Can I improve my smile?

Cosmetic dentistry became the specialty of the 90s. Dentists are being inundated with materials, courses, lectures, and techniques. The results are dramatic. Dentists have not realized how important a smile is to most people. The end result sees both patients and dentists getting great satisfaction from the experience.

What is involved in cosmetic dentistry?

Dentists have a variety of techniques at their disposal to improve someone's smile:

• bleaching
• reshaping and bleaching
• bonding
• direct
• indirect
• crown
• filling in spaces

Bleaching

Figure 1

Before and after the bleaching

Bleaching - or tooth whitening - uses chemicals with a base of hydrogen peroxide (see Figure 1). The techniques are harmless and have been approved by health authorities. Like all bleaching, it is not permanent. It lasts approximately 3 years. Numbing the teeth is usually not required. There are several bleaching techniques, which are all open to further modification:

• isolate teeth with rubber dam and apply concentrated chemicals
• place chemicals in a special tray and leave in mouth for one hour a day for 3 weeks
• use over-the-counter chemical-fortified toothpaste morning and night for 6 weeks
• apply chemical to tooth and activate with a powerful blue light for 3 seconds, total treatment one hour.

Reshaping and bleaching

Prior to bleaching the dentist may wish to use fine polishing diamonds to narrow, shorten or straighten the outline of the teeth, and also remove superficial stains in the enamel. After the reshaping, the bleaching is performed. Freezing is often not needed.

Bonding

Figure 2

Before and after direct bonding

Bonding is the process of adding composite or ceramic filling materials to the teeth. This procedure is performed in 2 ways:

• Direct bonding - composite is added and shaped to the teeth and set with blue light (see Figure 2). The time required for 6 teeth is about 2 hours. The advantage of this procedure is the dentist and patient have complete control of shape and colour and it is performed in one visit. Freezing is often not needed. It does require considerable artistic skill that most dentists need to develop through practice.
• Indirect bonding - an impression is taken and instructions sent to the dental laboratory. The ceramic is fabricated and returned to the dentist to be inserted on the second appointment. The dentist reduces more tooth structure as a general rule. The advantages are better colour, smoothness, and a natural look. The disadvantages are the need for 2 visits, much higher cost, and 4 hours of time. The dentist and patient do not have as much control over colour and shape.

Crown

A crown is the time-honoured method by which 50% of the tooth is reduced to a peg shape and one of several new ceramic systems are placed on the tooth for excellent results. Two visits are required and the procedure takes about 6 hours. This system can be considered an option if bleaching, reshaping ,or bonding do not meet the dentist's or patient's criteria for success.

Filling in spaces

Figure 3

Before and after the fill in spaces procedure

Using the new composite filling materials, the teeth can be widened, shortened, rounded, or flattened to achieve a more pleasing result (see Figure 3). Freezing is often not required. It takes about ½ hour to 2 hours. There are many patients for whom this procedure can be performed.