The following article is provided to give a general introduction to art and science of cosmetic dentistry for our clients at Dental Aesthetics Professionals. Cosmetic Dentistry is both a combination of solid dental science and creative dental art. The science aspect comes from using the latest technologies and medical processes to create a healthy mouth and set of teeth. The art aspect comes from using the latest in techniques and dental materials to create a perfect smile that compliments the facial features of the specific client. The overall process is unique for every individual. Here are a few introductions and explanations of some of the overall process for your education.

Cosmetics & Smile Design*

People have become more aware of the importance of their smile and the impact it has not only upon their appearance but, also on the perception other have of them for both daily social and business interaction. When people possess an attractive and healthy smile, studies have clearly shown it is highly likely that it will drive a positive, welcoming image and an air of perceived confidence in communication. This is why cosmetic dentistry has become of such critical importance from celebrities in entertainment to the movers and shakers of the business world. People have become more conscious of the need for a professional appearance. We may not realize it but it is simple human nature and the smile is almost always the first aspect noticed in that appearance.

Cosmetic versus General Dentistry*

As opposed to dental health, which focuses more on oral health and hygiene, cosmetic dentistry focuses on the appearance of the teeth. A cosmetic dentist will focus on the shape, color, straightness and appearance of both the teeth and gums. With the many advances in the cosmetic dentistry field, people no longer have to settle for chipped, crooked, discolored teeth or the resulting poor quality smile. When visiting a general dentist, the teeth and gums general health would be their main concern. However, a cosmetic dentist would focus additionally on the appearance relative to the clients facial features. A cosmetic dentist has undertaken specific training and advanced education on dental aesthetics. If a dentist is capable of whitening/bleaching, implants, veneers, bonding, dental bridges, orthodontia and such, they can justifiably use the title of cosmetic dentist.

Cosmetic Dentistry & Bleaching/Whitening*

In the world of cosmetic dentistry, teeth whitening or bleaching is one of the most popular procedures. With the surge of over-the-counter whitening products, whitening of teeth is more available to the public. However, bleaching via a professional dentist has the most effective and instant results and is actually much safer. With teeth whitening, the user can restore the natural color of a tooth and that can be accomplished with everyday products such as toothpaste containing a tooth whitening agent. With teeth bleaching, the teeth reach a whiteness that goes beyond the natural tooth color. A cosmetic dentist may recommend in office bleaching or may recommend a prescription take home system that can be used safely by the user on their own. Products used by the dentist usually contain a compound known as oxygen peroxide which is chemically stronger than carbamide peroxide, which is commonly found in over the counter products. Whitening is normally recommended for patients that have discolored teeth with stains and with little to no restorations. What clients need to know is that teeth whitening is not just a “do it and get a great smile thing.” It is a process that needs to be performed properly to avoid potentially serious damage to the teeth and equally serious – THE PAIN THAT COMES WITH IT! Failing to properly prepare for a teeth whitening process can result in dental pain for very long periods of time. Not to mention serious dental sensitivity to cold and heat. A conservative regiment of pre-preparation with your dentist through a careful dental cleaning and fluoride rinsing regiment is critical to getting the bleaching results that will last.

Cosmetic Dentistry – Bonding*

Dental Bonding is a composite resin filling that is placed on a tooth to improve its appearance. This material is more often used to fill cavities though it is also used in cosmetic dentistry to change the color of teeth, close minor gaps or reshape teeth if chipped, broken, or irregularly shaped conditions exist. To help the bonding material adhere to the tooth, the surface is roughened and coated with a conditioning liquid. A thin layer of the bonding material, in the selected color, is then placed on the tooth or teeth and molded to the desired shape. The material is then hardened with the help of an ultraviolet light. Once hardened the cosmetic dentist will smooth out any bumps and finish off the appearance with a careful polishing. Bonding is recommended as a correction of cosmetic defects, such as exposed roots due to abrasion and areas of low bite pressure since the bonding material can chip from the tooth.

Cosmetic Dentistry – Contouring and Reshaping*

Dental contouring, also known as tooth reshaping, is a technique used for minor defects such as chipped, irregularly shaped, mildly crooked, or overlapping teeth. This is a cosmetic treatment that gives you instant results by removing a small amount of enamel from the tooth to change the shape. The enamel is reduced by fractions of a millimeter to eliminate imperfections, this procedure is often paired with bonding, a tooth colored composite that is sculpted to the desired shape on the tooth. The tooth will then be polished and smoothed to a regular appearance. Dental contouring is, in minor cases, an alternative to braces. Though contouring is low in cost, generally almost painless, and a possible substitute for braces, one must keep in mind the disadvantages of reshaping the teeth. The enamel being removed is an important component of the tooth structure and removing too much enamel can result in tooth sensitivity. Contouring and shaping must only be performed by a dentist after an evaluation of the impact to the tooth and overall dental health.

Cosmetic Dentistry – Crowns*

A dental crown, besides being required for functionality, can be considered part of cosmetic treatment. Crowns are used by dentists to cover dental implants, protect a tooth that is left weak due to endodontic dental procedures, repair a broken tooth, cover a misshapen tooth, support a tooth with a large filling, or as support for a dental bridge. A crown basically covers the whole tooth. Different materials are used to make crowns, such as metals, porcelain fused to metal, all porcelain or all ceramic, etc. The process for obtaining a crown requires the natural tooth to be filed down from the chewing surface and around all sides. This is done to make room for the crown that is to cover the tooth. If the tooth is missing a major portion of its surface due to damage or tooth decay, the dentist will need to “build up” the tooth surface with various dental materials since the crown will require support. Once the tooth is filed, an impression of the tooth shape and as well as the opposing tooth surface will be taken, this is to ensure that the occlusion (the dental bite pattern) will not be affected by the crown device. This impression will be then sent to a dental laboratory that will prepare the crown for the tooth. Depending upon the complexity of the condition and the type of crown chosen, the crown is generally ready for cemented onto the tooth in about one to two weeks. Some dental offices are equipped to make an in-office crown which can be prepared and installed in a single visit. However, this particular process generally incurs a much greater cost.

Cosmetic Dental Implants*

Dental implants can be used to replace either a single tooth or several missing teeth. Dental implants have become exceptionally popular in recent years due to their highly functional and natural appearance/fit as opposed to conventional bridges, dentures, or partials. The reason implants are more functional than other procedures is because the tooth as well as the root are being replaced, giving the implant a generally much stronger support. Dental Implants are a surgery that is performed in the mouth. Due to this, there are certain qualifications a potential recipient must meet, such as good overall health, healthy gums and enough dental bone within the jaw to support the implant. The titanium implant is inserted into the jawbone where it is to begin a process called osseointegration. This is a bio-physics process in which the implant and the bone bond together permanently. This overall healing process takes between 3 to 6 months. Once the dentist has confidence the implant is sturdy enough to support the enormous force placed upon it during eating, etc. the restoration will be placed on the implant.

The final product will appear like a normal healthy tooth.

Cosmetic Dental Gum Treatment/Lifts*

Cosmetic dentistry is about improving the smile and gum treatment is a part of this process. When an individual smiles and too much of the gums show, the balance and symmetry of the smile seems off. However, the proper balance between the gums and teeth can be attained by actually removing a small portion of the gum. This will allow more of the tooth to show making the smile look proportional, attractive and balanced. The problem can be additionally complicated not just from too much gum showing but, also that the gum line is asymmetrical and disproportional. This makes the smile appear crooked or slanted. To correct this condition, the dentist will apply anesthesia and carefully remove excess gum tissue that is necessary to balance the smile. Stitches are usually needed for this procedure. Using modern dental laser technology, in some cases, even stitches can be avoided. When a laser is used to remove the excess gum tissue, generally minimal bleeding occurs and soreness may last for one to two days. If the procedure is performed with conventional methods the patient may be limited to a soft food diet until the stitches are removed. Gum reshaping is usually accompanied by dental veneers on certain teeth to closed gaps or change the shape of the tooth to create the perfect smile.

Cosmetic Dentistry & Papilla Regeneration*

I have a What!? Yes, you have a Papilla – don’t panic everyone does and this is a good thing. The papilla is a structure that is essential to the appearance of a beautiful, healthy smile. The papilla is the gum tissue that fills the contact point between the teeth. The papilla can deteriorate or be lost as a result of untreated periodontal disease, smoking, flossing or even age. The loss of the inter-dental papilla also called “black triangles” is not only aesthetically undesirable but can be very uncomfortable since food can easily get trapped there and foster tooth and tissue decay. There are both surgical and non-surgical solutions to treat this tissue deformity. In the surgical approach to this issue, the dentist will perform surgery on the gum tissue. A process called debridement and root planning is also generally performed and a collagen barrier membrane will be positioned around the problem area. In some cases, a process known as bone grafting may also be required. The surgery location is then stitched back together and ready for healing process to begin. A series of follow-up dental exams are performed to evaluate the process and assure healing is progressing. Procedures to regenerate papillae vary, with each case different per individual. The ultimate result of regeneration of the papilla is a quality and more natural gum to teeth transition.

Cosmetic Dentistry – Orthodontics & Braces*

Invisalign© is a dental cosmetic alternative to conventional metal braces, which are used to straighten teeth. Unlike traditional braces, which consist of metal brackets and wires, Invisalign© is a series of clear, customized, removable, plastic aligners that go over the teeth and are designed by digital computer modeling. This plastic aligner is to be switched every two weeks, with each new aligner progressively shifting the teeth the proper amount to the final aesthetic position for a uniform smile. In a period of generally one year, 18 to 30 aligners may be required and each are to be worn for at least 20-22 hours per day in order to see progress. The success of Invisalign© relies greatly on the patient’s commitment. which involves removing the alignments only to eat or brush teeth so that the treatment goes according to plan. If the patient does not wear the aligner for the advised length of time, the treatment period will lengthen more and the cost will increase to an already expensive treatment. It should be “clearly understood” the Invisalign© technique of teeth straightening is recommended for individuals who have only slight imperfections on the arch of their teeth yet, have a proper bite pattern or occlusion. Only a skilled dentist can determine if the Invisaline© process will work for each patient.

Cosmetic Dentistry – Orthodontics & Braces*

Orthodontics is a complicated dental science in which the prevention or correction of misaligned teeth, and/or jaw lines is promoted. Dental misalignment (malocclusion), which is common to some degree in virtually all people, may prevent us from eating or speaking correctly and thereby affecting the functionality of our teeth. This malocclusion therefore makes orthodontics to be considered as a restorative process. Orthodontics can also be considered cosmetic dentistry since the alignment of the teeth is a quintessential part of the perfect smile. Whether receiving orthodontics for restorative or cosmetic reasons, the advantages, such as straight teeth, jaws and occlusion, better oral hygiene, clear speech, and better facial appearance are beneficial to the patient. Many only see orthodontic treatment as a cosmetic benefit. In reality, it is so much more. There are many dental “health” aspects that are equally beneficial. The most common term branded to orthodontic treatment is “braces,” which consists of brackets being bonded on to each tooth and bands that are bonded to the molars. The arch wire of braces is a thin, metal wire that runs through each bracket, applying light pressure on the teeth. The wire is attached to each bracket with the help of elastics that come in a variety of colors. These are generally changed at each visit in addition to the arch wire being adjusted or changed, according to the movement of the teeth. There are different types of braces available today as opposed to the old styles of braces from years past. Some of the processes of modern braces today (if the patient condition allows) are very comfortable and can be much less visibly noticeable. Depending upon the overall dental condition, some braces can even be placed behind the teeth thereby rendering them almost invisible.

Cosmetic Dental Veneers*

Veneers are a thin layer of composite or dental porcelain that is placed on the front of a tooth to create an aesthetically pleasant smile. A veneer can help correct crooked or gapped teeth, chipped teeth, discolored teeth, shape of a tooth or worn down teeth. In some cases a veneer can improve your dental occlusion (the way you bite). Your cosmetic dentist will remove about half a millimeter of enamel from the surface of your tooth, which is equal to the thickness of the veneer. An impression will be taken of the tooth after which this will be sent to a laboratory that will design the perfect fit veneer. Generally, it takes about 1 to 2 weeks for the final Veneer set to be delivered. Veneers have a translucency and glass like appearance that allow them to create a very natural tooth like appearance. The selection of the color of the veneer is very critical since once it is cemented into place on a tooth, the color can no longer be altered. It is recommended that if bleaching of ones teeth is planned, this process should be performed first to assure that the final veneer will perfectly match the bleached teeth. Porcelain veneers are very resistant to staining. There are many advantages that veneers offer for dental smile improvement, however, the client must understand there are disadvantages as well. Due to the removal of enamel on a persons tooth, the tooth may become sensitive to cold or heat. For those with high levels of tooth sensitivity, a veneer may not be the optimum solution. Since the veneer procedure is not reversible, the tooth must now always have a veneer. If a veneer happens to chip or crack it cannot be repaired, it must be replaced as a whole. Additionally, if a client suffers from grinding of the teeth (bruxism), veneers are not recommended since this process can cause the veneer to crack or chip.

Cosmetic Dentistry – Smile Design*

The complete smile makeover or Smile Design (as cosmetic dentists like to refer to it), is a series of procedures used to improve the smile for purely aesthetic reasons, taking facial appearance, lips, and gum tissue into consideration. This process should not be confused with the process of full mouth reconstruction which is necessary for the functionality of the teeth rather than appearance. In smile design, a variety of procedures are used in unison to change the tooth color, the alignment and spacing of teeth, changes to tooth length, replacement of missing teeth, and the balance of uneven, chipped, or cracked teeth. If the teeth are discolored, the dentist and client will discuss the best options to achieve a white smile based on the overall condition of the teeth. Depending on the overall health of the client’s teeth, the dentist may want to use a teeth whitening procedure, porcelain veneers, or other specialized treatments “only after” teeth and gum health improvement. It is rather pointless to create a perfectly strait and white unhealthy tooth that is going to eventually have to be removed! If teeth are misaligned, the client might need orthodontic treatment or if the ideal conditions of the particular teeth set exist, the dentist might consider a faster solution such as veneers implementation or specialty straitening methods such as the Invisalign© braces option. Spacing in between your teeth might be treated with orthodontic treatment as well or veneers. Missing teeth can be replaced with dental implants or bridges. A smile makeover may also help you achieve a more youthful appearance by giving you fuller lips, and cheeks through cosmetic dentistry.

Cosmetic Dentistry – Full Mouth Reconstruction*

Full mouth reconstruction may sound “scary” but it is not. Don’t panic. In reality, it is a combination of several dental methods used to create an healthy relationship between the gums, bones, muscles and teeth in order to achieve not just an aesthetically pleasant smile but more so a functionality, health and comfort within the mouth. Remember, a healthy and comfortable teeth and mouth always comes first, the perfect smile comes second. If a client has teeth that have been lost to trauma, teeth severely worn due to acid erosion, severe jaw discomfort and muscle/headache pain caused by teeth misalignment (malocclusion), full mouth reconstruction may be required. The dentist will determine if full mouth reconstruction is necessary by conducting a specialty examination where the condition of the teeth from aspects of alignment and bite, as well as jaw movement pain will be taken into account. This process is sometimes referred to as equilibration. This is a unique examination which is notably different from simple tooth health exams. From the results of this examination, the dentist will determine which procedure is necessary for a particular condition. The procedures may include processes such as veneers, crowns, bridges, or even dental implants to help establish proper dental occlusion and jaw alignment. The dentist will also take into account any existing periodontal conditions discovered which may require dental health improvements such dental scaling and root planning, as well as topical medication treatments to stop progression of periodontal disease. Dental pockets (spaces between teeth and gums), mobility of your teeth (loose teeth), excessive or insufficient gum line, as well as assessment of bone density or deterioration will be part of the detailed periodontal portion of the examination contained within a full mouth reconstruction effort. Another exam your dentist may conduct is of your Temporomandibular joints condition (TMJ), jaw muscles, and occlusion. If diagnosed with certain jaw or muscle conditions, you may require braces or even a night guard. In certain severe cases, orthognathic surgery (a form of jaw and muscle surgery) may be required. As can be seen, full mouth reconstruction can be considered a dental cosmetic procedure as well as a functional dental health condition. In all cases, it is simply part of the process for obtaining the perfect healthy smile.

* – All information contained in this article is for “informational purposes only.” It is not to be interpreted as direction towards a diagnosis/treatment recommendation. Reader must directly consult a dentist for any evaluation/specific treatment advice.

©2012 Dental Aesthetics Professionals. No portion of this article may be reused without the written permission of the author.

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