Cosmetic Dentistry Services: Problems and Solutions

These before and after photos, taken in our practice, are for educational purposes. Cosmetic dentistry should only be undertaken following accurate diagnosis of conditions in the mouth and following a thorough discussion of alternative treatments.

Tooth Whitening

"My teeth are too dark"

Tooth whitening (bleaching) is the first answer to teeth that appear too yellow or gray.  It can be accomplished (1) at home by the patient, over a period of one to two weeks, by using custom-made trays to hold a 10- 22% peroxide solution, or (2) in the office by the dentist, during a 90-minute appointment, using light-activated peroxide.  When done in the office, individualized carrier trays are also provided, so that "touch ups" can be done at home.  Touch-ups are required on a 9- 12 month basis.

All-ceramic Crowns

Case #1: "I hate that dark line up at the gumline."

This "dark line" is caused by gum recession, which exposes the edge of the metal that is used underneath crowns, or "caps."  Advances in dental technology have produced several types of high-strength all-porcelain or all-ceramic crowns that do not use any metal at all.

Case #2: "My teeth look too short, and a lot of gum shows when I smile."

Sometimes the shape of the gums need to be changed before crowns are made.  This sculpting of the gums is done by a gum specialist (periodontist).. Once the shape and position of the gums is correct, crowns can be made.  In this case, the crowns have a very thin layer of metal under the porcelain for reinforcement.

Case #3: The patient below had porcelain veneers (below, left)), one of which fractured. In addition, the teeth to either side of the center teeth were disproportionately small, so all four front teeth were treated with all-ceramic crowns (no metal underneath the porcelain).

Case #4: Eight all-ceramic crowns (below) made to replace metal-ceramic crowns that are yellow in color and that, due to gum recession, display metal edges.

Porcelain veneers

Case #5: "I had some bonding done a few years ago, but now it has chipped."

Porcelain veneers are often the best choice when front teeth break, or when bonding needs to be replaced.  Porcelain veneers are thin, custom-made covers for teeth that can be made with comparatively little alteration of natural tooth structure. They can be used to change tooth color, shape, and apparent position.

Case #6: Another example (below) of porcelain veneers- two upper front teeth have been treated.

Case #7: Porcelain veneers can also be used to improve tooth shape, and to close unwanted spaces between teeth. Notice below how much this patient's smile has been improved by porcelain veneers on five of the six upper front teeth.

Case #8: An additional example of porcelain laminate veneers, used on the six upper front teeth.

Composite Resin Bonding

Case #9: Composite resin bonding is used to solve cosmetic problems that do not require porcelain veneers.  It is ideal for changing the color and shape of teeth in certain instances.  Below (left) the porcelain veneers on the four front teeth look out of place.  After four additional teeth were treated with bonding, there is harmony of color and shape, with a significant improvement in the smile.

Case #10: Composite resin bonding is also ideal for closing spaces between teeth when covering the entire tooth surface is not necessary, as below.

Smile Analysis

Case #11: "My teeth just don't look right"

Perhaps you don't like the way your teeth look, but don't know why.  The problem may be tooth length, width, position, characterization, color, or the contour of the gum.  The systematic analysis of these different factors is called smile analysis. Once the problem is understood, solutions can be proposed.

The smile line is an imaginary curved line formed by the lower edges of the upper front teeth.  The curvature of the smile line ideally follows the curve of the lower lip.  Below, this smile line has been improved by multiple adjacent porcelain fused to metal crowns. Since this patient has just finished with braces, these crowns are joined together to stabilize the position of the teeth after orthodontics.  Notice how these crown do not appear to be joined together.

Cosmetic Simulation

Case #12: "How do I know I will like the results of cosmetic dental treatment?"

The patient below has tooth wear due to night grinding (bruxism).  I performed a cosmetic simulation to enable this person to see the result of my proposed treatment. Tooth-colored materials are applied in a way that allows them to be removed again before you leave the office.  Photographs will allow you to evaluate the proposed result at home, or share the decision with friends or family.

Completely closing the space between the front teeth would make the teeth look too wide.  Also, this patient wanted to keep some space.
Before treatment	Cosmetic simulation	Completed treatment with composite resin bonding

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