June 5, 2021
Hard or soft bristle tooth brush for the best clean?
Welcome to the tenth issue of YOUR DENTAL CARE News.
In our ninth issue we discussed What is cosmetic dentistry. If you missed this issue please visit our website https://www.procarefamilydental.com.au/news.
In our last issue we discussed what cosmetic dentistry can do to improve an individual’s smile. This issue will explore the various techniques and materials at our disposal to achieve the desired outcome. In our final article we will consider the advantages and disadvantages of having cosmetic work done.
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We are fortunate that dental materials have come a long way since the days of porcelain and metal alloys. Improving a persons’ tooth shape or masking blemishes which mark teeth are easier to achieve with longer lasting results.
Some conditions which can cause a smile to look unattractive include missing teeth, discolouration, cavities in teeth, misplaced teeth, gaps between teeth, teeth of inappropriate proportion, and blemished tooth surfaces.
These conditions can either be congenital or developmental. That is, the person is either born with the defects or some form of trauma, like dental decay or accidents, has caused the problem.
The techniques we have at our disposal to fix cosmetic issues relating to tooth shape, gaps and minor position issues can be divided into 2 main groups.
These are direct or indirect prostheses. The direct technique involves the restoration to be directly applied in the mouth whilst the person is in the dental chair and completed in one visit. The indirect technique involves impressions being taken of the prepared teeth in the first visit. A laboratory technician fabricates the restoration on a stone model of the teeth, from the earlier impression. The final restoration is then cemented on the teeth at a second visit.
The dental materials used in indirect techniques include porcelain/ceramic materials (See Figure 1) and also some types of reinforced resin material. These indirect materials have the best cosmetic outcomes and are also stronger. Their disadvantage lies in their high cost and also it is difficult to repair them should they chip or crack.
Figure 1. Ceramic veneers on the upper teeth in this patient seen immediately after they were cemented.
Direct techniques involve the reinforced resin commonly used as filling materials. These materials are quite versatile and newer technology seems to be improving their appearance and the ability to achieve a high polished surface. Also their inherent strength properties are improving with each new generation of material. This makes them appear more like porcelain than resin.
The greatest advantage in using these materials is the ease in repairing chips and breaks. Easily done in a single visit and allows for less cutting of tooth structure in some cases.
Often these techniques are applied after the teeth are first bleached or orthodontics are applied to move the teeth into better positions prior to the teeth being remodeled.
Figure 2. Presenting condition with mild crowding of teeth & an uneven smile line.
The patient in figure 2 presented with the desire to have straighter teeth without any orthodontic intervention. In this case we decided to use the direct resin approach and the teeth were modified with the composite resin without having to remove tooth structure.
Figure 3. After the composite resin was applied to the teeth.
Figure 3 shows the case completed on the same day of presentation. The change to the teeth colour is rather subtle but the poor exposure from the camera makes the picture in figure 2 appear darker and the change much more dramatic than it really is. Improvement of the uneven appearance produces a symmetrical smile.
Figure 4. There is a yellow blemish in the tooth to the right of the midline which needed masking.
The case in figure 4 shows a single tooth which had a developmental defect in the enamel and dentine. The options here included the use of ceramic veneers or composite resin. The latter option is the most conservative of tooth structure as only the blemish is masked. No tooth structure was removed, other than some of the blemished area prior to the application of composite resin.
Figure 5. The same case in figure 4 after the composite resin was applied to the blemished area.
Besides the use of these dental materials other techniques like microabrasion of the superficial enamel layer, followed by the use of tooth mousse tooth paste, can remove some superficial white spots in teeth. The microabrasion can involve the use of an abrasive which is applied with some phosphoric acid or by using air pressure to sandblast the surface.
I hope this short article explains some of the ways a smile can be improved using current materials. In our next article we will look at the advantages and disadvantages of cosmetic dentistry.
Thank you for reading and until next time…………Keep smiling!
Dr Roland Chong