Dental Questions: What are my options in improving the esthetics of a single tooth?

This new tooth was restored using only bonding and disking. What a change!

Teeth can become cosmetically damaged through a number of different means; from chipping to fractures, staining, decay or even as a result of problems in development. Likewise, our office offers a variety of ways to restore your teeth and make them appear natural in your mouth once again.

As with any procedure, we start the process by making sure the tooth in question is sill alive and healthy. There is no sense in restoring a tooth with serious underlying problems. Secondly, we assess the extent of the damage. For minor chips and blemishes, a combination of bonding and “disking” may be the perfect fix. This process is virtually drill-less and conserves as much tooth structure as possible. You may be surprised to see what we can achieve without a crown or veneer!

For teeth with larger blemishes, or those missing a substantial amount of structure, we will often elect to utilize a crown or veneer. Cosmetic veneers are usually placed on anterior (front) teeth to modify their appearance. Since they are cemented to only one surface, they do not add any additional structural integrity. In other words, the underlying tooth must be in good condition to receive a veneer. In contrast, crowns can be used to improve the cosmetics of a tooth that has lost a significant amount of structure.  Since crowns wrap around the tooth, they can restore shape in every dimension while adding strength and rigidity to the underlying enamel and dentin.

In any instance, the result of your treatment will be a beautiful and natural looking tooth. We pride ourselves in offering high quality cosmetic solutions, no matter what the problem. If you would like to know more about bonding, veneers or crowns, please give us a call!

The Golden Proportions: A Case Study

Last month, we posted a blog article on  The Golden Proportion, a set of dimensions based on ideal proportions found in nature. When it comes to the smile, these proportions are only one piece of the aesthetic puzzle. The position of the lips framing the teeth, the angulation of the teeth, and the location of the dental midline are all examples of factors that influence our interpretation of a pleasing smile. However, the golden proportion is an interesting feature to study, as it is so deeply rooted in mathematics.  To better explain how the golden proportion helps define facial esthetics, we assembled a few real-life cases for you to examine!

Case 1

Central tooth width to length ratio: 74% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width:

• Central 7.4
• Lateral 4.6
• Canine 2.8

Comments:

Case 1 has centrals that follow an ideal width to length ratio at 74%.  In evaluating the golden proportion, the laterals and canines are wider than ideal. The frame of the lips is much wider than in Case 2 or 3, so the gum tissue above the gum/tooth margin is very visible.  

Case 2

Central tooth width to length ratio: 96% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D:

• Central 1.618
• Lateral 1
• Canine 0.168

Golden proportion ideal measurements, assuming the central is ideal width would be

• Central 8 
• Lateral 4.9
• Canine 3.0

Comments:

Case 2 has centrals that are nearly 1:1 in the width to length ratio and have a square appearance.  It appears that the centrals have some wear on the biting edge and that they could stand to be 1-2 mm longer.  The laterals and canines are slightly wider than the golden proportion measurement.  The patient's lips frame the overall smile so that hardly any of the biting edge or gum/tooth margin of the teeth show.  Thus, the aesthetic discrepancies are less noticeable.

Case3

Central tooth width to length ration: 90% (ideal is 75-80%)

Golden proportion ideal measurements based on a 2D picture:

• Central 1.618
• Lateral 1
• Canine 0.168 

Golden proportion ideal measurements, assuming central is ideal width:

• Central 9
• Lateral 5.6
• Canine 3.5 

Comments:

In reviewing the three cases presented here, Case 3 has nearly exact golden proportions.  The central tooth width to length ratio is slightly greater than ideal at 90%, but the upper lip covers enough of the gum/tooth margin of the centrals that this ratio isn't as relevant in evaluating aesthetics.  Also, the upper and lower midlines are slightly off center from one another, but the upper central midline is perpendicular to the floor of the mouth and centered with the patient's nose.  Thus, the midline is aesthetic even though the upper and lower midlines don't match each other.

Cosmetic Bonding

Often times, patients will be very satisfied with their oral esthetics aside from one feature. Thier teeth can be straight, white and well spaced, saving for a single tooth. In these cases, orthodontics may be impossible or unnecessary for purely esthetic results. Here, cosmetic bonding proves to be the most predictable and reliable treatment to a perfect smile.

In this case, bonding was added to compensate for a short lateral incisor (left of center).

Cosmetic bonding is one of the most underappreciated cosmetic procedures offered in dental offices. Using the same tooth colored material as fillings, we rebuild and recontour teeth to better fit and fill out your smile. This material is extremely durable, and can be used to lengthen, widen or "even out" the appearance of your front teeth. Our patients are always satisfied with the results, as the transition from natural tooth to filling material is virtually undetectable.

Here, bonding was used to close the gap between the patient's two front teeth.

Your appointment will begin with a short consultation on esthetics and a few photographs. We strive to match your expectations and desires before we start working in your mouth. Once a decision has been made on how and where to add bonding, we use high pressure air abrasion to temporarily roughen the tooth surface. This step is comparable to rubbing wood with coarse sandpaper before painting. After the tooth surface is prepared to accept composite, we add our bonding agents to the indicated area, followed by the tooth colored composite. Our composites come in a variety of shades and color, and can match practically any tooth shade. The material is added slowly, contoured to your tooth, and set solid via a high intensity curing light.

After we select an appropriate tooth color and light cure it, we begin shaping the material to resemble a completely natural tooth. The refinement process utilizes  sanding discs, polishing points and a number of sensitive techniques. The results look and feel completely natural in your mouth.

However, there are limitations to cosmetic bonding. It can generally compensate for deficiencies in tooth structure, but cannot address size issues such as overcrowding. Additionally, once structure has to be built out over 3-4mm, bonding becomes a less reliable long term cosmetic solution. For these in-depth cases, we typically recommend more involved esthetic procedures. Finally, bonding can interfere with teeth whitening or whitening results. Since bonding material does not respond to hydrogen peroxide, it does not change shade proportional to your natural teeth. Hence, we recommend you complete a bleach treatment prior to performing esthetic bonding.

Many consider veneers, orthodontics and whitening  as the standard of dental esthetics. However, we urge you to consider bonding to address your mild to moderate cosmetic dental concerns. The minimally invasive nature of these procedures makes them convenient and accessible to many patients. Feel free to call our office with any questions or concerns you have about the process, materials or results behind cosmetic bonding.