Cosmetic Dentistry typically involves the placement of veneers or crowns on the front teeth. Materials utilized for these procedures are typically made of porcelain, due to its ability to predictably and bond to natural tooth structure, and provide excellent esthetics.
There is probably not a single dentist in America that does not claim to do Cosmetic Dentistry. The large majority of Dentists have had some kind of training in completing these kinds of cases. However, I do believe that the way we handle cosmetic cases does set us apart from the majority of clinicians that are improving the smiles of our population. There are a few principles that sit at the top of my list, and define my philosophy of cosmetic dentistry:
- Making quality the highest priority: Decisions about how treatment is carried out should not be influenced by cost-effectiveness, expediency, and marketing. We do not utilize systems that you see advertised on television and on the Internet (e.g. Lumineers™). Many of these companies promote methods of treatment that typically provide results well below the standard of care we expect when providing cosmetic care for our patients. If dentists will use a particular national lab or system, they can get listed on the website of the company that is spending big bucks to market their product. These companies are making big promises to patients and clinicians. Patients are led to believe no drills or needles are needed, and clinicians are promised that their system will make cosmetic procedures (that they always dreaded or found difficult to execute) easy, cheap, and profitable. Taking the step of undergoing a cosmetic treatment regimen is a major decision for a patient, and it is not the time for clinicians or patients to cut corners. The most important principle we dedicate ourselves to is utilizing techniques and materials that have remained top performers in evidence-based literature. We abide by standards set forth by the American Academy of Cosmetic Dentistry for all cosmetic cases.
- “Hands On” Approach: This is an approach to patient care that I try to utilize throughout my practice, but it is absolutely critical to the success of a cosmetic case. Reaching a cosmetic goal with a patient’s teeth unfolds diagnostically thru the use of a “wax-up.” Using a stone model of the patient’s teeth, I sit in my lab using wax to form the teeth into the new smile we would like to see upon completion of treatment. Although a lab technician can do this chore effectively, I believe it gives dentists, who are capable of doing the wax “mock-up” personally, a much better chance of having a successful case. The wax-up is the most critical component of a cosmetic dentistry case. It serves as a diagnostic tool to help reveal problems with occlusion (a patient’s bite), challenges we will have in achieving the patient’s cosmetic goals, and also allows fabrication of a reduction guide to assure conservative treatment. Most importantly, a wax-up acts as a medium in which dentists and patients can communicate the goals and desired outcomes of cosmetic treatment.
- Conservation of Natural Tooth Structure: A critical objective during cosmetic treatment is maintaining a patient’s natural tooth structure. This goal is balanced by the thought that if we are too conservative in our shaping of the teeth, we could compromise our chances for an excellent cosmetic outcome, or get stuck with too much porcelain at the gum line. At a minimum, a very conservative reduction of enamel is always required close to the gum line to avoid an unnatural shape at the end of the veneer. Otherwise, the health of the gums is impaired, and the restoration is more prone to decay. More often than not, this is the problem with “no-prep,” or “no-drill” veneers that are advertised all over the Internet and at chain dental shops. When time is taken to obtain an excellent wax-up, informed and guided reductions can be made only where needed utilizing a reduction guide fabricated from the wax-up.
- Occlusion: Occlusion (referred to by most people as their “bite”) is simply defined as the way teeth meet and function. It is a major consideration in providing cosmetic services for our patients. When at all possible, our goal in every case is to improve upon our patient’s occlusion. Believe it or not, the main function of the front teeth is not to provide a beautiful smile, but to protect and guide the rest of the teeth in your mouth, as well as the Temporal Mandibular Joints (TMJ) and muscles involved in chewing. Many times in cosmetic procedures we have the opportunity to significantly improve upon the occlusion of patients, realigning and shaping them to reassume the protective role for which they were intended.
- Solving “Non-Cosmetic” Problems: Many of the patients that we treat as “cosmetic” cases really started with no cosmetic concerns at all. Structural failure, decay, root canals, old/failed fillings and crowns in most of the front teeth all add up many times to a need for a patient to seek a more definitive correction of these issues. Cosmetic treatment many times is the solution to many of these problems, through the utilization of veneers and crowns on all or most of the front teeth.