veneers? (top)
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Veneers are new porcelains that were developed that could be made
very thin, yet very lifelike. The many deficiencies of bonding were
overcome by these new materials as they did not wear and did not lose
their appearance. For the first time, dentistry had a cosmetic option
that would last a long time.
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- Veneers are actually thin porcelain facings that
are bonded to the front teeth (and sometimes back teeth). To do veneers
a dentist will lightly shape only the front of the tooth, although
in some instances, this may not be necessary. Impressions are taken
and sent to a laboratory where the actual veneers are fabricated.
Using modern shade guides and by varying the shapes, contours, and
sizes of the teeth, dentists can improve the smile of almost anyone.
Fractured teeth, cracked teeth, teeth with gum recession, overlapped
teeth, and even missing teeth can be altered to create a more pleasing
smile. While this technique can do many things, it is important to
note that there are some instances when it must be used in conjunction
with other dental techniques such as capping or orthodontics.
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I’ve seen caps on some people and they look awful. Why is that?
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The older technologies, some of which are still used today, have metal under the porcelain in the making of caps or crowns as they are called – even on front teeth! This metal has a tendency to show through and becomes even more visible if someone gets a bit of gum recession. However, in the last 10 years, 5th and 6th generation porcelains that are as strong as metal have been developed that not only look exactly like your teeth, but are as strong as metal crowns when bonded to the teeth. For a cosmetic dentist, this has been the greatest development ever.
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about cosmetic fillings on the back teeth? (top)
Before we discuss cosmetic fillings, it is useful to make a distinction between "filling" and "restoration". Fillings are where a dentist makes a hole in a tooth, almost always undercutting the tooth for retention, and places a material consisting of two parts which when mixed together or activated in some fashion, hardens. Restorations, on the other hand, involve at least a two part process where the actual restoration must be fabricated outside the mouth before it is placed in the patients mouth.(See
Restorative Dentistry) -
- As far as fillings for the back teeth go, there are currently three types available. First, the old standby silver-mercury fillings (amalgam) which are not very esthetic, however, have been the filling of choice. Until recently. Composite fillings have the advantage of being tooth colored but like the old silver fillings have a limited life depending on size and existing biting and chewing patterns. The third choice is a more permanent restoration using gold or porcelain. While gold can last a lifetime, it is not esthetic at all. Due to advancements in porcelain technology and techniques we now have the ability to make life-lasting porcelain restoration.
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- One note. Many people have heard of "porcelain fillings" at one time or another. In reality, fillings cannot be made out of porcelain because the material must be shaped at over 2000 degrees. In fact, this is the process of porcelain restorations. Fillings which are done in one appointment are made of plastic, some with glass particles in them to enhance their strength; because of the glass particles dentists may refer to them as "porcelain" when they are really a composite of a bonding plastic with microscopic glass particles.
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What exactly is whitening? (top)
Tooth whitening is a relatively new technique where a chemical is
held in close contact with the teeth. There are two types of whitening
processes: first, Power
Whitening, which is done in the dental office, generally in less
than 1 hour. In this technique, the dentist applies a non-toxic chemical
to the teeth and activates it with a laser. This technique creates
amazing results immediately compared to the at-home method; second,
whitening can be done by means of a thin, clear plastic tray that
is made to fit the teeth in advance into which the pateint places
the bleaching gel. To get the proper fit, the dentist must first take
impressions of the teeth, upper and lower, and then mold the clear
plastic material to the model of the teeth. When this is done, the
holding tray is amost invisible. The chemical used is carbamide peroxide
which comes in more than one strength, the weaker strength for purchase
at drugstores and other retail outlets, and the more effective strength
to be dispensed only through dentists. The reason for this is that
there is some danger of gum reaction with the stronger chemical which
should be monitored periodically by a dentist. The process usually
takes about two weeks for the uppers and the same time for the lowers
when done professionally.
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What results can I expect from whitening my teeth? (top)
Results vary from person to person depending on their age and the existing tooth color. Generally speaking, one can expect an amount equal to or greater than 2-6 shade differentials as seen on a dentist's shade guide. This is usually such a change for most people that they are grateful for the result. To whiten teeth more than this, the treatment of choice may be porcelain veneers. It must also be noted that bleaching does not change the color of any fillings, white or silver, and does not affect the color of any caps that have been done previously.
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Are there any other cosmetic techniques worth mentioning? (top)
- Indeed there are. Almost any dental procedure can be cosmetic, that is, improve someone's appearance when done with the proper materials in the hands of a trained dentist. Procedures such as capping can be done with the new porcelain materials without the standard metal underneath. The key here is that an experienced dentist will know the right type of porcelain to use for the desired outcome. You may have seen someone with poorly done caps - they're the ones with dark lines around the front teeth.
In some cases the best cosmetic treatment for someone may be the use of all these techniques at the same time, depending on the desires of the person and the current condition of the mouth.
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