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Cosmetic Dentistry

Dental Bonding

Dental bonding is a procedure that is often used to restore teeth affected by decay as well as for the repair of chipped or fractured teeth and masking a range of dental imperfections such as stains, discolorations, gaps, misshapen, or undersized teeth. A popular method for restoring and improving the appearance of a person’s smile, dental bonding qualifies as a cosmetic procedure by virtue of the fact that the composite resins used for the procedure are tooth-colored and come in a range of shades that blend seamlessly with natural tooth structure.

A dental bonding procedure, which is performed to fill a cavity or to cosmetically repair a chip, fracture, enamel defect or gap between teeth is known as a “direct composite restoration.” For a direct composite restoration, both artistry and precision are required as the dentist places the selected shade of composite resin and carefully sculpts it to rebuild or improve the appearance of a tooth.

In terms of the cosmetic repair of dental defects, the masking of discolorations or the closure of gaps between teeth, a dental bonding procedure is considered the most economical and quickest method of care out of all the cosmetic solutions available for these types of corrections. Unlike porcelain veneers or ceramic crowns, dental bonding is a minimally invasive, one-visit cosmetic procedure. Moreover, unless a cavity is being cleaned and prepared prior to a dental bonding procedure, no drilling of tooth structure and no anesthesia is required.

How is a dental bonding procedure performed?

When performing a bonding procedure, it is important to enable the composite resin to firmly adhere to the underlying tooth structure. To do this the surface of the tooth is etched and then painted with a liquid bonding agent just prior to the placement of the filling or cosmetic bonding. As the dentist places the composite resin, it is carefully sculpted to achieve the desired shape and then cured with a special light or allowed to set. Once hardened, the newly bonded restoration is polished and buffed for a smooth finish. Some dentists may offer composite veneers as an alternative to porcelain veneers, artistically bonding and blending successive layers of composite resin to transform the appearance of a tooth.

Caring For Bonded Teeth

While a bonding procedure offers an excellent and cost-effective method of care for the treatment of minor cosmetic dental issues, there are a couple of considerations with this approach.  Teeth that are restored or cosmetically enhanced with a dental bonding procedure are  as a rule more susceptible to staining and chipping than with other types of cosmetic treatments. For this reason, highly pigmented foods and drinks are to be avoided along with tobacco products. As dental bonding can easily chip and break, it is also important not to bite into hard objects or foods and to avoid oral habits such as biting one’s nails or chewing on pens. However, with proper hygiene and care, a bonded restoration can last for many years.

 

Teeth Whitening

A teeth whitening procedure or bleaching simply refers to any process that will make the teeth appear whiter. It is considered a non-invasive procedure that is designed to whiten and brighten teeth that are stained, discolored, darkened, or yellowed. First introduced to the public in the 1980’s, the popularity of teeth whitening products and procedures has soared. According to a survey conducted by the American Academy of Cosmetic Dentistry, when respondents were asked, “What would you like to improve most about your smile?” The most common response was: whiter and brighter teeth.

How white a tooth appears depends upon how light is reflected and scattered off the enamel, the outermost layer of the tooth. Teeth can look dark or discolored for a variety of reasons, with an imperfect appearance the result of outer surface stains or discoloration from within the tooth. While external tooth stains are typically due to certain foods and tobacco, internal tooth discoloration is mainly the result of hereditary factors, certain medications, tooth decay, restorations, or trauma. Additionally, the aging process can influence the color of a tooth. This is because over time the outer layer of enamel becomes thinner showing more yellowish tones from the underlying layer of dentin.

What are the advantages of a professional teeth whitening procedure performed by a dentist?

Although over the counter teeth whitening systems purchased in stores or online have become popular, there are health concerns and limitations with these products. If the manufacturers protocol is not correctly followed, certain products can damage the teeth and soft tissues in the mouth, and may not deliver the results as promised. Teeth whitening systems contain varying concentration of either hydrogen peroxide or carbamide peroxide, which act as the bleaching agents. When sensitive teeth, exposed roots, cavities, broken fillings, cracked teeth, or loose dental work are present, a teeth whitening procedure may be contraindicated. Also, since whitening systems do not have an effect on the color of dental fillings, crowns or bridges the presence of restorations is an important cosmetic consideration in treatment planning.

In general, individuals with yellow tones to their teeth respond best to teeth whitening procedures. Brown and grayish tinted teeth bleach respond less well and may require significantly longer dentist supervised tooth whitening regimens or alternative cosmetic treatments. Finally, teeth whitening may not be recommended in the presence of sensitive teeth, worn enamel and significant gum disease.

As a rule the healthiest and most effective methods of teeth whitening are the ones managed and supervised by the dentist. An in-office teeth whitening procedure as performed by the dentist is the most reliable and safest way to get the maximum results quickly. In as little as one hour a prescription-strength, in-office whitening procedure can dramatically whiten and brighten the natural teeth by several shades, while the surrounding tissues and any sensitive areas of the teeth are carefully isolated and protected from the bleaching agents.

A home whitening system from the dentist along with custom trays that have been fitted to the teeth is also an excellent option. Custom trays keep the bleaching agent in maximum contact with the teeth and away from the other areas of the mouth. With a take-home teeth whitening system, maximum results are less rapid than an in office procedure and are typically achieved over a longer period of time. A home whitening system can be used by itself or as recommended by the dentist as a follow up to an in office procedure in order to perfect or maintain the results.

 

Veneers

For teeth with imperfections that cannot be addressed with teeth whitening procedures, but are not so flawed as to require full coverage crowns, dental veneers can provide the desired cosmetic improvements.

Dental veneers are custom-fabricated facings that offer a conservative and cosmetically pleasing way to improve the appearance of teeth that are chipped, gapped, worn, slightly crooked, misshapen or darkly stained. With dental veneers, the color, shape, size, and length of the teeth can be changed for the better. Bonded to the front surfaces of the teeth, veneers can be used to enhance the appearance of a single tooth or multiple anterior teeth.

The two most common types of veneers are porcelain veneers, which are also known as porcelain laminates, and composite veneers. While porcelain veneers are the most commonly offered option in care, composite veneers can also achieve excellent results. Starting with a smile makeover consultation and a comprehensive assessment of a patient’s oral health as well as a discussion of the cosmetic goals, the dentist will determine a treatment plan to achieve the most pleasing outcome of care.

Porcelain Veneers

Porcelain veneers are ultra-thin facings that are custom fabricated from the highest grade of dental ceramics and offer the following benefits:

  • Require very little preparation of underlying tooth structure
  • Can be fabricated from start to finish in just a few visits
  • Porcelain reflects light in much the same way as teeth for a naturally beautiful looking smile
  • Once bonded, porcelain veneers are strong and durable and can last for many years with proper care
  • Resistant to stain and discoloration
  • Well tolerated by surrounding periodontal tissues

Composite Veneers

When direct composite veneers are the selected method of care, the dentist applies carefully selected shades of tooth-colored composite resins to the fronts of the involved teeth.  As the composite resin is placed, it is meticulously sculpted to create the desired shape, length and overall form of each tooth. Each layer of applied composite is then cured with a special light, and additional layers of composite are placed as required to achieve an aesthetically pleasing and functional result. Once the final result is completely set, the dentist will smooth and polish the direct composite veneers to a naturally brilliant finish.

While composite veneers frequently offer the advantages of being a single visit procedure, easy to repair and an economical alternative to porcelain veneers, they are not as strong or resistant to staining and wear as dental ceramics. However, by avoiding certain dietary choices and habits, practicing good oral hygiene and getting routine dental care, direct composite veneers can offer an effective and long lasting cosmetic smile improvement.

 

Ceramic Crowns

Once commonly referred to as, “porcelain jackets,” today’s all-ceramic crowns are fabricated from advanced generations of aesthetically appealing, lifelike materials affording strength and durability approaching that of tradition metal and porcelain fused to metal crowns (PFM).

When a tooth requires a full coverage restoration to rebuild its structural integrity and appearance, how good the crown will look and how well it will withstand the forces of oral function are major considerations in choosing the type of crown. In the past, only metal crowns or ones fabricated out of porcelain fused to an underlying substructure of metal offered the strength required to bite and chew without breaking. While porcelain fused to metal crowns to this day remain a popular choice for strong, attractive and long-lasting restorations to rebuild teeth that are damaged, decayed, misshapen, worn down, undersized, or have had a root canal procedure, there are some drawbacks. For one thing, the thin metal margin at the collar of a PFM crown may be visible at the gumline (especially in the presence of receding gums). Also, due to the presence of an underlying metal shell, porcelain fused to metal crowns do not come close to handling light in the same way as natural tooth structure or dental ceramics.

Advantages of Ceramic Crowns

While the trade off between appearance and strength used to mean that porcelain or all-ceramic crowns looked better but did not have the strength and durability of porcelain fused to metal crowns that is no longer the case. All-ceramic crowns are not only capable of producing incredibly lifelike results, but thanks to the range of materials available today, all-ceramic crowns are stronger and more reliable than ever before.

Some of the advantages of all-ceramic crowns include:

  • All-ceramic crowns interact with light in much the same way as natural teeth and can closely mimic their translucency and luster
  • All-ceramic crowns can be made thinner and require less tooth reduction
  • All-ceramic crowns are kinder to the surrounding tissues, for potentially healthier long-term results
  • All-ceramic crowns are resistant to stain and discoloration
  • All-ceramic crowns are metal-free and safer for individuals with allergies or sensitivities to metal

With the range of engineered dental ceramics available today, which material is selected for crown fabrication depends upon the location of the tooth, the stresses on that tooth and the esthetic requirements of the case. Certain all-ceramic crowns are more suited for back teeth, while others are able to fulfill the aesthetic requirements presented by a front tooth.