A Perfect Smile

http://thestar.com.my/health/story.asp?file=/2008/11/2/health/2418562&sec=health

Sunday November 2, 2008
A perfect smile
Age WellBy Dr SIM TANG ENG
Constructing an aesthetically pleasing smile is now easier due to the advances in aesthetic dentistry.
A BRILLIANT smile lights up anyone’s day, especially if the recipient of the smile gets to see perfect, pearly whites.
However, not many of us are born with straight, perfect pearly whites.
As a result of the combination of our genes and the way we treat our teeth, they can become stained, decayed, broken, crooked, twisted, loosened and even missing; while our gums can recede or conversely, look too prominent.
Driven by patient demand, the field of aesthetic dentistry has gained much prominence in recent years. Due to advances in dental technology and materials, coupled with a better understanding of the various clinical problems, dentists can now create more aesthetically pleasing smiles.
What constitutes an attractive smile?
When designing smiles, aesthetic dentists aim to have teeth shapes and dimensions to be proportionate with one another and in harmony with the surrounding gum.
This concept is called optimising the White (referring to teeth) and Pink (referring to gum) aesthetics. This is important as each complements the other.
Therefore, to design a smile to be more proportionate, symmetrical and harmonious, the aesthetic dentist may do one or more of the following:
1. Reposition crooked and twisted teeth
2. Reshape disproportionate teeth
3. Re-shade stained/yellow/dark teeth
4. Replace missing teeth
5. Reposition the gum line
6. Reshape the gum
There are various treatment options available to achieve the aforementioned objectives.
Orthodontics (braces)
This involves the use of metal wires and brackets attached to teeth to correct or align crowded teeth and uneven bite.
It can also be used to close gaps or for minor tooth alignment to enhance a person’s smile.
The single most important advantage of using braces is that it leaves the natural teeth intact. However, tthe treatment involves regular follow-up over a period of one to two years. Nonetheless, I must stress that this is still the best option for correcting over-crowded teeth and minor gap closure.
The good news is ceramic aesthetic brackets are now available to replace the “eye-catching” metallic brackets.
Porcelain veneers
Porcelain veneers are thin, custom-made ceramics designed to cover the front side of teeth. They’re made by a dental technician, usually in a dental lab, working from a model provided by your dentist.
You should know that this is usually an irreversible process. Typically, the teeth receiving porcelain veneers must first be lightly trimmed or prepared to make room for the veneers.
After the teeth are prepared, the dentist makes an impression for the dental laboratory which fabricates the veneers on a stone model made from the impression.
At the next appointment, the finished veneers are tried in the mouth to assess the colour, form, and fit. Then each veneer is bonded to the prepared tooth with composite resin cement.
Once bonded to the enamel surfaces of the tooth, the porcelain veneer is very strong, although patients are still advised to avoid biting hard foods or objects, to prevent chipping.
Porcelain veneers are used to close small gaps in your front teeth or correct teeth that are stained, badly shaped or crooked. Teeth with large fillings may not be suitable for porcelain veneers and may need to be treated with crowns.
Alternative treatments for teeth that might be treated with porcelain veneers include tooth whitening (for yellow or mildly discoloured teeth), direct bonding with composite resins (for slightly spaced teeth and minor aesthetic corrections), and full coverage with crowns (for extensively restored teeth and more complex aesthetic modifications).
Porcelain crowns
Crowns are dental restorations that cover the entire tooth on which they are cemented. They are indicated for rebuilding broken or decayed teeth and restore them to their original size and shape. They are also used to strengthen teeth with large fillings and very little sound tooth structure left.
Crowns can be either porcelain-fused-to-metal crowns (PFM crowns) or full porcelain crowns. The former consists of porcelain supported by a metal coping on the inner surface to combine the aesthetics of porcelain with the strength of the metal. While this has been very popular in the past, it is losing its appeal due to its poor aesthetics as a result of the metal coping which blocks light transmission through the underlying tooth. This optical setback gives the PFM crowns a very opaque and unnatural appearance.
While full porcelain crowns offer superior aesthetics due to their translucent nature and similar optical properties with natural tooth structure, they were shunned in the past for lack of fracture toughness or mechanical strength.
However, the advances in material science and dental technology has changed this.
The present generation of full porcelain crowns are very durable and have fracture toughness that can well withstand normal chewing forces. It is now possible to achieve very life-like and durable restorations with full porcelain crowns.
This option is made even more attractive by the escalating costs of gold, which has made the PFM crowns very expensive. Note that I am assuming gold alloy, as professionally recommended, is being used as the metal in PFM crowns.


The Harley Street Smile Clinic concentrate solely on creating perfect smiles for our patients. Read some of our testimonials to learn what cosmetic dentistry has done for peoples' confidence
http://www.harleystreetsmileclinic.co.uk/cosmetic-dentistry-testimonials.html