• Cosmetic Dentistry

1. Smile Makeovers
2. Porcelain Veneers
3. Porcelain Crowns
4. Tooth Whitening
5. Resizing Teeth
6. Teeth Straightening
7. Gappy Smile
8. Gummy Smile
9. White Fillings
10. Occlusion

• Restorative Dentistry

1. Dental Implants
2. Gum Treatment
3. Correcting Congential Defects
4. Crowns and Bridges
5. Dental Bonding
6. Tooth Restoration
7. Replacing Gum Tissue

• Cosmetic Dentistry Care

1. Heredity
2. Hygiene
3. Professional Care
4. Habits

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Cosmetic Dentistry - Step by Step Procedures

Cosmetic Dentist Serving San Jose, Sunnyvale and the Bay Area

Descriptions of Cosmetic Dentistry Techniques and Restorations

Prior to the early 1980’s, cosmetic procedures were relatively unknown in dentistry. Dental schools did not teach “cosmetic” dentistry. Early attempts to beautify the smile were limited to moving teeth with orthodontics or reshaping teeth and cementing porcelain fused to metal crowns. Braces allowed the orthodontist to close spaces and straighten crowded teeth. Crowns were used to change the color, size, or shape of teeth.

Modern cosmetic dentistry would not be possible without adhesive dentistry. Adhesive dentistry is a relatively new branch of dentistry that allows the dentist to “bond” restorative materials to tooth structure and porcelain. Research in adhesive dentistry is prolific and improvements are rapid. At the time of this writing, bond strengths of restorative material are about the same as natural tooth structure.

All cosmetic dentistry procedures can be divided into adhesive and non-adhesive groups.

Adhesive Procedures

Direct bonding

Direct bonding is used for small fillings and minor cosmetic procedures; for example, a chipped tooth.

1. Preparation-teeth are shaped and all decay removed
2. Etch-teeth are etched with 37% phosphoric acid for 10-30 seconds to prepare the tooth surface
3. Bonding agent -there are many different bonding agents and chemicals used to create a polymerized resin tooth surface
4. Light curing-the bonding agent is polymerized by exposure to a specific wavelength of light
5. Restoration-the tooth is restored using a tooth colored resin. The resin has a putty-like consistency until polymerized by light.
6. Shaping, finishing, and polishing-the polymerized resin is shaped, smoothed, and polished to a natural tooth surface and color.

The final result is a very natural looking restoration. This type of restoration is very durable and usually lasts 7-10 years.

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Veneers

Veneers are primarily used for cosmetic purposes. A porcelain veneer is a laboratory created facing that is bonded to tooth structure with adhesive dentistry. It is usually .5 mm to 1.2 mm thick and is very similar to a false fingernail. Veneers can be used to close spaces between teeth or to change the color, shape, or position of teeth. Crowded teeth can be given the appearance of natural straight teeth with veneers.

1. Preparation-teeth are shaped and old fillings and decay are removed
2. Retraction-retraction cord is gently placed between the gum and tooth structure. This keeps the teeth clean and prepares them for an accurate impression.
3. Impression-a very accurate impression (mould) is made of the prepared teeth. The impression is sent to a dental laboratory where it is poured with a type of plaster called die stone. This creates an exact model of the prepared teeth. This model is used to create the veneers.
4. Provisional veneers-the cosmetic dentist fabricates temporary veneers from a very strong acrylic resin and places them on the prepared teeth

Second appointment

1. Provisional veneers-the temporary veneers are removed and the teeth are cleaned to prepare them for the placement of the porcelain veneers.
2. Etch-teeth are etched with 37% phosphoric acid for 10-30 seconds to prepare the tooth surface
3. Bonding agent -there are many different bonding agents and chemicals used to create a polymerized resin tooth surface. These chemicals are applied to the tooth surface and create “hybrid” layer that is part resin and part tooth.
4. Light curing-the bonding agent is polymerized by exposure to a specific wavelength of light
5. Cementation-the veneers are cemented with a light cured resin

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Crowns

Crowns are laboratory created restorations used to strengthen weak or fractured teeth. Most crowns used in cosmetic dentistry are ceramic and contain no metal. They are usually bonded to tooth structure with adhesive dentistry. Crowns can be used to close spaces between teeth or to change the color, shape, or position of teeth. Crowded teeth can be given the appearance of natural straight teeth with crowns.

First appointment

1. Preparation-teeth are shaped and old fillings and decay are removed
2. Retraction-retraction cord is gently placed between the gum and tooth structure. This keeps the teeth clean and prepares them for an accurate impression.
3. Impression-a very accurate impression (mould) is made of the prepared teeth. The impression is sent to a dental laboratory where it is poured with a type of plaster called die stone. This creates an exact model of the prepared teeth. This model is used to create the veneers.
4. Provisional crowns-the dentist fabricates temporary veneers from a very strong acrylic resin and places them on the prepared teeth

Second appointment

1. Provisional crowns-the temporary crowns are removed and the teeth are cleaned to prepare them for the placement of the porcelain veneers.
2. Etch-teeth are etched with 37% phosphoric acid for 10-30 seconds to prepare the tooth surface
3. Bonding agent -there are many different bonding agents and chemicals used to create a polymerized resin tooth surface
4. Light curing-the bonding agent is polymerized by exposure to a specific wavelength of light
5. Cementation- the crowns are cemented with a light cured resin

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Inlays and onlays

Inlays and onlays are both laboratory created restorations, but have different uses. Inlays are relatively small restorations used to replace small to moderately size fillings or decay. They are not used to strengthen teeth. Onlays are larger restorations covering part or all the chewing surface of molars and bicuspids and are used to strengthen teeth. Onlays are ideal choices for teeth that need strengthening, but are not damaged enough to require a crown.

Direct bonding

Direct bonding is usually completed in one appointment without the use of a laboratory. It is used to for small fillings and to change the shape, color, and position of teeth. It is also used to close spaces between teeth.

A small amount of tooth colored resin is applied to the tooth surface and bonded with adhesive dentistry.

Non-Adhesive Procedures

Whitening (bleaching)

Whitening is one of the most popular cosmetic dentistry procedures. All teeth whitening methods use carbamide peroxide or hydrogen peroxide to whiten teeth.

Home whitening procedures include over the counter products (Crest Whitening strips, trays, and toothpaste) and custom bleaching trays fabricated in dental offices. The major advantage of home bleaching is cost. Over the counter products are effective, but do not perform as well as dental office fabricated trays.

Dental office whitening procedures use a very strong light source and stronger peroxide than over the counter products. These procedures are significantly more expensive than home bleaching, but are very effective and fast. Office whitening is usually completed in less than an hour while watching television.

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Reshaping

Reshaping is a simple and inexpensive way to improve a smile. Minor changes in contour and length of teeth can make a significant difference in a smile. The minor reshaping of teeth does not require anesthesia or shots since enamel is inorganic and has no nerve.

Orthodontics (Braces)

Braces can be used to move teeth and improve appearance, function, and longevity of teeth. They can be classified as removable and non-removable.

Removable appliances can be used for mild to moderate movement of teeth. The most popular removable appliance is Invisalign. Invisalign uses cad cam technology to create a series of clear plastic forms, aligners, custom made to fit each patient. This computerized technology makes each aligner move teeth in tiny increments with a new aligner every two weeks. Treatment time and cost is similar to traditional non-removable orthodontics.

Other removable appliances include Crozat and activated retainer type appliances. These appliances need periodic adjustment to wires, screws, or springs. They are used for mild cases requiring small movement.

Non-removable, traditional, braces are bonded to individual teeth and can’t be removed. Complicated cases of malocclusion can often be corrected with traditional braces. The braces are a either metal or clear brackets bonded to teeth. A wire connects each bracket and is used to move teeth up, down, and laterally. Traditional bonded brackets make it easier for the dentist to control tooth movement.

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