Cosmetic Dentistry

  • Ceramic veneer

Ceramic veneer is a thin layer of custom-made tooth-colored porcelain restoration that covers the front  of your teeth to improve the smile.  Porcelain veneer is the most aesthetic and durable restoration in smile enhancement. It’s the golden standard in cosmetic dentistry to improve the appearance of teeth that are discolored, with irregular shape, size, length and gaps.   Due to its structure and property, ceramic veneer resists staining and discoloration and mimics the light reflection of natural teeth the best.   

The process of doing ceramic veneer usually takes 2 visits in our office: one for consultation and the other to prep the teeth and deliver the restoration at the end of the visit with the aid of the CEREC CAD/CAM system.   During the consultation visit, explain to your dentist the cosmetic goal that you are trying to achieve and your dentist will evaluate your teeth and decide if ceramic veneer is the appropriate treatment ( eg. a crown might be a better choice if you miss significant tooth structure or have large restoration ).  Impressions and clinical photographs of your teeth might be taken for a preop workup of your case.  On the day of the treatment appointment, your teeth will be numbed and a thin layer of enamel is removed from your teeth to accommodate the thickness of the veneer, then digital impression of your teeth is taken and the veneers are milled on site using the CEREC CAD/CAM.  After checking the shade and fit, the dentist bonds the ceramic veneers to your teeth permanently.   Postop instruction includes not biting on hard objects with the ceramic veneer as it can crack or chip under excessive biting force; people who clench and grind their teeth habitually are advised to wear night guard to preserve the service life of ceramic veneers.  

Ceramic veneer generally lasts between 10 and 15 years, up to 20 years. After this time, the veneers would need to be replaced.    

  

  • Composite bonding

 

If the veneer is done with composite instead of porcelain, it’s called ‘ composite bonding ‘ or ‘dental bonding’.  It is an aesthetic and cost-effective treatment alternative to the ceramic veneer in improving your smile.  Thanks to the innovation in modern composite material and placement techniques, composite bonding comes in as a close second to the golden standard, ie. ceramic veneer, in cosmetic dentistry.   

When it comes to choose between composite bonding and ceramic veneer, cost is a major factor.  Composite bonding usually costs half of that of ceramic veneer but it can be a fairly aesthetic solution.  It’s also easy to repair if a piece is chipped off, while with ceramic veneer, the whole piece needs to be replaced.  Composite bonding also requires less time to get done by comparison.  The shade-matching composite is applied directly onto the teeth where it will be shaped and sculpted by the dentist and a blue light beam shines onto and hardens it.    Discoloration and staining are usually associated with composite bonding over a period of time, which can be addressed by polishing the veneer at your cleaning appointments.   Composite bonding generally has a shorter lifespan than ceramic veneer, 5-7 years , up to 10 years.   It might need some touchup during its service years.  

Both ceramic veneer and composite bonding are used to give you a great smile makeover, how do you know which one to choose is dependent on your wants and needs.  In general, porcelain veneers provide a better look than composite bonding.  If you’re looking for an aesthetic and cost-effective solution, then composite veneer will be a good fit. However, if you are looking for the most natural and durable treatment solution and cost is not a consideration, porcelain veneer will give you an amazing smile.   Regardless of which material you choose in the end, you can rest assured that both offer fantastic smile enhancement.    

  • Teeth whitening  

 

There are two types of teeth discoloration: external and internal.   External discoloration are on the enamel, the surface layer of teeth, cleaning and polishing in dental office or using abrasive toothpaste can remove it.  Internal discoloration are in the dentin of teeth, the inner layer of teeth, high concentration of peroxide products which are only provided or sold from dental offices  are needed to correct it.  

A majority of teeth looking yellow or grey are due to discoloration in the dentin layer of teeth, not the enamel layer.    Causes of yellow teeth include aging (as our hair turns gray, our teeth turn yellow), genetics ( some people are born with yellower teeth ), tetracycline staining  ( taking tetracycline before the age 10, even as a fetus when mom takes it ), fluorosis ( taking too much fluoride ) and trauma to the teeth etc.   

To achieve whiter teeth, you can choose from ceramic veneer, composite bonding or teeth whitening by peroxide products offered in dental office.   The difference is teeth whitening will not last for years like ceramic veneer and composite bonding do, mostly 6 months and up to 2 years.  You need regular touchups to maintain the result and the result you can get from teeth whitening depends on the shade where your teeth starts with.  If you want predictable and significant shade improvement that lasts, ceramic veneer and composite bonding are the better choices.  

If you choose to whiten your teeth, the dentist will evaluate your teeth and make sure they are disease-free before the whitening procedure, as whitening teeth that have cavities and gum disease can exacerbate the problems.     Since composite and porcelain restorations won’t be whitened, replacing the composite and porcelain restorations might be necessary to match the shade for the whole mouth.  If the following situations describe you,  teeth whitening might not be right for you: your teeth are already very sensitive; you have GERD or acid erosion on your teeth; you have gum recession; your gums are sensitive; you are allergic to hydrogen peroxide;  you are pregnant or breastfeeding; you’re under age 18.  

We use Opalescence in the Wilbraham Dental Associates, an award-winning professional whitening product and leader of long track record for more than 20 years to help you achieve the brighter and whiter smile you desire.   There are two options to do it: in-office procedure and take-home kit.  If you want to get the result faster and hassle-free, choose the in-office procedure ( using 40% hydrogen peroxide).    There is no light or heat involved as Opalescence uses chemical activation.  Whitening methods that use light, heat, LED and laser should be avoided as they can damage the pulp of the teeth.   If you prefer to do it at home by yourself with multiple applications to achieve the result, we offer Opalescence take-home kit along with a pair of custom trays.  A proper concentration of Opalescence gel ( 45%,35%,20%, 15% and 10% carbamide peroxide ) that suits your case will be recommended.    The custom trays offer the best coverage on your teeth and are used in future touchups too to maintain the result.    

A few words of caution about whitening toothpaste.   They mostly work by the heavy abrasive agents in them and sometimes low concentration of peroxide.  They can help remove the surface stain on the enamel of teeth but are not effective in whitening the discolored dentin of teeth.  Due to the abrasive nature of whitening toothpaste and the location it works, ie. Enamel of the teeth, It’s suggested not to use it for more than two weeks at a time and brush gently, because when enamel is worn, teeth begin to look worn, old, and discolored.  

About over-the-counter whitening strips: they usually contain 6-14% hydrogen peroxide, eg. Crest whitestrips.   Using whitening strips can lead to damage to gum and uneven teeth whitening as they don’t use custom trays which professional whitening does.  Whitening strips can come into contact with the gum and oral tissue in the mouth and cause irritation and soreness.   Whitening strips can’t get into the curves between the teeth, which can make your teeth look whiter on the flat surfaces, but yellow at the peripherals.  If you have crooked teeth, even results will be hard, if possible, to achieve with whitening strips.  

About whitening mouthwash:  it might contain low concentration of hydrogen peroxide too, but it’s not effective in whitening teeth.  Peroxide needs to be at a higher concentration and stay on the teeth for at least 15 minutes or more to seep into the dentin of tooth to produce a result.

Tooth sensitivity is not uncommon associated with whitening. If sensitivity occurs, it is usually temporary and can be relieved by desensitizing treatment.  We recommend in-office fluoride varnish and wearing the custom trays with the Sensodyne antisensitivity toothpaste placed in the trays for 30 min/day during the whitening process.  

 

  • Smile design and makeover

Are you happy with your smile?  What is it that you like or dislike about your smile and teeth?  A smile makeover is the process of improving the appearance of smile through the cooperation of one or more dental disciplines, such as cosmetic dentistry, orthodontics, periodontics, restorative dentistry, implant dentistry and oral surgery etc.   The design process evaluates the shape, size, color, angle, alignment of your teeth, the level and symmetry of your gum, the jaw joints, the chewing muscles, your bite, any wearing  and the consequent shortening of your teeth, any teeth in diseased state etc and use interdisciplinary approach to restore an optimal smile for you.  If you are interested in a smile makeover, a comprehensive exam will be set up to collect all the data, such as taking impression of your teeth and mounting the upper and lower arch models on a device to duplicate the position of your jaw joints, both dental arches and their relationship; taking X rays and a series of clinical photos including headshots and intraoral photos of different views and angles etc, to thoroughly analyze your smile and design your case.    Depending on the complexity of the case, a smile makeover can be satisfied with cosmetic dentistry only or it might need a multi-disciplinary approach such as orthodontics, periodontics etc together to achieve the desired result.