One of the photos to the left does not confirm to the “rules” of an attractive smile. There is a missing tooth, a gap, short teeth, uneven biting edges and a protruding fang. However it suits the 6 year old owner and many would see it as an attractive image. The other photo shows uniform bright white teeth that often divides opinion because it tends to look ‘unnatural’. Aesthetic dentistry in the UK tends to request a final result that appears uniform and healthy but retains some natural elements and small colour variations, not too obviously ‘made over’.
The point being made is that beautiful results need a unique balance of features that often do not conform to all the “rules”. The best results deliver what you want and not what someone else imposes. The results should be personal and unique to the individual . The time taken to discover the balance required for an individual is reflected in the higher fees associated with cosmetic dentistry.
Smile Makeovers
All smile makeovers begin with a discussion of expectations.what you are expecting to achieve. The following extensive planning is to confirm what is actually possible and the best way to achieve it. Surounding teeth are usually X Rayed to check for adequate support or hidden problems that require resolution before treatment begins. Photographs are useful as a baseline starting point and can allow simulation to help discussions about the final goals. Plaster casts with wax mock ups can also confirm mutual understanding of the final goal, confirm what is realistic in long term function against the biting force and direction of the individual.
Almost all smile makeover treatments start with tooth whitening. Please see the separate section the different tooth whitening systems.
Missing teeth
Missing teeth can be replaced by dental implants, bridges or dentures. The best option in an individual case will be determined by several options:-
- The position and quality of the biting teeth in the opposing jaw so that the functional chewing forces do not damage the final restoration.
- The quality of the teeth adjacent to the space. If the adjacent teeth are perfect there would be a good reason to keep treatment on them to a minimum which would tend towards implants or dentures. However teeth that have a guarded prognosis or require significant treatment anyway may suggest a bridge option.
- The volume and quality of the supporting bone and gum. When bone volume has shrunk significantly, dental implants may require additional stages to replace the volume. The additional time and associated cost needs to be considered.
- General health if treatment times are prolonged.
- Available budget, although in some cases a lower cost option such as an implant supported denture compared to an implant supported fixed bridge might provide better function than the bridge.
In the four images below, there is a missing central incisor space with a shifted center line and reduced residual space to fit the replacement tooth. Three main restorative options were possible but required a very different budget and timescale. The computer simulated images helped the patient to decide on what would be the best outcome for them.
- Original image
- Existing space filled with an adhesive bridge
- Full arch orthodontics, requiring premolar extraction to correct center line shift and open residual space. Dental implant supporting and an all ceramic crown in the space created.
- Short / medium course orthodontics to close residual space and Veneers on the 3 front teeth to harmonise the shape of the three incisor teeth (accept additional center line shift
In this case the costs could range from less than £1000 to around £5000 and the treatment time taken could range from a few weeks to supply a bridge only (option 2) to circa two years for full arch orthodontics and implant treatment (option 3) .
Tooth position
Almost all people have some slight irregularity in their tooth position. The solution will depend on how much irregularity and how visible it is.
In general terms orthodontics moves the tooth roots and requires additional treatment time. After orthodontic movement the teeth will tend to want to return to their original position. Adults will often need to maintain the new tooth position for life using a night time retainer or a fixed wire anchored to the back of the front teeth. The advantage of orthodontics it that it reduces the need for healthy teeth to have veneers or crowns.
Recent advances in orthodontics can mean shorter treatment times and invisible appliances. St Johns Dental Practice are approved by Invisalign, Six Month Smile, Simply5 and Inman Aligners as well as conventional fixed braces.
See section on Orthodontics
The shape of teeth can be changed by removing excess enamel in procedures such as “ameloplasty” which removes protruding areas of tooth or “IPR” which reduces the width of teeth to assist orthodontic alignment. The amount of change is limited to the thickness of the existing enamel.
Tooth reduction is often combined with “cosmetic bonding”. For example a rotated tooth will have a protruding area and a deficient area, the protrusion is reduced and deficit is built up in tooth coloured filling or overlaid with a veneer, the end result is the new tooth face aligned in harmony with its neighbours. It is worth noting that the biting edge of the front tooth can feel “thicker” after such a procedure.
Crowns and veneers can appear to change a tooth position within a couple of weeks. The procedures are discussed in detail below.
Crowns & Veneers
A traditional crown preparation removes the outer surface of the tooth. The crown slides over the residual tooth rather like a thimble. In the image shown the metallic tip is a cast post and core that was fitted into the tooth root. Generally there is extensive tooth removal that we would avoid if possible, however in this case a road traffic accident had broken the front tooth and killed the tooth nerve. The tooth was treated endontically (nerve removed and sealed) before the post was inserted to retain an all ceramic crown.
A classic veneer preparation contrasts to the full wrap around of the traditional crown because it is a thin later that is bonded to the front surface of a tooth. Some veneers systems can be so thin that they do not require any drilling at all and the increase in final thickness is hardly noticeable. At the other end of the spectrum some veneers wrap around all of the circumference of the tooth and are considered as crowns. Veneers are often likened to contact lenses or false fingernails. Veneers systems like Lumineers , Thineers, and Da Vinci are brands that often come with additional warranties. Veneers can be made from resin, traditional porcelain, pressed ceramics and cast ceramics. StJohns Dental practice is an accredited Lumineer provider that has experience of many veneer materials.
White, bright and even style veneers across the front eight teeth
Natural veneers across the front four teeth
How to Compare Cosmetic Dentistry
Costs in dentistry can be complicated, but most people would like to be able know that when they are paying for a premium service that they are getting a premium product.
The harder thing to quantify is the quality of the skill and experience of the dentist. An ideal dentist is technically skilled, has good artistic judgment and is a good communicator.
