Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.

Cosmetic Dentistry

For as long as I have been a dentist, I have been taking classes and teaching other dentists the value of cosmetic’dentistry. On completing my’second year of post-graduate’training in hospital dentistry in 1988, I became an instructor, and I was given the job of solving cosmetic problems for our patients in our hospital general practice. Some of these patients had teeth broken after intubation for general surgery. My job was not only to give them new’teeth but to make them look good. During those years,I learned the importance of working with various dental’specialists, as well as knowing what was needed in order’to get the final results. The doctors doing the treatment were new dental graduates in their first years of practice.

Since the doctors were graduates of dental schools from all around the United States, they sometimes presented’different ways of solving the same problem. Needless to’say, I learned just as much as I taught in that program.

Tooth-colored fillings are mostly what we call composites.”These are taking over from acrylics as the long-term filling materials, because they can match the color of your teeth and last longer. Composites used in dentistry are basically hydrocarbons with quartz and glass particle fillers.

Composites are widely used in the aerospace and other industries to provide for lighter strong materials that can be formed into various shapes. Porcelain is the other long term material that we use for crowns and bridges, which are mostly tooth-colored.”In the past, porcelain fused to metal or all-metal crowns was the technology for crowning teeth. This technology has served us well and is still the treatment of choice in cases where you have decay or fillings with margins that go below the gums. Porcelain fused to metal is also the’technology used to build porcelain bathtubs.

With the advent of Cad Cam technology, and zirconium use as a substructure to porcelain, we now have many options to make teeth look beautiful. 3M? Company uses’technology to color the zirconium substructure the same color as the root structure, and then lab technicians apply porcelain to it, creating beautiful teeth. The resulting crown maintains the tooth color over a long time and is’very aesthetic. It costs a little more, but it is well worth the investment.

Cad Cam technology uses a camera to take a picture of’the prepared tooth and fabricate the missing part of the’tooth, using computer correlation technology to mill it.”In-office Cad Cam machines can be found in some offices and are mainly used to restore posterior (back) teeth.

Most cosmetic anterior aesthetic crowns or veneers are’still finished by the artistic skills of trained lab technicians.”Some technicians use the Cad Cam technology to fabricate the substructure and then apply porcelain for’the final result.

A patient came to my office with an interesting request.

Hey, Doc, I want a smile just like yours, she said.

Do you mean the shade of the teeth or the shape I asked.

I just like the look of your smile.”

I completed my examination and found she had no upper’teeth and only the lower front teeth. Th e remaining bone in the upper was enough to support an upper denture, but on the lower, I would have to place some crowns and a lower appliance.

Do you have any pictures of you in your late teens or early’twenties One where you have a full smile

Yes! And yes, I would like to smile like that again.”

I collected all the information and proceeded to make an upper smile that showed teeth when she smiled. The contour on the appliance was shaped like real gums, and’the contours of her teeth were made like her own teeth from the pictures. No metal clips showed on her lower appliance, and we later took pictures together that showed’that indeed she could smile as well as I did.

Cosmetic dentistry involves smile creation, and the materials are not always porcelain veneers. All restorations can be used as cosmetic enhancements. The reason I encourage the use of bone grafts after extractions is that it creates the contours that we need to enhance the cosmetic result. All dentistry that is considered functional can also be cosmetic.

Is Cosmetic Dentistry Art or Science

Dentists have long known that different styles of teeth fit people with different facial structures. We have used the concepts of theGolden Proportion to help us with rebuilding an aesthetic and functioning smile. Dentists who are’very serious about cosmetic dentistry benefit from joining and participating in the various programs set up by theAmerican Academy of Cosmetic Dentistry. The more an office combines the science of materials and techniques with the artistic talents of sculpting a harmonious smile,’the closer they get to great results and a satisfied patient.

As a dental resident at Long Island Jewish Medical Center,I clearly remember a young lab technician, who worked on’the development of thin porcelain wafers to cover unattractive’teeth, telling us how they could solve cosmetic problems. They were called porcelain veneers. I became one of the early adopters of this conservative treatment mode with my longest case that I know of, still in place’since 1989. Later on, I studied with Larry Rosenthal, who gave hands-on courses for other dentists. His techniques on straightening rotated teeth were very helpful then and are still helpful today. Good fundamentals are always helpful. In North Carolina, Ross Nash and Rob Lowe have passed on valuable information to dentists, from the use of photography to lasers used to enhance your results.

Cosmetic dentistry may involve working with different’dental specialists to get a cosmetic, as well as functioning, occlusion. New types of braces,’those that are “invisible as well as “internal, can provide answers to adults who may be self-conscious during treatment.”The most important part of your cosmetic treatment is that one dentist is in charge of coordinating all the’treatment that leads to the result that the patient wants.

Sometimes part or parts of your treatment have to be done by another dental specialist, and your cosmetic dentist will do the final restorations.”A periodontist may be needed to treat your gum disease or sculpt your gums so that when you smile, the amount of gum shown is not unattractive. An oral surgeon may be needed if you have lost considerable amount of bone, need your jawbone repositioned or impacted teeth extracted. A prosthodontist may be needed if you have had extensive’tissue loss from cancer treatment or an accident requiring a special prosthesis. An oral and maxillofacial radiologist may be needed if a 3-D model shows an unidentified artifact. An endodontist may be needed if you require a root canal treatment, or retreatment of a previous root canal, to make your cosmetic restoration feasible.

Most of the cases treated in our office require combination’treatments, with or without sedation. Sometimes we have’to do an extraction, place an implant, do a bone graft , root canal a tooth, place a fiber post, and then choose the right’type of porcelain for each tooth to get’the smile to look uniform. A lot of patients ask for’veneers or lumineers; however, they may not be a candidate for those options because several teeth require several other types of treatment.

The more a patient knows about what they want, the more we can advise them if it is achievable or unrealistic.

Sometimes the achievable requires a little more perseverance on the part of the patient and doctor. Cosmetic’dentistry is a combination of science and art.


Chapter 9: Dentistry and the Heart, Artificial Joints, Chemotherapy, and Radiation