Few of us are born with flawless teeth – and the same goes for celebs! Those red-carpet megawatt smiles take a little more than oral hygiene. The good news is, there’s a wide choice of cosmetic dentistry treatments to help you achieve your own A-lister smile.
From veneers and crowns to bridges and dental implants, we take a look at some common methods for correcting slight or significant cosmetic dental issues.
Veneers
Regardless of what causes unattractive teeth, dental veneers can solve a range of cosmetic dental issues and create a white, straight ‘Hollywood’ smile. Dental veneers are custom-designed wafer-thin shells of tooth-like material that, when applied over the surface of a tooth, can cover worn tooth enamel and rough edges, uneven tooth alignment or spacing, crowding, staining, as well as chips or cracks.
Discoloured teeth that are resistant to tooth whitening treatments can also be corrected using dental veneers.
Veneers can increase the dimension of the tooth, thickening them and/or making them squarer or longer. Unlike a crown, which covers the entire tooth, a veneer typically covers the visible front part of the tooth and slightly wraps over the biting edge.
The translucent quality of today’s veneers provides a more natural appearance than what has typically been available in the past. The two most common materials used in the manufacture of veneers are porcelain and composite resin.
Porcelain veneers
Porcelain veneers can create a very natural tooth appearance due to the translucent properties of the porcelain, allowing the veneers to mimic the light-handling characteristics of natural tooth enamel.
The pieces of porcelain are usually only around 0.5mm thick and are bonded to the front surface of the teeth. Despite their thinness, porcelain veneers are very hard and wear-resistant – unlike some other bonding materials, porcelain is an impervious ceramic and is resistant to staining.
It typically takes two dental visits for porcelain veneer treatment. At the first appointment, the enamel on the front side of the tooth is trimmed back. The amount of enamel the dentist shaves back is conservative, usually the same amount as the veneer itself, around 0.5mm.
Next the dentist takes an impression of the tooth or teeth that have been prepared for the veneers. These dental moulds are sent to a dental lab technician who will in turn make the veneer. In some cases, because so little tooth is removed, no provisional restorations are needed in between dental visits.
At the next appointment (usually one to two weeks later), the dentist cleans the repaired surfaces of the teeth and fits the veneers. The fit is evaluated by both the dentist and the patient and checked for colour and shape.
Once the veneers have been approved, the relevant teeth are cleaned with a mild acidic solution and a tooth-coloured bonding adhesive is applied to the teeth and veneers. This is typically dried and then hardened to the teeth with a curing light. Any excess dental cement is then removed and the veneers are polished.
Although porcelain is inherently brittle, when it is firmly bonded to a sturdy substructure, i.e the prepared tooth, it becomes very strong and durable. However, because of its brittle consistency, the veneer can chip if hit by hard objects and will need to be replaced. It is therefore advisable to cease fingernail biting, eating hard foods such as stone fruit, chops and ice, or chewing on pens and pencils. By avoiding such objects and maintaining proper dental hygiene, dental veneers can usually last in the vicinity of around 10 to 15 years.
It is important to bear in mind that porcelain veneers are almost always irreversible because the tooth is reshaped during the preparation process.
Composite veneers
Dental composite, the restorative used with cosmetic tooth bonding, is more opaque than porcelain and doesn’t mimic the translucency and light-handling characteristics of tooth enamel as readily. Composite material is also more susceptible to staining and such veneers will typically not be as long lasting as their porcelain counterparts.
However, in the hands of a skilled dentist composite veneers can create beautiful and natural-looking teeth. They also offer certain benefits over porcelain veneers: usually much less cost; less or no tooth intervention (shaving down of the tooth during the preparation process); and they can be performed in the one visit.
During the procedure the dentist applies a tooth-coloured composite resin to the tooth and sculpts the pliable resin to create an aesthetically pleasing result. A curing light is then shone onto the pliable resin to permanently harden it. In the final step, the dentist smooths out imperfections and polishes the resin.
The most notable benefit of a composite veneer is that it can be repaired if damaged. The downside of composite veneers is they generally will not look as natural as a porcelain veneer and they are typically not as durable.
Dental bridges improve the appearance of the smile, prevent bite alterations and help prevent gum disease
Crowns
Crowns are used to restore and protect chipped, damaged or broken teeth. They are dental restorations placed in or over a tooth when conservative restorations such as bonding aren’t enough to restore form and function. A dental crown sits over the existing tooth and covers the outer surface, which is why it is also often referred to as a cap.
Inlays or onlays are like a partial crown, usually made of porcelain. An inlay usually replaces a filling while an onlay covers more tooth surface.
Crowns improve the appearance of teeth, restore tooth function and enhance oral health. They can be made of tooth-coloured material, metal or a combination. Some metal-free crowns incorporate stress-bearing materials to make them stronger and wear longer. All-porcelain or all-ceramic crowns are the most popular materials used in modern-day dentistry as they create a natural-looking aesthetic result and eliminate the dark line at the gum line often seen in metal-fused crowns.
All-porcelain crowns are similar to porcelain veneers, however more natural tooth structure is removed than with veneers, typically around 1.5 to 2mm in thickness all around the tooth. Additionally, while veneers cover only the front of the tooth, a crown usually covers the tooth in its entirety.
During the initial treatment session, the tooth is prepared for crowning by the dentist. This involves a thorough clean of the tooth, removal of any decay and reshaping it using a special dental drill for shaping teeth, typically under local anaesthetic. An impression of the tooth is then taken using a special dental putty and a replica of the mouth is created for the dental laboratory to make the restoration and custom-fabricate the new crown. A temporary restoration is fitted to protect and cover the prepared tooth.
At the second visit, the dentist removes the temporary restoration and roughens the outer surface of the prepared tooth with a special etching acid to give the dental cement a good surface to bond to. The dentist then sits the crown over the tooth to ensure it fits perfectly and that it meets the patient’s wishes. Once approved, the restoration is permanently secured with an adhesive bonding agent or dental cement.
The procedure is irreversible, however the longevity of results depends on how well the crown is cared for and maintained. In most cases, with a good oral hygiene program including regular brushing, flossing, check-ups and a tooth-friendly diet, dental crowns can last around 10 to 15 years.
Fixed dental bridges
Bridges are artificial teeth that cover the gap where a tooth is missing or a gap
is present, anchoring to the two teeth on either side. They can be used for one or more missing teeth.
Dental bridges offer many advantages – they not only improve the appearance of the smile and even the shape of the face but also reduce strain on the teeth at either side of the missing tooth, prevent bite alterations and help prevent gum disease and tooth decay due to accumulation of food in the gap.
There are three main types of dental bridges. Arguably the most common type is the traditional fixed bridge, in which the artificial replacement tooth, known as a pontic, is attached to two crowns (abutments) or dental implants. The restorations are cemented on the teeth on either side of the missing tooth, which support the permanent bridge.
Another type of permanent bridge is the resin-bonded or Maryland type, which doesn’t require crowns on the teeth either side of the missing tooth. A ‘wing’ type retainer made of either metal or tooth-coloured material is bonded to the back of the supporting tooth, which is then attached to the replacement tooth. This type of bridge is more conservative as it involves less adjacent tooth structure removal. However, depending on the patient’s bite, it may not be as strong as a conventional bridge.
The other main dental bridge is the cantilever bridge. This type is typically used when there are teeth present on only one side of the space, where the pontic is attached to one or more adjacent teeth on one side. Cantilever bridges may also be used in areas such as the front teeth, which are susceptible to lower stress.
Similar to the placement of dental crowns, the procedure of fitting a bridge first involves shaping and trimming away the teeth on either side of the missing tooth. Following this preparation, an impression is taken of the teeth and sent to the laboratory technician to make the bridge and crown, during which time a temporary bridge is fitted for the patient to protect the prepared teeth and exposed gums. At the next appointment the custom-made bridge is placed in the patient’s mouth to check the fit before being permanently cemented.
Dental bridges offer a natural-looking solution to replacing a missing tooth or teeth and do not need to be removed from the mouth for cleaning. They can be made to resemble the existing colour variations in the patient’s teeth and control size, shape and texture, as well as mimic the feel and function of natural teeth.
Provided the patient practises proper dental hygiene, including regular dental visits and professional cleanings, a dental bridge can last around 10 to 15 years in most cases.
Dental implants can create a more youthful appearance, since missing teeth can cause the face to collapse and look older
Dental implants
Dental implants are artificial tooth root replacements that are used as part of prosthetic (artificial replacement) dentistry to compensate for tooth loss. Often the result is not only an enhanced smile but also a more youthful appearance, since missing teeth cause the face to collapse, which can make a face look older.
Teeth can be lost because of tooth decay, root canal failure, gum disease (periodontitis), trauma to the mouth, excessive wear and tear, and congenital defects. People who have lost teeth might feel self-conscious when smiling or talking or can experience functional problems with eating.
Dental implants are stronger and more durable than their restorative counterparts (bridges or dentures). Implants may be used in conjunction with other procedures. For example, a single implant can serve to support a crown replacing a single missing tooth. Implants can also be used to support a dental bridge for the replacement of multiple missing teeth. Because implants can also help maintain bone, they can help prevent additional tooth loss and a sunken facial appearance.
Today’s implants are virtually indistinguishable from other teeth. Once the implant, usually made from titanium, is surgically placed in the bone, it takes around four to six months for it to become integrated into the jaw (a process called osseointegration). A ceramic porcelain tooth restoration is then matched to the original tooth colour and is attached to the implant. These feel more natural than conventional replacement bridges or dentures.
Usually implants can be placed with the patient awake, however anaesthesia can be used upon request. If necessary, pain medications can be prescribed.
Like natural teeth, implant restorations require regular daily oral care and professional dental hygiene appointments. Provided they are well cared for and the patient remains healthy, dental implants can last indefinitely.
Fillings
White fillings are for people with smaller gaps, chipped teeth or to fill the edge of a tooth. They are made of a composite of resin and glass particles, cemented onto the existing tooth using a bonding agent. One appointment is required and, while they are less resilient than veneers, results can be long lasting if properly cared for.
Chipped, broken, discoloured or decayed teeth may be repaired or have their appearance corrected using a procedure called composite bonding. A dental composite material with the look of enamel is applied into the cavity or onto the surface of a tooth, where it is then sculpted into shape, contoured and hardened with a high-intensity light.
The result is a restoration that blends invisibly with the remainder of the surrounding tooth structure and the rest of the natural teeth.
Gum lift
The health and appearance of the gums play an important role in the general aesthetics of a smile. A ‘gummy smile’ describes a smile where there is too much exposure of the gum above the upper front teeth, which makes the teeth appear shorter. If this is the case, a gum lift may be the most appropriate solution.
A gum lift is a surgical procedure where the gums are lifted to improve not only their appearance but also the size and shape of the teeth. The position and shape of the gum is surgically modified to show more of the natural teeth and less of the gum when smiling.
Removal of excessive gum and reshaping of the gum line can give a fuller, more aesthetically pleasing smile. Alternatively, a gum lift may only be required for one or two teeth to create harmony and symmetry. It can be performed in combination with other cosmetic dentistry procedures or on its own.
The procedure is performed in one visit. It is typically minimally invasive with mild post-operative discomfort. Maturity of the gums to their final position takes approximately 12 weeks.
For some patients, a gummy smile can be corrected using a special laser gum-reshaping treatment to remove excess gum and expose more of the tooth.
Teeth straightening/orthodontics
Orthodontics is an area of dentistry that straightens crooked teeth and corrects malocclusions, or bad bites. Orthodontic treatment involves constant pressure on the teeth which pushes the teeth towards the correct position and causes the bone in the path to dissolve. Where there is negative pressure in the area that follows the moving tooth, bone growth is stimulated. As teeth slowly move through, bone grows to support the teeth in their new position.
The four common treatment options are: standard metal braces; clear braces; concealed braces (placed on the inside of teeth); and Invisalign (the virtually invisible plastic or polymer aligners). The length of treatment varies anywhere from several months to several years, depending on the severity and complexity of each individual case. Patients will be advised to wear a retainer after the braces are removed.
