Improve Your Smile: Cosmetic Dentistry 101

Today, cosmetic dentistry is more popular than ever, from whitening and shaping, to closing spaces and replacing teeth. And dentists have a wide array of tools and techniques at their disposal for improving the look of your smile.

Before deciding to undergo any cosmetic procedure, it's important to know the benefits and risks, and what you can expect during the process. Make sure you're clear about what it will cost, how much experience your dentist has with the procedure, and whether any special maintenance will be needed afterward.

 

Teeth Whitening

 

Over time teeth can become stained or discolored, especially after smoking, taking certain medications, or consuming foods and beverages such as coffee and tea. Using a chemical process, your dentist can bleach your teeth in one of two ways. He can do an in-office procedure, or provide you with a system to use at home.

Your dentist can create a custom mouthpiece that ensures the right amount of whitening solution reaches your teeth. You may find whitening at home more convenient. But it can take two to four weeks. In-office whitening can take place in one or more 45- to 60-minute visits.

Keep in mind, your teeth can become stained again if you continue exposing them to the same substances that originally stained them. Since whitening products are not meant to clean teeth, it is still important to continue practicing daily oral hygiene by brushing twice a day and flossing at least once a day.

 

Bonding

 

Bonding may improve how your teeth look if they have excess space between them, or if they are chipped, broken, stained, or cracked.

Dentists also use bonding materials to fill small cavities or to protect the exposed root of a tooth.
The dentist can usually do this procedure in a single office visit by applying an etching solution followed by tooth-colored materials -- sometimes composite resins -- directly to the tooth's surface where needed.

Although bonding can last for several years, it is more likely than other types of restorations to chip or become stained.

 

 Veneers

 

These custom shells, made of porcelain or plastic, cover the front sides of the teeth to change their color and/or shape. Veneers can improve teeth that:

• Have spaces between them
• Have become chipped or worn
• Are permanently stained
• Are poorly shaped
• Are slightly crooked

Dentists often suggest veneers for some of the same problems that bonding addresses. Yet, the process for inserting veneers is not reversible like dental bonding, which can be removed.
Veneers are less expensive than crowns. And they last longer and have better color stability than bonding.

Before inserting veneers, the dentist first takes an impression of your tooth, then buffs the tooth before cementing the veneer in place. A beam of light helps harden the cement which secures the veneer to your tooth.
Porcelain veneers are made in a laboratory. So you would need a second visit to the dentist to have them inserted.

Crowns

 

 Sometimes called caps, crowns completely cover a tooth, restoring a normal shape and appearance. You may need a crown to:

• Cover a misshapen or discolored tooth
• Protect a weak tooth
• Restore a broken or worn tooth
• Cover a tooth with a large filling
• Hold a dental bridge in place
• Cover a dental implant
• Cover a tooth that's had a root canal procedure

Crowns can be made from metal, porcelain fused to metal, resin, or ceramic materials. Because crowns are costly, dentists usually suggest them only when other procedures can't produce a pleasing result.
Sometimes a dentist can make an in-office same-day crown, or a temporary crown. But it takes more than one visit to receive a permanent crown. The dentist prepares the tooth for the crown, makes molds of the tooth, provides you with a temporary crown, and then places the permanent crown at a separate time.
Permanent crowns can have a long life if you take good care of them.

 

Enamel Shaping and Contouring

Enamel shaping and contouring involves removing or contouring dental enamel to improve the appearance of your teeth. Dentists may combine this process with bonding.
Often used to alter the length, shape, or position of teeth, reshaping and contouring can correct:

• Crooked or overlapping teeth
• Chipped and irregular teeth
• Minor bite problems

You may be a good candidate for reshaping and contouring if you have normal, healthy teeth, and there's still adequate bone between your teeth to support them.

 

Braces

Today, people of almost all ages are benefiting from braces. Braces not only improve the look of teeth that are crooked or crowded. They can improve an irregular bite and correct jaw positioning and jaw joint disorders.

Braces are worn to apply light pressure to the teeth and reposition them slowly, usually over the course of one to three years.

To place braces, your dentist or orthodontist bonds brackets made of metal, ceramic, or plastic to your teeth. Then she places arch wires through the brackets, which guide the teeth into their correct positions. Dentists can attach lingual braces to the backs of teeth, hiding them from view.
After your braces are attached -- and after each visit where your dentist tightens your braces -- expect some discomfort for a few days. Also, regular oral hygiene becomes especially important while you are wearing braces.

Risks with braces are minimal. But people with allergies to metal or latex, or those who have periodontal disease, are at greater risk for problems during treatment. Root shortening is also a minor problem for some people.

An alternative for correcting minor spacing problems involves wearing a series of clear, customized appliances called aligners, or invisible braces. Your dentist will reshape and replace them about every two weeks to progressively move your teeth. Unlike traditional braces, aligners can be removed while eating, brushing, and flossing.

Often there are two phases to treatment with braces: wearing braces, and then using a retainer to hold your teeth in their new position. Retainers can be removable or permanently bonded in behind your teeth.
 

Bridges

Sometimes called a fixed partial denture, bridges are used to replace missing teeth with artificial teeth. Bridges can be made of gold, alloys, porcelain, or a combination. Dentists anchor them onto surrounding teeth after preparing them for crowns. Then a false tooth joins to the crowns and the bridge is cemented onto the prepared teeth. Only your dentist can remove a fixed bridge.
The success of your bridge depends upon its foundation. So remember that oral hygiene to keep remaining teeth healthy is particularly important if you wear a bridge.

 

Implants

Implants are one of the more involved and expensive cosmetic dentistry procedures, but are a long-term solution for replacing missing teeth. They are an alternative to bridges -- which use adjacent teeth as anchors -- and to removable dentures, which rest on your gums. An oral and maxillofacial surgeon implants them surgically into the jawbone.
Implants have three parts:

• Titanium metal, which fuses to the jawbone
• An abutment, which fits over the part of the implant that sticks out from the gums
• The crown, which a special restorative dentist creates for a natural, tooth-like appearance

You can get an implant to replace a tooth. Or two or more implants can provide a stable support for replacing several teeth. If you have bone loss from periodontal disease or lost teeth, the surgeon will likely need to first graft bone so the implant has something to secure to.
Having implants requires several steps, including:

1. A comprehensive exam, X-rays, and consultation
2. Surgical implantation of the titanium posts
3. Taking impressions of the upper and lower jaws
4. Making a model for the creation of the dentures or crowns
5. Placement of the crown
6. Follow-up exams with members of your implant team

 

Other Periodontal Plastic Procedures

An array of other procedures can also improve your smile. They include procedures to help with:

• An uneven gum line
• Teeth that look too short or too long
• Exposed roots
• Indentations in your gums or jawbone

If problems like these are a concern for you, ask your dentist about your best options for correcting them and creating a smile that you can be proud of.

 

Dental Health and Veneers

Dental veneers (sometimes called porcelain veneers or dental porcelain laminates) are wafer-thin, custom-made shells of tooth-colored materials designed to cover the front surface of teeth to improve your appearance. These shells are bonded to the front of the teeth changing their color, shape, size, or length.

Dental veneers can be made from porcelain or from resin composite materials. Porcelain veneers resist stains better than resin veneers and better mimic the light reflecting properties of natural teeth. Resin veneers are thinner and require removal of less of the tooth surface before placement. You will need to discuss the best choice of veneer material for you with your dentist.

What Types of Problems Do Dental Veneers Fix?

Veneers are routinely used to fix:

• Teeth that are discolored -- either because of root canal treatment; stains from tetracycline or other drugs, excessive fluoride or other causes; or the presence of large resin fillings that have discolored the tooth
• Teeth that are worn down
• Teeth that are chipped or broken
• Teeth that are misaligned, uneven, or irregularly shaped (for example, have craters or bulges in them)
• Teeth with gaps between them (to close the space between these teeth)

What's the Procedure for Getting a Dental Veneer?

Getting a dental veneer usually requires three trips to the dentist – one for a consultation and two to make and apply the veneers. One tooth or many teeth can simultaneously undergo the veneering process described below.

• Diagnosis and treatment planning. This first step involves your active participation. Explain to your dentist the result that you are trying to achieve. During this appointment, your dentist will examine your teeth to make sure dental veneers are appropriate for you and discuss what the procedure will involve and some of its limitations. He or she also may take X-rays and possibly make impressions of your mouth and teeth.

• Preparation. To prepare a tooth for a veneer, your dentist will remove about 1/2 millimeter of enamel from the tooth surface, which is an amount nearly equal to the thickness of the veneer to be added to the tooth surface. Before trimming off the enamel, you and your dentist will decide the need for a local anesthetic to numb the area. Next, your dentist will make a model or impression of your tooth. This model is sent out to a dental laboratory, which in turn constructs your veneer. It usually takes 1-2 weeks for your dentist to receive the veneers back from the laboratory. For very unsightly teeth, temporary dental veneers can be placed for an additional cost.

• Bonding. Before the dental veneer is permanently cemented to your tooth, your dentist will temporarily place it on your tooth to examine its fit and color. He or she will repeatedly remove and trim the veneer as needed to achieve the proper fit; the veneer color can be adjusted with the shade of cement to be used. Next, to prepare your tooth to receive the veneer, your tooth will be cleaned, polished, and etched -- which roughens the tooth to allow for a strong bonding process. A special cement is applied to the veneer and the veneer is then placed on your tooth. Once properly position on the tooth, your dentist will apply a special light beam to the dental veneer, which activates chemicals in the cement, causing it to harden or cure very quickly. The final steps involve removing any excess cement, evaluating your bite and making any final adjustments in the veneer as necessary. Your dentist may ask you to return for a follow-up visit in a couple of weeks to check how your gums are responding to the presence of your veneer and to once again examine the veneer's placement.