The American Heritage Dictionary defines cosmetic as “the correction of physical defects.” Cosmetic dentistry is the correction of dental defects including a wide variety of problems, including dark fillings; broken teeth; yellow teeth, the closing of spaces; and the changing of the shape, contour, position and even the sizeof your teeth.
Procedures designed to help you achieve a whiter, brighter, more beautiful smile can be as simple as placing whitening strips or as complicated as full-mouth reconstruction utilizing crowns, bridges, veneers, implants; even orthodontic treatment (the realigning of your teeth with “braces”), depending on the treatment plan.
The Cosmetic Solutions
Whitening works by applying carbamide or hydrogen peroxide solution to the tooth surface. Peroxide whitener reacts with water to form hydrogen, which produces the whitening. The degree of tooth whitening obtained is directly proportional to the strength of the whitening solution and the amount of time the solution is in contact with the tooth. Concentrations used for tooth whitening can be as low as 2-5% or as high as 22-35%. Some patients experience no side effects in whitening, while others experience tooth sensitivity and/or burns to the soft tissue. See Whitening/Bleaching.
White, bonded fillings
White fillings, whether in your smile or in your back teeth, may need replacement for cosmetic or health reasons.
- Over time, the composite fillings in your front teeth will stain from various foods, coffee, tea, dark soda, or tobacco.
- The margins of your fillings may become defective over time, and the accumulation of bacterial plaque on these fillings can create recurrent decay, necessitating replacement.
Direct bonding with composite (composite veneers)
Direct bonding involves the complete coverage of the front of your teeth with tooth-colored filling material. Prior to placement of the composite material, tooth structure may or may not need to be removed, depending on each individual case. The tooth is etched and an adhesive is placed on the surface, followed by the layering of various colors of composite designed to mimic natural tooth structure. The direct bond is then contoured and polished to a high shine. Direct bonding may be able to close spaces, straighten teeth with minor misalignments, and improve color, shape, and contour. Although this procedure is usually less expensive than placing porcelain crowns or veneers, this material will stain over time and does not last as long as porcelain. This is because composite is a porous material, while porcelain is a very dense, smooth material.
If you look at many kitchen countertops, you will notice that they are covered by a very thin layer of Formica that is glued to a wooden frame. Think of the wooden frame as your tooth and the Formica as the porcelain veneer.
The purpose of placing veneers is to avoid excessive tooth removal. A very thin portion of your tooth is removed from the front, sides and biting edge of the tooth. Laboratory-constructed veneers are then bonded to the remaining tooth structure to replace the removed tooth structure, thus obtaining the desire cosmetic result (closing spaces, as in the example).
Typically, veneers are used on the front upper and lower teeth, but they can be used on all teeth that show in your smile. One of the most difficult procedures is placing a single veneer or crown on a front tooth because the challenge of capturing the exact color of surrounding teeth, translucency and surface finish is difficult. If your dentist has done this to your satisfaction, he or she has an exceptional eye for detail and extremely good communication with his or her dental laboratory.
Reasons to place porcelain veneers:
- When there are several spaces to close or fewer large spaces, the treatment plan may indicate that more teeth need to be prepared to achieve the desired results; if too few teeth are used, the final result may leave you with oversized teeth. The general rule is that the more space there is to close, the more teeth need to be prepared. The filling of space is distributed over a greater number of teeth, creating a much nicer result.
- The preparation is designed according to the final goal of the treatment plan, such as giving the appearance of moving the teeth forward, backward, right, or left.
- To change the length or shape of the teeth
- To change the color of the teeth
- To make minor changes in the position of a tooth
A porcelain veneer does not cover the entire tooth. Therefore, if large changes in position are needed, a full crown may be necessary to bring the tooth into the desired alignment.
Depending on the condition of your teeth, the use of full crowns may be necessary to achieve a desirable cosmetic result. Remember, veneers do not cover the entire tooth, and if any of your teeth have had large composite fillings that extend to the “back” of your tooth, a full crown may be needed to cover the old, defective composite restorations. If your teeth are crooked and you’re not interested in having your teeth straightened through orthodontia (see Braces), the teeth can be either partially or completely realigned by the way the teeth are prepared and how the crowns are constructed. There are a number of different types of porcelain crowns that can be used to cosmetically restore a smile (see Crowns and Bridges).
Braces (orthodontic treatment)
Orthodontic treatment, or “braces,” is most often thought of as cosmetic; however, one of the primary goals of this type of treatment is the correction of proper function. Proper function of the teeth preserves the beauty of your teeth over a lifetime. Overall, cosmetic dentistry implies the correction of physical defects only; unfortunately, if appropriate function is not considered, the cosmetics may fail over time. To learn more about the advantages of orthodontics, (see Braces).
Inlays and Onlays
See article Inlays and Onlays.