Cosmetic Dentistry - DC Dental Clinic

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CREATE THE PERFECT SMILE

Cosmetic dentistry is the general term used to describe dental treatment that improves the appearance of teeth, gums and/ or bite.

It focuses on improving your smile.

Your general dentist can usually undertake these treatments and where necessary, you may be referred to a specialist for more complex and specialised care.

It is our aim here at DC Dental Clinic to help you achieve your aesthetics goal. Our focus is to help you achieve excellent oral health with healthy teeth, functional occlusion (bite) and a confident smile.

What does cosmetic dental treatment involve?

HERE ARE SOME OF THE SERVICES WE CAN PROVIDE FOR YOU

Crowns

What is a dental crown?

It is a tooth-shaped “cap” that is placed over a tooth.

A crown is used to restore the shape, size, strength, and improve the appearance of a tooth. The aim is to return the tooth to its original form and function.

When do I need a crown?

Your dentist may recommend crown for tooth heavily damaged with decay or weakened with repeated fillings, as a crown offers more protection than a regular filling. A tooth that has undergone root canal treatment will also similarly benefit from the protection of a crown.

Discoloured teeth due to a previous injury from trauma or heavily stained teeth that are unable to be treated satisfactorily with regular fillings, are also commonly treated with crowns. Existing crowns that have failed due to decay or fracture may also require replacement.

Crowns are also used to restore the coronal portion of a dental implant (the portion of implant above the gum used in function).

What does the procedure involve?

A crown will usually require 2 visits. Your dentist will first take an impression (mould) of your teeth. The tooth is then shaped and trimmed under local anaesthesia to fit the crown. A second impression of the prepared tooth is taken and sent to the dental laboratory ready for the ceramist to design and fabricate the crown.

During the interim, a temporary crown will be fabricated chair-side on the day, fitted and cemented onto the prepared tooth. You will be able to function comfortably and be given instructions on after-care of the temporary crown.

On the second visit, the temporary crown will be removed and the tooth cleaned in preparation for cementation of the laboratory-designed crown. The crown will be checked for fit, comfortable and functional occlusion (bite), as well as it’s satisfactory aesthetic appearance. Once satisfied, the crown will be cemented. Your dentist will discuss and demonstrate ongoing after-care for the crowned tooth, with your oral hygiene routine at home.

Types of crowns.

Crowns can be made of ceramic, porcelain, full-metal gold alloy, or a combination of porcelain and gold alloy. The types of crowns recommended will depend on the existing condition of the tooth, the location of the tooth within the aesthetic (cosmetic) zone and the occlusal (bite) demand on the tooth.

Full Metal Gold Crown

Metal crowns are commonly made of an alloy; a composition of both precious and non-precious metals, designed to construct a crown that is ideally strong, durable, resistant to wear and corrosion and able to be accurately made without the need for adjustment.

This type of crown is commonly prescribed for molars in least visible areas of the mouth, where the cosmetic requirement is not a concern. It is strong even in thin-sections, therefore requiring minimum amount of tooth clearance during preparation of tooth. This is excellent to preserve as much tooth as possible. It also bonds strongly to tooth, and withstands biting and chewing forces very well, so is therefore very durable. Yet, it wears similarly to the natural enamel layer on a tooth, thus the recommended choice for patients with heavy grinding habits, reducing the risk of wearing away opposing teeth. Its ease with fabrication ensures minimal adjustment during fitting procedure and best fit of the crown to the tooth.

Ceramic Crowns.

There are a wide variety of highly aesthetic “tooth-like” crowns available nowadays. These ceramic crowns are the recommended crowns of choice in the highly aesthetic (cosmetic) zone. They can vary in opacity from very translucent (light reflecting) to very opaque. In general, the higher the glass content in its structure, the more translucent or “tooth-like” it will appear and the more crystalline in its structure, the more opaque the appearance

What are the types of ceramic crowns?

There is a long history of use of feldspathic porcelain crowns in dentistry. It closely mimics the natural colour and translucencies of the natural tooth, hence the wide use in highly cosmetic, highly visible areas of the mouth. However, as it is predominantly glass in structure, it is weak and prone to fracture.

The addition of fillers add strength to different types of ceramics for example, Lithium-disilicate or more commonly known Emax crowns, exhibit greater strength, exceptional light-reflective property, mimicking natural teeth and wear at the same rate as tooth enamel.

Zirconia crown is the strongest ceramic crown available on the market. It is composed of crystalline metal oxide, that is extremely resistant to wear and very durable. However, as it is very “hard”, it can be abrasive to the opposing teeth. It is also less translucent compared to other ceramics, so although “tooth-like” it does appear more opaque than a natural tooth. So, this type of crown may not be ideal for a front tooth, but is an excellent choice for less visible areas.

Recent development of zirconia-layered crowns, where the core of the crown is fabricated with zirconia and then layered with translucent porcelain on the visible outer surface, achieved a crown with both great strength and more tooth-like translucency. This type of ceramic may then be considered for highly visible area of the mouth.

Porcelain-fused-to-metal crown is a type of crown where porcelain is layered and bonded onto an alloy of metal substructure (core under the cap). The metal alloy core provides the strength and durability similar to a full-metal crown, while the porcelain outer layer provides “tooth-like” appearance. However, the light-reflectivity property giving it its “life-like” quality, may be slightly compromised due to the dark metal core. A common complaint is that the underlying metal may show through at gum level, should gums recede over time. Fracture of the bonded porcelain layer may also occur and this may compromise the appearance and possible integrity of the crown.

Preparated molar tooth for dental crown placement. Medically accurate 3D illustration

Veneers

Series shots of dental veneer placement and installation on the tooth.

What is a veneer?

A veneer is a thin shell of material, either made of porcelain or composite resin (white filling material), that is bonded to the front surface of a tooth. The veneer is colour-matched to the natural tooth enhancing the shape and form of the tooth, to improve the aesthetics of the tooth.

It can be used in treatment of a single-tooth or multiple teeth, with the aim of transforming your smile.

Veneers can be used to improve the appearance of:

Chipped front teeth
Stained or discoloured front teeth that are not treatable with bleaching
Worn down teeth
Diastema or gaps between teeth
Peg-shaped or misshapen tooth

Advantages and Disadvantages.

One of the main advantages of dental veneers are that they are relatively non-invasive, in that they are prepared and bonded to teeth with minimal changes made to the teeth. Therefore, they are considered more conservative compared to crowns. The procedure is also less complex and relatively less painful than other more invasive procedures.

The colour, shape and form of veneers are customizable to your facial feature, bite and your smile. It is important to discuss your goals and aspirations of your smile with your dentist during the planning process. This is to ensure the final veneers will give you a realistic and highly cosmetic smile appearance, while maintaining all of your individual characteristics that makes your smile unique.

It is important to be aware that ongoing and long-term maintenance of your veneers is required. Once veneers are placed, the veneers are permanent. In case of failure, the veneers will need to be removed and replaced. The underlying teeth should be healthy and functional, but to maintain the preferred colour, shape and form, replacement of the veneers will always be necessary.

Common complications are that porcelain veneers may fracture or chip; composite resin veneers may stain and decay may also occur under veneers in a poor oral hygiene environment.

Some patients may also choose to bleach the natural tooth or teeth prior to placement of veneers. It is important to do so prior to placing the veneers because once placed, the colour of the porcelain or composite resin veneers cannot be altered.

What are the types of veneers?

The right type of veneer depends on the condition of the existing tooth or teeth and the reason the veneer and/or veneers are required for example, closing gaps or masking stains. These determine the amount of preparation (“trimming”) necessary on the natural tooth or teeth, the final colour, shape and form desired and the level of complexity and cost involved.

Bonded composite resin veneers are fabricated in-chair. This type of veneers are a great choice for a “single-visit”, where veneers are placed in one visit.

What is involved? The initial appointment is the smile analysis and planning stage. Your dentist will first discuss your concerns with your smile appearance and find out your goals and the desired final outcome. This will involve careful examination of your profile, your smile, your teeth, your bite and speech. At this planning stage, photos of your profile and smile will be taken, along with a mould of your teeth and your bite, as well as radiographs (x-rays) where required.

Following the smile analysis and planning stage, the composite resin is applied to the surface of the tooth and contoured by the dentist to match the desired colour, shape and form in the designed smile. The bite is adjusted ensuring that they are comfortable on function and the final polishing ensure the veneers show similar lustre, as natural teeth and prevent staining by providing easy-to-clean smooth surfaces. The treatment is usually comfortable and may or may not require local anaesthetic, depending on the tooth preparation required. This type of veneers is also relatively more affordable than porcelain veneers. However, in situations where a tooth is heavily stained or a significant change to the shape or form of the tooth is required, the composite resin veneer may be limited in its application.

Porcelain or ceramic veneers are fabricated in the dental laboratory. This type of veneers gives similar lustre and light-reflecting property of natural teeth, thus giving a very realistic and highly aesthetic appearance. It is also more stain resistant than composite resin veneers, thus it is often more lasting than composite resin veneers. However, this type of veneer is also difficult to repair so if cracked or chipped, it will usually require replacement of the veneer.

What is involved? Following the smile analysis and planning stage, the first appointment will involve preparation or trimming of the teeth. Once this is done, an impression or mould of the teeth will be taken. A provisional or what is commonly known as “temporary veneers” will be placed over the teeth for a short period of time. The temporary veneers will allow you to provide feedback on the appearance and function of the new veneers, before the final veneers are made according to the final design. In the final appointment, the provisional veneers are removed and the finished porcelain veneers are cemented onto the teeth. The porcelain veneers are first placed onto the teeth and the colour, shape, form and fit is checked. Once satisfied, the veneers are then bonded. This is usually done under local anaesthetic and following the final cementation procedure, you will be able to function, eat and talk as normal. There may be postoperative sensitivity that follows the placement of new veneers. There will be a follow up visit following the second visit, to check that any postoperative sensitivity resolves and that you are functioning comfortably and happy with your new smile.

No-prep veneers. This type of veneers involves no preparation of the natural teeth. It is very conservative and usually reserved for teeth with no extensive fillings, worn teeth requiring rebuilding of lost tooth structure, or misshapen or crooked teeth with room to accommodate the veneer to improve appearance.

Bridges

A bridge is a dental prosthesis that is used to replace one or more missing teeth. It is constructed of an artificial tooth; the pontic; joined to the adjacent teeth or dental implants.

A bridge will span the area where tooth or teeth are missing. It is permanently fixed to the adjacent teeth; either to the natural teeth or dental implants that surround this space. The natural teeth or dental implants that support the bridge are called abutments. Depending on the type of bridge, natural abutment teeth may be reduced in size to accommodate the bridge to fit over them.

What are the benefits of a bridge?

What are the risks of dental bridge?

So what are the alternatives to dental bridge?

The main alternative to a dental bridge is using removable denture, known as a partial denture, or dental implant.

Types of bridge. There are four main types of dental bridges:

Conventional bridge. This is the traditional bridge where the false tooth; the pontic; replacing the missing tooth is joined to the teeth on both sides of the gap with dental crowns. The crowns are cemented onto the adjacent teeth anchoring the bridge across the gap. This type of bridge is ideal where the natural teeth on both sides of the missing tooth are structurally sound.
Cantilever bridge. Similar to the traditional bridge, the cantilever bridge is a type of bridge where the false tooth; the pontic; is joined to only one tooth adjacent to the gap. The crown cemented onto the abutment tooth anchor the pontic in place of the gap. This type of bridge is ideal where the missing tooth to be replaced is smaller in dimension to be anchored to a structurally sound tooth next to the gap.
Maryland bridge. Similar to a cantilever bridge, the Maryland bridge is anchored to one abutment tooth next to the missing tooth. The false tooth; the pontic; is adhered to the tooth next to the gap with either a metal or porcelain backing cemented onto the abutment tooth. This bridge requires minimal preparation to the anchoring tooth, as the backing is adhered using cement thus ideal to minimize loss of tooth structure. It is commonly used to replace missing front tooth.
Implant-supported bridge. Unlike the other types of bridges, this type of bridge uses dental implants to anchor the false tooth; the pontic; without utilizing the natural tooth adjacent to the gap. A dental implant or multiple dental implants are surgically placed into the missing teeth area acting as anchor for the bridge. Porcelain crowns are then fixed onto the dental implants replacing the missing teeth. Each dental implant may replace a missing tooth or the bridge may have a pontic suspended between two dental implants supported crowns. This type of bridge is ideal when the natural teeth adjacent to the missing tooth may not be structurally ideal to be used as support for bridge.

Maintenance of the bridge.

The care and maintenance of the bridge is similar to the care of your natural teeth. To ensure longevity of your bridge, you will need to clean the bridge carefully daily. You will need to brush your teeth with fluoride toothpaste twice a day, as you will normally do with your natural teeth. This is followed by flossing to clean in between the gaps. There are many tools available to help with flossing around the bridge for example piksters or superfloss to thread under the pontic. You will be given instructions and showed how to care for your bridge during the fitting appointment.

Dental bridge of 3 teeth over molar and premolar. Medically accurate 3D illustration of human teeth treatment

WHITENING (BLEACHING)

Teeth whitening is a common cosmetic procedure to improve the appearance of discoloured teeth. There are many causes of discolouration and it is best to discuss this with your dentist followed by a thorough check up to determine the cause of discolouration and if whitening is the right treatment for you.

There are many over-the-counter treatments available in the market but these products can be less effective and riskier. The Australian Dental Association advises that only registered dental practitioners have the expertise to assess whether bleaching is safe for you, to recommend the most appropriate technique and materials, and to provide treatment that meets safety and quality regulations.

What are the causes of teeth discolouration or staining?

Most common cause of staining occurs from an external source, this is known as extrinsic staining. It is usually diet and lifestyle habits related. For example:

Food and drink we consume on a daily basis such as coffee, tea, red wine, soft drinks and food with colouring.
Smoking or chewing tobacco
Poor oral hygiene
Intrinsic staining, on the other hand, is cause by process within the tooth either during the development and formation of the tooth or in tooth that suffered a traumatic injury resulting in a necrotic or injured nerve. For example:

Tetracycline (antibiotic) staining
Excessive fluoride exposure
Necrotic tooth
Endodontic or root canal treated tooth
Age-associated wear
Developmental disorder
It is important to note that whitening is not suitable for you if you:

Are pregnant or breastfeeding
Suffers from sensitive teeth
Suffers from gum disease and as a result have receding gum line. However, patient with gum disease that responded to therapy and is stable may be viable for whitening treatment.
Have untreated decay or cracked teeth
Are looking to whiten fillings, veneers, crowns as these dental materials will not whiten.

How does whitening work?

Tooth whitening is the removal of stain either physically or with a chemical reaction achieved with bleaching agent to lighten the colour of a tooth. Chromogens, the organic compound that accumulate in tooth from intrinsic and extrinsic staining causes staining and tooth whitening is a process that breaks down the chromogens into lighter coloured compound.

What we use to whiten and why.

Hydrogen peroxide and carbamide peroxide gels are commonly used. When manufacturer’s instructions are followed, these bleaching agents are generally the most effective, safest, cost-effective, best researched whitening treatment gels available.

Types of whitening treatment.

Tray-based tooth whitening system.

This system involves the use of a tray, either custom-fitted or pre-fabricated tray, loaded with carbamide peroxide or hydrogen peroxide gels and patient is required to wear the tray for the manufacturer’s recommended length of time every day. The treatment usually last up to two weeks and result should be visible within few days. This system is usually preferred as it is cost effective, convenient to use the treatment at home and additional kit may be purchased should patient opt repeat treatment in near future.

In-Office whitening system on the other hand, involves delivery of higher concentration bleaching gel and is usually performed by a dental professional. It delivers result on the day and if required, patient may also continue at home treatment with the tray-based system following the in-office appointment. Due to the risk of gingival irritation from the use of higher concentration bleaching gel, the gums are usually protected with a barrier. The bleaching gel is applied onto the teeth for a manufacturer’s recommended period of time and depending on the bleaching gel used, some manufacturer recommended application of blue light with wavelength of 480nm to 520 nm to increase effectiveness of the bleaching gel. This bleaching process is then repeated 3-4 times throughout the treatment.

Other types of whitening systems available also include whitening toothpastes, whitening strips and paint-on whitening gels and whitening mouthwashes. These products contain small amount of varying concentration of carbamide peroxide or hydrogen peroxide. However, the products may not deliver significant level of whitening and results do vary significantly.

Complications with tooth whitening.

Tooth sensitivity or gum irritation is a common side effect of bleaching. The severity of sensitivity is highly dependant upon the concentration of the bleach used and the duration of the treatment. The higher the concentration of bleach and the longer this high concentration of bleach is in contact with tooth/gum, the higher the risk of severe sensitivity. Tooth sensitivity usually occurs immediately either during the treatment or post treatment and can last up to several days. However, tooth sensitivity is usually very manageable. It is important to let us know if you have severe sensitivity problem prior to treatment. You may be recommended to use Tooth Mousse (desensitizing cream) or a desensitizing toothpaste eg. Sensodyne post treatment. In the case of use of tray-based system, you may need to adjust how often and for how long you wear the trays to manage sensitivity but this will not affect the result. Avoiding acidic drinks eg. Cola, fruit juice and white wine during the duration of the treatment and post treatment period can also help. Sensitivity is not permanent. If unmanageable, bleaching will be ceased and other alternative treatment options should be considered.

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DC Dental Clinic

Cosmetic dentistry, Veneers and whitening

CREATE THE PERFECT SMILE

HERE ARE SOME OF THE SERVICES WE CAN PROVIDE FOR YOU

Crowns

Veneers

Bridges

WHITENING (BLEACHING)

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