Enhancing Your Smile With Porcelain Veneers

The purpose of porcelain veneers are to improve the health and appearance of the teeth. Porcelain veneers can look completely natural and whiten dark yellow stained teeth or tetracycline stained teeth. Teeth can be whiter and straighter looking (often referred to as Instant Braces). The shape of teeth can be improved, lengthened, shortened, fuller or less full, be more round, more square or bolder looking. A porcelain veneer is a thin shell of heat-fired porcelain that is custom made to fit your teeth. They are separate veneers of porcelain that are bonded to the teeth. The patient brushes, flosses and eats normally. Whatever the needs or desires of the patient, veneers can be an effective cosmetic solution that will last for many years. The restored teeth will permanently be whiter than the natural teeth. The oldest case by Dr. Sam Muslin was completed in 1984 and the patients teeth are still better looking than his natural teeth would have been by now. The veneers have been in his mouth for over 23 years and the patient is 85 years old.

A porcelain veneer is a thin shell of heat-fired porcelain that is custom made to fit your teeth

Non-Invasive Cosmetic Dentistry With the development of the thin non-invasive, no tooth grinding type of cosmetic treatment, the patients natural tooth structure can be saved. No grinding on the patients teeth is also referred to as Non-Invasive Dentistry or Non-Invasive Porcelain Veneers. Sometimes if a tooth is protruding, some surface grinding is necessary to make the teeth line up evenly. NonInvasive Porcelain Veneers can create permanently whiter teeth. Patients can have white teeth without the hassle of bleaching or ongoing teeth whitening to maintain a whiter color. Continual use of bleaching agents such as Zoom, or BriteSmile, or Crest Whitening Strips or any other teeth whitening or teeth bleaching agents compromise the tooth structure. Teeth bleaching can make the teeth sensitive towards temperature, sweet and fruit juice. Ceramic dental bonding that is non-invasive or requires no grinding protect the teeth. Less Tooth Sensitivity The non-invasive porcelain veneer adds another layer of porcelain to the existing tooth. The tooth can be much less sensitive, much whiter and very natural looking. Less tooth sensitivity is a huge advantage if the dentist is highly skilled in dental bonding. The extra layer of porcelain over the existing tooth covers all of the sensitive areas. The patient can have an exceptional smile that highlights their eye color, complexion and lips. There are many brands of non-grinding or non-invasive porcelain veneers such as Lumineersa made by Cerinate, Da Vinci Labs, Glidewell Labs and Mac Labs. Many other dental porcelain labs make veneers that require no grinding. The non-invasive porcelain veneers are not new; many cosmetic dentists

have been doing them for many years. A word of caution: thin porcelain veneers require an artistic and talented hand skill or the results can look unnatural .

A word of caution: thin porcelain veneers require an artistic and talented hand skill or the results can look unnatural

Traditional Porcelain Veneers The traditional porcelain veneer requires the tooth to be reduced (ground down with a dental drill) about 1mm in order to make room for the porcelain. The porcelain veneer will fit inside the area of tooth that has been ground away. The advantage of the traditional veneer is the porcelain is thicker and can hide a dark colored tooth better than thin porcelain veneers. The disadvantage is that the healthy natural tooth structure has to be ground away. The dentist has to be very precise with the work otherwise the teeth can be sensitive after treatment due to the loss of tooth structure. This type of veneer is better if the patient has buck teeth and needs to have them less protruded. The teeth will not be sensitive if bonding was completed to perfection. Bulky Porcelain Veneers My teeth look too thick! This type of bad porcelain veneer is too thick and square. They lack the natural contour of a tooth. They look heavy and have a tendency to collect food near the gum line because they are too think and over contoured. Over contouring refers to a sudden bulk of tooth that abruptly emerges from the gum line which then collects and traps food. A natural tooth has a streamlined contour so the food slides off easily and does not collect food. Listen to what this person has to say about her bad porcelain veneers experience. Fake Porcelain Veneers My teeth look like dentures! Some veneers are way too white. White teeth can still look very natural but cannot have too much opacity. Opacity refers to the density of the white color. If there is too much white coloration, the light translucency through the tooth is interrupted. The tooth looks fake or has the Chickletts look. Cosmetic dentistry goes beyond the skills of the conventional dentist. The average dentist does not do enough of it to know how to control all of the variables from one patient to the next. Just taking a weekend course is not enough. Be very selective with the dentist you choose. Ask for photos of his or her work or speak to their patients that had it done.

What are the Different Types of Tooth Whitening?

Tooth whitening has become a safe, efficient way for many people to brighten their smiles. Many alternatives exist, from over the counter products to professional treatment options. When choosing among these alternatives, consider effectiveness, method, cost, and any possible risks. Consult an oral health care professional for individual recommendations.

The least expensive tooth whitening option is an over the counter (OTC) daily use product, such as toothbrushes, toothpaste or chewing gum.These products mechanically remove surface stains, provide temporary results, and usually only offer an improvement of one or two shades. In general, these tooth whitening methods do not make a dramatic difference, but may be useful to maintain professionally-whitened teeth. Other over the counter products, such as tooth whitening strips and paint-on products, use a low concentration of a peroxide-based whitener. Still relatively inexpensive, this category of products can reduce age or diet-related staining and provide up to two shades of whitening. So, if limited results are sufficient for you, this is an economical alternative.

Tooth whitening products offered over television and the Internet should be used with caution. Some of the products in this category contain acid-based agents along with peroxide. The acidic products can damage the teeth and soft tissues. Also, because the trays used for some of these products are not custom-fitted, some users may swallow the whitening product.

If you decide to try teeth whitening strips, you need to place them on both your top and bottom teeth in the front.

Professional tooth whitening is available in two forms: in-office and at-home treatments. The in-office procedures are the most costly of all methods of tooth whitening and may require more than one visit.Peroxide agents are applied to the teeth either directly or in trays, and some use a laser, or light source, to accelerate the whitening process. The big advantage of this method of tooth whitening is the immediate result. This method can improve the smile five shades or more, but can also cause some temporary sensitivity.

How to Correct the Spaces Between Your Teeth

There are four ways to correct the spaces between your teeth. Diagnosing the reason the spaces are present will determine which of the treatments will best suit your needs. They are Orthodontics (moving the teeth) , Bonding (bonded tooth-colored fillings) , Dental Veneers/Laminating (bonded porcelain facings) or Dental Crowns (capping ) We are only going to discuss Bonding (white fillings) in this topic. A diastema is a space between front teeth. Diastemas are closed by orthodontics or restoration. A highly successful technique is addition of composite. A space which is too large and closed with composite results in teeth that are esthetically too wide and orthodontics is recommended. Space closure requires placement of composite two adjacent teeth. Placement of composite onto one tooth can be done it proper tooth dimensions allow it. Anesthetic is not required unless dentin or root structure is involved. Diamond burs prepare tooth structure creating a rough surface for improved bond strength and to produce bevels that show through tooth color at restoration cavosurface areas. Cross section of enamel rods improves enamel bond strength. The back of the mouth is a dark area because it receives no light. Composite must block out darkness or a restoration appears dark. Placement of opaque material to the lingual covered with translucent material to the facial achieves a natural looking restoration that is not influenced by this darkness. Blending composite color to tooth color is further achieved by proper composite selection, placement and preparation design. Restoring small diastemas or restoration of teeth that have a large buccal lingual dimension do not require placement of lingual opaque composite. Bonding to enamel provides strength to hold composite onto tooth structure and minimize microleakage. Removal of caries often creates areas of mechanical locking that aids retention. Strength of enamel bonding is increased by beveling across enamel rods. A longer bevel or chamfer preparation creates more surface area for strength and provides a long gradual show through of tooth color for better color transition. A translucent outer layer of composite provides a chameleon effect picking up and showing through surrounding color. Gingival control eliminates a black triangle in the papillae area. Placement of composite subgingival is achieved by placement of a matrix that reflects gum tissue to allow bonding and composite placement. Tooth structure is prepared, a plastic matrix placed, etching and bonding completed on one tooth. A lingual wall of composite placed trying to achieve ideal interproximal contours and light cured. Dimensions are made exact or too large. Cured composite is difficult to add to when the oxygen inhibited layer is lost but it is easily removed. Wrapping a matrix is avoided because it produces a straight contour and eliminates the oxygen inhibited layer. A contoured matrix or hand shaping produces convex interproximal areas. A layer of translucent composite is placed across the facial aspect, shaped with hand instruments and light cured. Final shaping and polishing is achieved with burs, sandpaper disks, rubber wheels, points, cups, and polishing pastes. Mesial distal dimension is measured on the restored tooth and compared to the distal mesial dimension of the adjacent tooth and space. Adjustments are made to the restored tooth with burs or sandpaper disks. Restoration of the adjacent tooth is achieved using the same technique. Close approximation of composite to composite on the adjacent tooth is achieved by holding the matrix against the adjacent composite with an instrument and light curing.

before fillings

after a simple fillings in between the gap

White dental fillings

White fillings with composite bonding Dental bonding is a technique that has been used in cosmetic dentistry for many years and can transform your smile in just a single visit. The process involves the skilful/artistic use of the correct amount and colour of dental composite, which is a mouldable material with a paste-like consistency made from acrylic resins and a variety of fillers, depending on the type used. Bonding is used for a variety of cosmetic dental procedures, including:

before bonding

Composite fillings,which is not only for restoration of decays,can also use for change your teeth's colour and shape

Filling dental cavities white fillings Replacing metal or amalgam fillings Repairing broken and chipped teeth Closing gaps between teeth (diastamas) Reshaping teeth Smile makeovers composite veneers (although porcelain veneers are the better option for this)

Composite fillings are as white as your natural teeth because of this they called white fillings.At first when they were developed they were only used for anterior teeth.By the time their durability were increased against masticatory forces because of this they can be used in the molar teeth.

Composite white fillings Dental composite bonding is a popular choice for fillings because the material can match the shade, translucency and even the texture of your own natural teeth and provides a much better result than old amalgam/silver fillings, which can be unsightly when you smile. Cosmetic dentists often replace old metal fillings with tooth-coloured composite. There is much debate in dentistry as to the safety of mercury-containing amalgam fillings, and many dentists are of the opinion that metal fillings must be removed using a safe protocol, which involves isolating the teeth using a rubber dam material.

old metal fillings changed to composite fillings

Can bonding be used for all cavities? Bonding is not suitable if you have large cavities in your teeth, as the material does not have a strong structure over large areas. Bonding is ideal for small fillings that are not exposed to great forces. With recent advances in dental technology, many dentists are turning to the use ofCAD/CAM CEREC technology to produce ceramic fillings (inlays), which have the advantages of both strength and aesthetics and can be fitted in the same visit within an hour. Some practices may have their dental technicians fabricate a ceramic filling, which can take two to three weeks.

CEREC - Computer Assisted Restoration

So what is the procedure of composite bonding? If the procedure requires a local anaesthetic (not all bonding procedures do), your dentist will first numb the area by injecting a local anaesthetic into the gum area around the tooth. The tooth surface where the composite will be applied is thoroughly cleaned to remove any debris or tartar accumulation, as the composite needs a clean surface to bond to. Once the correct shade of composite has been selected by your dentist, the tooth is kept dry by surrounding it with cotton rolls or a latex sheet (rubber dam), and then shaped or roughened by the dentist using a special tool.

Figs. 14: Defective amalgam filling with secondary caries in tooth 24. The composite filling in tooth 25 seems acceptable from the occlusal aspect (Fig. 1). The cavity margins were prepared with an oscillating instrument to prevent iatrogenic damage to the adjacent healthy tooth structure (Fig. 2).

The treatment field was isolated with OptraDam (Fig. 3). A glass ionomer cement liner, Vivaglass CEM, was applied and light cured (Fig. 4).

The surface of the tooth is then etched with a special phosphoric-acid-based gel, which provides a better surface for the composite to adhere to. The composite (bonding agent) is then applied to the etched tooth surface and exposed to a special light source (curing light), which activates the composite to harden and set. The bonding agent is often applied to the tooth in several thin layers (1mm-2 mm) until the desired shape, translucency and texture is achieved. The final step involves polishing and buffing the composite to give the desired shape and smooth finish.

Figs. 58: The enamel margins were etched selectively for 30 seconds (Fig. 5). The phosphoric acid was allowed to react for only ten seconds on dentin (Fig. 6). Tetric-N Bond was applied (Fig. 7). The adhesive was polymerised with curing light in the Low Power mode (Fig. 8).Figs. 912: OptraMatrix was placed and the proximal cavity walls were built up (Figs. 9 & 10). After finishing tooth 24, the same technique was applied on tooth 25 (Fig. 11). The restorations after the last layer was applied (Fig.12).

What are the disadvantages of composite bonding? The main drawbacks of bonding are that it doesnt have the strength of other restorative materials such as ceramic or porcelain, and it has a greater tendency to stain than your surrounding natural teeth or porcelain.

Old composite dental filling.

Can any dentist carry out bonding? Yes. However, you must note that bonding requires a high level of artistic skill and not all dentists are equally skilled. Some cosmetic dentists will have undertaken extensive postgraduate training in the field of dental bonding. Be sure to ask your dentist what experience he/she has in this area and if you can see photos of their previous work.

Post operative discomfort after fillings (why they sometimes cause prolonged sensitivity to cold or pressure) When any type of filling is done on a tooth, some sensitivity to cold and pressure is normal. This often lasts for as much as a month after the filling is done. The amount of post operative discomfort associated with any given filling depends on the depth and extent of the cavity preparation which in turn depends upon the depth and extent of the original area of decay or of the old filling which is to be replaced. In many instances the living nerve in the tooth is not especially healthy at the time the filling is done, and the trauma caused by removal of the decay or the old filling can push the nerve over the edge causing an irreversible pulpitis (inflammation of the nerve) which will lead to the eventual death of the nerve. Situations in which the nerve of the tooth remains exquisitely sensitive to cold, or hurts spontaneously without an external stimulus may have a dieing nerve, and the only solution to this problem is either to perform a root canal treatment or extraction on the tooth. A second problem that can cause prolonged sensitivity to cold or pressure on a recently filled tooth is hyperocclusion. This is a technical term that means that the filling is simply too high and strikes the opposing teeth with too much force when the patient closes his mouth. This can cause very severe sensitivity to cold and sensitivity to pressure, especially pressure applied to the side of the tooth. This is a very common problem because the patient is generally numb when the dentist carves the top of the tooth. The patient may not be closing into his normal bite and the dentist may miss a high spot. The solution to this problem is to return to the dentist for an occlusal adjustment, which means that the dentist determines what spots on the tooth are high and grinds them down. Finally, removal of an old filling or decay may reveal a crack in the floor of the cavity preparation. This can lead to cracked tooth syndrome which means that the tooth hurts whenever pressure is applied to one or more cusps (points) of the tooth. Cracked teeth happen all the time in dentistry, and they are one of our most challenging diagnostic problems. The sudden appearance of cracked tooth syndrome does not mean that the dentist did something wrong. It is generally due to a pre existing crack which suddenly allowed the tooth segments to spring apart when the old filling was removed, or when the dentist cut a new surface in order to remove decay. The management and prognosis for cracked teeth is complex and I urge you to read the page I have provided to explain it. Composite fillings present unique technical challenges to the dentist which he or she does not face when placing an amalgam filling. These difficulties are the primary reason why many dentists refuse to place composite fillings in back teeth. The technique for composite fillings is more demanding than that used for amalgam fillings. Iatrogenic (dentist caused) problems associated with composite fillings are generally due to one or more of the following: Undercured composite Modern composite filling material begins as a paste which is placed in the cavity preparation after a proper bonding technique has been performed. The paste is packed into the tooth and then hardened using a very bright light which triggers a chemical reaction causing the paste to harden into a very hard tooth colored filling. As light curing became more and more perfected, both the composition of the filling material and the construction of the curing lights evolved over time. Newer curing units (lights) are extremely bright while the older units were much less bright. A brighter light means deeper and faster curing of the composite. Many of the older curing lights were perfected before composite had evolved enough to be placed into

back teeth. Because of the depth of the fillings in back teeth, many of these older lights are not bright enough to cure the full depth of a posterior composite filling. This problem can be overcome by filling the tooth in thin increments and curing each increment thoroughly before placing the next increment. On the other hand, the newer arc lights, and laser curing units, which are much more expensive than the older standard units are so bright that they can cure to a greater depth quite quickly. (The newest curing unit in dentistry uses LEDs which are less bright, but concentrate the light energy into wavelengths that are more likely to harden the composite.) If the composite used to fill your tooth was not cured enough, your tooth will remain sensitive for a very long time. The only solution for this problem is to remove the filling and replace it with a properly cured composite or an amalgam. Shrinkage stress All plastics tend to shrink when they transform from the liquid to the solid phase (similar to the way water tends to expand when frozen). Modern composites have been formulated to minimize this problem, both chemically and by using very dense concentration of glass particles as fillers. The glass, of course does not shrink, and much of the contraction caused by the hardening acrylic matrix is counteracted by the close packing of the glass particles. Even so, some microscopic shrinkage always happens, and this, when combined with the powerful bonding techniques available today, can cause the vertical walls of the preparation to be drawn together which can produce prolonged sensitivity to cold. If the dentist suspects that this is the case, it is sometimes possible to release the stresses using a simple technique called slicing, in which the dentist cuts a vertical groove from the top of the filling to the floor of the preparation from mesial (front) to distal (back) through the filling. This allows the cusps on either side to rebound relieving the stress. The groove is then refilled with composite and the filling is then as good as new. This procedure is fast and easy and saves a lot of time and trauma to the patient (as well as the dentist). Light cured composites always shrink toward the light source. Some of the shrinkage away from the walls of the cavity preparation, and to a to a certain extent away from the floor of the cavity preparation can be avoided by the use of a thin light-guide placed on the tip of the curing light. This concentrates the light and allows the dentist to shine the light for a few seconds on each cusp of the tooth instead of directly on the filling material itself. Thus, the light channels down the enamel and dentin of the tooth and causes the initial set of the material to draw toward the cavity prep walls rather than toward the chewing surface of the restoration. Another way to avoid shrinkage away from the walls of the prep is to use clear plastic matrix bands. (A matrix band is used to contain the filling material inside of the tooth in areas where the walls of the tooth have been breached in order to remove decay. If a matrix band were not used in these cases, the filling material would penetrate between adjacent teeth under the gum line, and would also bond adjacent teeth together. Most dentists use metal bands due to their ease of use. Not too many dentists use a clear plastic matrix due to the difficulty (some may say near impossibility) of placing a thin piece of pliable plastic between tight contacts between two adjacent teeth. Shrinkage away from the floor of the cavity preparation As mentioned above, light cured composites always shrink toward the light source. Since the light source is usually directed from the top of the tooth, the composite tends to shrink toward the light, often causing the filling material to pull away from the floor of the cavity preparation allowing a tiny void to form underneath the filling

between the bottom of the filling and the tooth surface. This void eventually fills with fluid and can cause hydrostatic pressure in the dentinal tubules which leads to sensitivity to pressure on the filling. This is the most common reason for pain when biting on a newly done composite filling. The only solution for this problem is to redo the filling. The dentist can often avoid this problem by placing the composite in increments that cover only part of the floor, or by the use of a self curing glass ionomer base used under the composite.