Cosmetic Dentistry

What is Cosmetic Dentistry?

Cosmetic dental treatments may include anything that has the direct effect of improving the appearance of one or more teeth to a patient’s desired outcome. Situations for which patients may desire cosmetic treatments of their teeth include: chipped or cracked teethdiscoloured teeth, worn-down teeth, teeth with gaps between them, crooked, crowded, or protruding teeth, and teeth that have changed colour as part of the aging process or after root canal treatment. Cosmetic treatments may involve one or many techniques to achieve the final goal. There are even some cases where cosmetic treatments involve treatments to re-shape or reduce the amount of gums covering the teeth - creating more naturally proportioned visible tooth sizes and elimination of the “gummy smile” look.


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Am I a candidate for Cosmetic Dentistry?

Any person who is unhappy with some aspect of their smile, whether it be related to teeth and/or gums, is a good candidate for cosmetic treatments. The solution may involve minor alterations of the teeth, or require more comprehensive involvement of many teeth.

How do I know which treatments are right for my needs?

The Dentist and the patient must work together to establish clear goals for a treatment outcome. The patient may have pre-existing ideals based on other smiles they have seen (media personalities ), or the treatment planning may be left up to the Dentist. Either way, there must always be goals in mind before treatment begins. It is very helpful for the Dentist to know how the patient truly feels about all aspects of the smile (teeth and gums), so that treatment planning has clear goals that will improve upon those issues of concern. A Personalized Esthetic Evaluation Form is the best way for the patient to be able to put their feelings and concerns down on paper. This form then serves as the starting point for discussions and goal-setting for the case.

What treatments fall into the category of cosmetic dentistry?

Since cosmetic dentistry strives to help patients who are displeased or embarrassed about some aspect of their teeth or gums, there are many treatments that help achieve the goals. (Some of the following will be explained in greater detail further down on this page, while others may be found elsewhere in the Patient Education library.)

Treatments may include: tooth whiteningreplacement of metal fillings with tooth-coloured composite resinsporcelain veneers, crowns, bridges, implantscosmetic bondingtooth contouring and shapingmicroabrasion, porcelain/ceramic inlays, gum lifts/reshapingorthodontics.

Can I see how my proposed treatments will look?

In many cases, it is possible to preview how proposed treatments will look. This preview can take one of numerous forms:
a) direct mock-up in the mouth using resin sculpted on to a few teeth may great for seeing how it may look to close a space between two teeth (easily removed),
b) computer generated enhancements from digital photographs taken of the patient’s smile, and
c) mock-ups made on plaster models of the patient’s teeth, usually done in tooth-coloured wax.

Teeth Whitening

Also known as bleaching, this treatment will lighten teeth that are stained or discoloured from such things as:
  • aging
  • tetracycline (antibiotic) staining
  • excessive fluoride uptake into enamel
  • trauma (injury) to the teeth
  • pulp degeneration or prior root canal treatment
  • restorative materials (silver, gold)
  • genetic and acquired illnesses
  • consumption of staining substances such as coffee, tea, or tobacco products
Whitening creates a brighter, more esthetic appearance by reversing the discolouration of tooth enamel with an oxygenation process provided by a safe peroxide gel. For at-home whitening, patients have an initial appointment at the dental office to take impressions so that custom trays may be made that fit snugly around their teeth. On a second visit, the trays are checked to ensure comfortable fit, to review instructions on usage, and to take photographs that document the starting colour of teeth.
Each day (after thorough brushing and flossing) a small quantity of a whitening gel is placed into the custom trays which are then placed over the teeth. Most commonly, the trays are worn for an hour or two. This is done over a period of two to four weeks or until the desired result is achieved.

The in-office procedure uses stronger concentrations that are applied to the teeth for a short time and strictly controlled by the Dentist. This may be done alone or in combination with the at-home process.
Although tooth whitening is not permanent, annual touchups of only a few days at a time can maintain the original whitened result.
  1. Additional notes:
  2. All professional and commercial products share a common peroxide chemistry that may vary to small degrees based on concentration, chemical stabilizers, flavors
  3. The in-office treatments have become more and more popular, but are actually less effective for the patient because the results are not as stable as those done at home, and costs much more because they are done in the dentist office where chair time is most costly
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Can the dark fillings in my back teeth be changed ?

The most commonly used filling material for back teeth around the world has been “silver amalgam”, a mixture of silver, tin, zinc, copper, and (unfortunately) mercury. The metal fillings have a long proven track record for durability and safety, but recent advances in other materials used for the direct placement of fillings - composite resins, now offer the benefits of strength, bonding to tooth surfaces, and natural appearance. The composite resins can be used to replace the older dark grey metal fillings, thus helping to brighten the appearance of the back teeth, and bring the appearance of the tooth back to its original unfilled state.
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What are Porcelain Veneers, and how can they be used to improve my smile?

Veneers, usually fabricated from porcelain, are a thin, semi-translucent "shell," custom made to fit precisely over an existing tooth. They are permanently bonded, held in place by a special resin that adheres the back of the veneer to the front of the tooth: The finished result is extremely strong and durable. Though veneers are not suitable for every patient, they are a cosmetic alternative for a variety of dental conditions affecting the front teeth, including:
  • closing diastemas (spaces between the teeth)
  • restoring broken, chipped, or worn teeth
  • covering unsightly, stained or washed-out fillings
  • whitening permanently stained or discoloured teeth
  • correcting uneven or crooked teeth
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How long will porcelain veneers last ?

Veneers can last for many years, depending on how well you take care of them. Because veneers are stronger than simple resin bonding, they are more resistant to stains, discolouration, or chipping. It is most important to maintain good daily oral hygiene, keep regular routine cleanings and assessments, and avoid oral habits such as biting nails, pens, or chewing ice. These precautions will help ensure that your veneers will last a long time and keep them looking as good as new.

How much tooth structure is altered or removed when getting veneers ?

The answer really depends on the specific demands of the case - sometimes veneers can be done with no tooth reduction at all, and other times more of the outer shell of the tooth needs to be reduced away. The goal is always to keep natural tooth reduction to an absolute minimum, while creating tooth preparations that will allow for the final veneers to achieve the cosmetic goals.

What is cosmetic bonding, and how is it different from porcelain veneers ?

Cosmetic bonding refers to the direct application of bonded resin filling material to the teeth to achieve desired cosmetic results. This is done in one visit with the Dentist, as opposed to porcelain veneers which take two or more appointments because they are made outside of the mouth by a dental technician. Many of the same results may be achieved through direct bonding of the teeth as compared to indirect porcelain veneers, though bonding cannot truly achieve the natural lifelike look that porcelain can.

Direct bonding is significantly less costly that porcelain (1/3 to 1/2 ) and can be done quickly when time constraints are tight. Furthermore, it can be repaired easily if chipped or fractured, and can be easily resurfaced if discolouration occurs. The material is not as strong asporcelain, is not as colour stable, and cannot match the natural tooth-like properties that porcelain can.

Cosmetic bonding is really best suited for use where finances are a real limitation, and where the patient may be younger in age such that further growth or shifting of teeth may occur.


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What is tooth re-contouring and re-shaping ?

Simple adjustments to natural tooth surfaces such as in length or in width can have instant and dramatic effects on a person’s smile. Uneven edges of teeth can be made more uniform, or teeth that are too wide in proportion to neighbouring teeth can be corrected very easily and quickly. These adjustments can be done on their own or in combination with other cosmetic treatments.


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What can be done for teeth that have white or brown discolourations ?

For teeth that have unsightly white and/or brown discolourations from a condition called Fluorosis, the technique of microabrasion can greatly improve the appearance of one’s smile. Because these discolourations are most often in the outermost layer of tooth enamel, careful buffing of the enamel can remove the stains completely, while leaving the tooth healthy and intact. Only a few tenths of a millimeter is often enough reduction to get down to more natural looking enamel.


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What can be done to change a gummy smile ?

There may be a few different reasons why a person has a gummy smile, so the solution is dependent upon the nature of the cause.  When examining the elements of a beautiful smile,  the gums serve to “frame” the teeth, and may be just as important to consider when planning cases.  A few teeth that look proportionally too small or square may just have excess gum covering the neck of the tooth, and a simple procedure called gingivoplasty can permanently remove the unwanted gum tissue and re-balance the visible shape of the teeth and the smile.


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Gum re-shaping, or periodontal plastic surgery may be done on its own, or in combination with other cosmetic treatments to teeth.


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There are certain instances where removing small amounts of gum tissue is just not enough - in these cases the gum tissue is repositioned higher up after some of the bone around the necks and roots of the teeth is removed. After sufficient healing has occurred and the gums are healthy and stable, the tooth treatments (ie. porcelain veneers) can be completed.


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In the most severe cases, the problem relates to the malposition of the entire upper jaw in which the teeth and gums are housed. These cases often require a combination of corrective jaw surgery and orthodontics to yield the best esthetic results.

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