Esthetic & Cosmetic Dentistry
Through the last century, dentistry has rapidly evolved thanks to the progression of science in general, but especially the development of new materials and computer technologies. Patients’ awareness of oral health and importance of saving each tooth has raised and combined with the availability of internet as the greatest source of information, patients’ requirements have raised. Today, patients are well informed before the first appointment with their dentist about possibilities regarding their dental problems. With all named changes, patients’ esthetic aspirations have raised. A good dentist must keep up with these changes so he can be able to offer the best possible therapeutic and esthetic solution for their patients.
Esthetic dentistry focuses primarily on the visual appearance of teeth and entire smile. However, it can never be the main guideline for therapeutic procedures, since the dentist is a doctor in a first place and they must follow the concept “Primum non nocere”. This means that your dentist will find the best possible solution for your esthetic needs in way of not jeopardize your health and the function of your oral cavity. There are plenty of the procedures that can make your teeth white and shiny and they can be more or less invasive and expensive, some are indicated in special cases, some affect just the esthetic of a smile while others can improve the functional flaws besides esthetics.
Teeth-whitening is probably the most desired esthetic procedure among dental patients worldwide, and more importantly the less invasive. After dental examination, your dentist will inform you if you are a good candidate for teeth-whitening. Teeth-whitening is basically applicable in all patients, but there are some conditions where it is contraindicated to perform like defective enamel and dentin disorders that are usually inherited, dental fillings with marginal defects, present caries lesions. Before the teeth-whitening procedure, professional teeth cleaning is necessary in order to remove tartar and plaque. When the teeth are clean, the whitening procedure may be performed. There are two types of teeth-whitening treatments that need a supervision of your dentist: in-office teeth-whitening and home whitening i.e. Walking Bleaching Technique. The differences between these two types of procedures are mainly in the concentration of the whitening agent. While the agent for in-office whitening contains 35-40% hydrogen-peroxide, whitening agents for Walking Bleaching usually contains 13-25% carbamide-peroxide. In consultation with your dentist, you will easily decide which technique and concentration is the best option in your case.
Composite and ceramic veneers
This treatment made a great entrance in dentistry when it appeared among celebrities 20 years ago as a Hollywood Smile. It is a “cosmetic” treatment that changes the shape, size and color of your frontal teeth usually in the upper jaw. The treated teeth are the one that is visible during your widest smiling. During the procedure, your dentist will prepare your teeth by removing the thin layer from the surface of your teeth, making a place for future veneers. Veneers may be made of composite or ceramic. Composite veneers can be made directly in your mouth by your dentist, or the silicon impression of prepared teeth can be made, in which case, the dental technician will produce veneers in-lab. Ceramic veneers give a more natural look to the teeth, and with modern computerized techniques such as CAD-CAM technology, you can have a natural smile within a day. Since your dentist needs to remove a part of your tooth in order to prepare the space for the veneer it is not a desirable method if you have completely healthy teeth with no cavities or dental fillings. However, with rapid progression of dental materials, the new method has developed, known as Non-Prep Veneers. This technique does not require any previous preparation of teeth which means that teeth stay intact and veneers will be simply bonded to your teeth’s surface. Veneers are a great solution if you want to make small changes to for frontal teeth such as the color, but also the smallest irregularity of the position, size and shape of your teeth.
Inlays, Onlays and Overlays
When there is a greater defect of your teeth, such as caries lesions or smaller fractures, your dentist will probably suggest a dental composite filling. For centuries dental caries removal and dental filling placement are the most common dental procedures. Inlays, Onlays and Overlays present the greatest alternative to dental fillings, since they can be made of a composite in a dental laboratory, but also from ceramics and gold. They have better esthetic properties since they are produced in-lab with a greater precision and more natural look. Their edges are more precise and suitable for defect of the tooth which provides better marginal adaptation. The differences between Inlays, Onlays and Overlays are in the amount of lost dental tissue that needs to be replaced. Onlays restore the smallest defects which match the I class dental filling or defect of the occlusal surface of the tooth. Inlays are similar to II class restoration or destruction of occlusal and proximal tooth surface while Overlays covers huge defects of a crown that are still not extensive in the way they need a crown.
Dental Crowns and Bridges
With the extensive loss of tooth structure a dental crown may be the only solution. Besides enamel and dentine loss, there are other situations that require a dental crown. After endodontic treatment, the tooth becomes weakened and usually needs a core build-up with suitable pins and crown. Regardless the indication for a dental crown or a bridge, beside a functional rehabilitation, this is always an esthetic challenge. Since it is an opportunity for getting a “new tooth/teeth” patients has a chance to choose the color, size and shape of their crowns. There are many sorts of dental crowns: metal-ceramic, zirconia- full ceramic crowns, full gold or gold-ceramic crowns. Depending on the indication, region in the dental arch with its chewing forces, present teeth, patients’ esthetic requirements and budget, different therapeutic options are possible.
Dental implants and oral surgery
There are few treatment options for tooth loss. Some are previously mentioned as a prosthodontics solution such as dental crown or bridge. Another solution can be implanted placement in the site of the lost tooth. Implants are safe and the best possible solution for the missing tooth. They are placed in the bone during a surgical procedure. After implant’s integration into the bone, the crown can be produced and fixated to the implant. This is the most comfortable, durable and safest solution for missing teeth whether is one or more tooth lost, even in edentulism. When loss of all teeth occurs, there are possible prosthodontic solutions supported by few implants like “All on 4” design where entire prosthodontics is fixed on four implants. Since implants are made of titanium, the shade of implant may be visible through the marginal gums which can compromise the esthetics. Therefore, advanced techniques have developed in order to avoid this problem. Zirconia implants can be used in order to avoid this disadvantage so as mesoabutments that are custom made with CAD/CAM technology for each implant in order to improve the esthetics and to avoid the presence of implant shade around the implants. Beside this, when an extensive alveolar bone loss is present, previous surgical interventions can significantly improve the visual appearance of the entire dental arch. Bone augmentation can affect final esthetics not only as a support for future implants but also in the way of grafting a missing bone and changing entire esthetical appearance by osteoplasty surgery. Another great way for esthetical improvement can be performed through gingivoplasty, surgical remodelling of soft tissue around the teeth.
When teeth of the lower jaw are not correctly positioned versus the teeth from the upper jaw, the bite may be incorrect which can lead to serious damage to the temporomandibular joint. Besides this functional problem, more often patients require orthodontic treatment for esthetic reasons. Small irregularities related to position and orientation of teeth can be corrected through orthodontic treatment. As for disadvantages of this therapy, patients usually suggest the longevity of the therapy which lasts up to two years, with monthly appointments for control and wire and brackets replacement.