Cosmetic Dentistry Part 1: Glossary

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? It may seem simple to many people but it is, in fact, really a very detailed process from the first appointment to the last appointment.

In this blog, I want to take the time to explain the techniques available. Then, in my next blogs, I will explain the process for those of you considering transforming your smiles.

First let’s list the different treatments that can help transform a smile:
1. Tooth Whitening
2. Orthodontic Treatment
3. Porcelain Veneers/Crowns/Restorations
4. Bonding
5. Implants
6. Bridges
7. Dentures

In the first four of these treatment options, the tooth that needs transformation is present. The last 3 treatments (implants, bonding, and dentures) are used to replace a single or multiple missing teeth.

I will review these terms here for your reference:
1. Tooth Whitening; the results are self-explanatory; at the end of this treatment the patient has significantly whiter, brighter teeth. Tooth Whitening can be achieved by several different treatment options.
a. Home Whitening: in home treatments, 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 consistently use the whitening system at home.

b. In Office: The other alternative is In-Office bleaching which is done in the dental office, usually 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. Often requiring only a single appointment, the patient usually achieves their whitening goals much quicker.

2. Orthodontic Treatment: Simply put, this means moving the crooked, shifted or rotated teeth into the correct position in the patients 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. Let’s look at these briefly:

a) Braces: 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 white or tooth colored brackets may be more acceptable to some patients. It is my experience that adjusting the braces is easier on patients that have the metal brackets as the porcelain or tooth colored bracket are move difficult to engage the wire changes and thus a little bit more uncomfortable during these adjustment appointments.

b) Invisalign: 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 and each clear aligner is 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 because they can be easily removed for eating and cleaning, 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.

c) Removable Appliances: These devices have two different uses. Primarily they focus on addressing problems with the jaws and try to correct these issues prior to full braces or Invisalign implementation. 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-down 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 the 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 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 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.

4. Bonding: 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 for resurfacing 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.
Usually I use esthetic bonding as an intermediary step for patients who are considering porcelain veneers but are deterred by the increased cost compared to bonding. One major advantage bonding has over porcelain restorations is that they can be used immediately by the dentist and require no impressions or lab time, thus reducing the number of appointments required and reduced costs.

5. Implants: Now we are getting into replacing missing teeth. In my opinion, 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 its 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. (I know this sounds confusing, read on to Bridges and Dentures to fully understand). I have written a lot about implants in previous blogs, so take a minute (or 10) to read up more about them. Suffice to say, I would be lost without being able to offer this treatment to my patients. When done properly, they look far more natural than other restorations and are far more comfortable for the patients.

 

6. Bridges; Bridges are made to replace one or 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 or teeth in between holding the crowns together. See the photo below. The problem with bridges is that patients can’t floss with them because the teeth are joined together and also that they required extensive drilling to the teeth on either side of the gap supporting the bridge.

7. Dentures: Dentures are made from acrylic. They are removable, false 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. (See photos below) Problems with dentures are that they are frequently loosened with time as the supporting jaw bones shrink with age. Dentures also tend to put stress on the supporting teeth. In addition, if the denture is worn on the upper part of the mouth, 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.

 

So now I have presented you with a very basic understanding of the options available for remaking a smile. While it sounds simple, there are in fact many steps the dentist must perform to get a great result. In my next blog, I will write about all the steps involved from the first call to our office to the final unveiling of a patient’s new smile.
Stay Tuned!!