What is cosmetic dentistry?
Cosmetic dentistry is a general term for a variety of dental procedures that do not necessarily have medical benefits, but have the benefit of improving a patient’s smile.
Cosmetic restorations (which may include crowns, fillings, inlays, onlays, bridges and veneers) are done to improve the appearance of the teeth. There may or may not be other reasons for doing them, such as tooth decay, chips (Figures 1a and 1b) or cracks. Cosmetic restoration of a single tooth is sometimes achievable with modern dental materials (even in highly visible areas of the smile). It may be possible to re-create the shade, transparency and optical characteristics of uniform natural tooth enamel, although it can be challenging.
The dentist may recommend crowns, veneers, or other types of restorations on neighboring teeth to better match the restoration placed on a damaged or discolored tooth. It may be true that the overall appearance of a patient can be enhanced with multiple restorations (e.g. intrinsically stained teeth that can’t be whitened can often be beautified with veneers).
However, if only one tooth is a problem, and cost or invasiveness are of concern, matching the involved tooth to the others, to the satisfaction of the patient is often achievable. Doing so requires skill, artistry, and close collaboration between the dentist and others involved in the procedure (e.g. a laboratory technician). If lab procedures are needed, precise blending of the single restoration usually involves a custom shade match, in which the patient visits the laboratory technician who will be making the restoration. This may not always be feasible. When it is, the technician will evaluate the patient’s teeth for basic shade, intensity of shade (chroma), shape, light/dark balance (value), and any subtle characteristics that will need to be re-created in the restoration to make it blend imperceptibly.
The restoration will be evaluated in different lighting conditions, because teeth can look noticeably different under different light sources. Usually, these will include incandescent sources (which have a yellow cast); fluorescent light (which looks blue); and full spectrum light (e.g. the sun). Full spectrum lighting is available for dental office light fixtures, and is often used for shade matching as it is the most natural light source.
If a visit to the lab isn’t an option, the dentist may be able to communicate with the lab using both black/white photographs (to establish value); and color images to show the shade, optical properties, etc . It is important that the color profiles of the camera, the computer, and the printer (if used) be synchronized to produce consistent color characteristics from the patient’s mouth, to the dentist’s imaging equipment, to the lab. To learn more about synchronizing color monitors (so the lab and dentist are seeing the same colors), search on “synchronize color monitors” and “display calibration.” It is essential that the monitor records the true color and lighting properties observed in the patient’s mouth to achieve a perfect match in the restoration.
The process of cosmetic procedures
Cosmetic dentistry is a general term for a variety of dental procedures. The process for each procedure is different.
Commonly prescribed dental procedures that may have a cosmetic focus include: crowns, fixed bridgework, dental implant restorations; fillings; onlays, orthodontic procedures; certain periodontal surgery procedures; removable dentures that involve visible teeth; tooth whitening; and veneers.
Your dentist can discuss with you the procedures that would be appropriate options in your case.
Some advantages and benefits of cosmetic dentistry
If an acceptable cosmetic result can be achieved by restoring only one tooth, the patient is spared the expense, treatment time, potential discomfort, potential complications, and maintenance issues associated with restoring more than one tooth. While the dentist’s goal is generally to treat a condition in the least invasive way possible, it may not always be practical to restore a single tooth and achieve the cosmetic expectations of the patient.
Modern dental materials and techniques are true bioengineering marvels, and generally allow teeth to be imperceptibly restored to the esthetic expectations of the patient. They are durable, color stable, and match the optical and shade properties of natural teeth with incredible precision.
Ultra-conservative tooth preparation techniques have been developed which do not always require removal of sensitive tooth structure. In appropriately selected cases, these can completely eliminate the need for local anesthetic, and the risks and discomfort associated with it.
Complete “smile makeovers”—involving crowns, onlays, and/or veneers on all or most of the visible teeth—have become commonplace in dentistry, and the results can be stunning. Smile makeovers and dental rehabilitation are usually indicated when multiple teeth are damaged, decayed or cosmetically unacceptable to the patient in ways that cannot be corrected less invasively. If an acceptable cosmetic result can be achieved less invasively, the need to reshape multiple teeth and place multiple restorations (that may need to be replaced multiple times over the life of the patient) can be avoided.
Bleaching, bonding of tooth-colored composite resin filling material, and minor adjustments to the shape of a patient’s teeth can often be achieved very economically, with outstanding cosmetic results that require little (if any) maintenance.
Potential disadvantages and risks of cosmetic dentistry
Custom shade-matching may be required in order to achieve the best cosmetic result for single cosmetic restorations. This requires the patient to visit the laboratory technician who is making the crown, which may not always be feasible. Multiple visits to the lab may be required.
Teeth that have irregular features, such as discolorations, dark shading, mottling or speckling can be very challenging to match, but a good ceramist can often do it. It is important that the patient decide whether masking such irregularities in the teeth is a treatment goal. If so, more than one tooth may require treatment. Restoring multiple teeth adds to the cost, complexity, and potential complications of treatment.
A beautiful, natural appearance is generally among the treatment goals whenever a visible tooth is restored (metals are still commonly used in non-visible areas). However, restoring teeth purely to improve the cosmetic outcome should be done as conservatively as possible in consideration of the patient’s expectations. Cutting away any sensitive tooth structure can cause the affected tooth to be sensitive after it is restored, and can lead to inflammation of the tooth pulp, which is not always reversible.
In such cases, additional treatment such as root canal therapy may be needed to alleviate the symptoms. These unfortunate occurrences are reported in the literature to happen in about 10% of teeth being prepared for a crown. They may surprise a patient who is unaware of the possibility with significant additional cost.
Depending on the type of cosmetic treatment the patient and dentist decide upon, local anesthetic may be needed. Local anesthetic may be uncomfortable, and has risks of its own which are generally minor, but which should be understood.
Cutting the teeth for dental restorations means the patient will have to maintain the restorations for life. It is likely that the original restorations will require replacement at least once during the patient’s lifetime, involving additional time and expense.
Dental restorations (crowns, fillings, bonding and veneers) can chip, discolor or dislodge from the tooth, requiring repair or replacement. Teeth can also decay beneath dental restorations, often requiring additional procedures to correct—in addition to replacement of the original restoration.
Your dentist may know of specific risk factors based on your individual medical or dental history, which you should understand, and which should be managed before treatment is begun.
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