COSMETIC DENTISTRY
Cosmetic dentistry is an area of dentistry that seeks to create a more aesthetically pleasing smile. Cosmetic dentists can whiten teeth, replace missing teeth and repair chipped teeth through a variety of cosmetic dentistry options, including tooth bleaching, porcelain veneers, dental implants, bonding, dental crowns and bridges.
   
 

TOOTH COLORED FILLINGS
Until recently, dentists filled and sealed cavities exclusively using (a silver and mercury) amalgam. Unfortunately, these fillings (or restorations) could weaken teeth, because too frequently, a large amount of the original tooth has to be removed. Modern dentistry has increasingly turned to composite fillings as a strong, safe and more natural looking alternative. Composite fillings utilize a soft, white plastic-based substance that hardens into a strong attractive material.

Pros and Cons of Composite Fillings
The major advantage of these fillings is that they come in a range of shades that closely match the color of an individual's tooth. Due to the increased strength of modern composite material, they can now also be used in the back teeth. Unfortunately, composite fillings are one and a half to two times more expensive than traditional restorations. Dental insurance typically covers the cost of fillings up to the price of the silver/mercury fillings.

The Filling Procedures
During your initial visit to the dentist, he or she begins by anesthetizing the tooth and removing any remaining decay. Once the tooth has been prepared, the dentist places the composite into the tooth where it binds to the original surface. The process is typically performed in several layers wherein each layer is cured or hardened with the use of a special light. Restorations (fillings) for the back teeth are referred to as a direct composite procedure. Indirect restorations need to be custom-made at an off-site dental lab and two visits to the dentist are required. Once the dental office receives the custom inlays, the patient returns to the dentist's office, where the inlays will be bonded into place. Individual inlays are not only composite materials; they are often made of porcelain.

After the Fillings Have Been Placed
Patients may have increased sensitivity in the tooth for several weeks following the procedure. Composite fillings are porous. Over time, they may become stained from coffee, tea, tobacco, etc. Many dentists place a clear covering over the filling to avoid any future staining. Composite fillings typically last 3-12 years, depending on the location of the restoration, an individual's occlusion (or bite) and one's home care. Indirect porcelain inlays do not stain as easily as direct composites.

 
   
  CROWNS
When a tooth is cracked, decayed or damaged, a crown may need to be fitted onto the tooth. A crown is a permanent covering that fits the original tooth. Crowns can be made of porcelain, gold or other metals, acrylic resin or a mix of these materials. Porcelain crowns typically have the most realistic appearance, and the newest porcelain is as durable as other materials. Crowns can lighten, reshape and realign existing teeth, creating a healthy and vibrant smile.

Preparing the Tooth and Crown
During your first visit, the dentist will numb the tooth or teeth to be crowned and remove the decay around it. Each tooth is then resculpted to provide an easy fit for the crown. This is a painless process generally performed in one visit.

An impression of your teeth is then taken and sent to the dental lab where permanent, custom-made crowns are created (this usually takes one or two weeks). During this interim period, temporary crowns made of an acrylic resin are fitted onto teeth.

Applying the Crown
An impression of your teeth is then taken and sent to the dental lab where permanent, custom-made crowns are created (this usually takes one or two weeks). During this interim period, temporary crowns made of an acrylic resin are fitted onto teeth.

Maintaining Your New Crown
The proper dental hygiene for normal teeth should be applied to your new crown. Daily brushing and flossing will help keep teeth, gums and new crown free from the bacteria that can cause gum disease. Avoid chewing on the hard foods such as ice or pistachios, which over time can cause crowns to crack or break. Given proper care, crowns can last several decades and may last a lifetime.

 
   
 

BRIDGES
A bridge is a device used to fill the space where teeth have fallen out or been removed. A typical fixed bridge consists of pontic (a filler tooth) that is attached to two surrounding crowns (abutments). Once complete, this bridge structure is cemented into the mouth. Without the use of a bridge, spaces in the mouth from missing teeth can cause multiple teeth to shift, lead to occlusion (biting) and/or jaw problems and may spur periodontal disease. Bridges safeguard the integrity of existing teeth and help maintain a healthy, vibrant smile.

The Process
Fixed bridges usually require at least two trips to the dentist's office. During the initial visit, the surrounding teeth are numbed with a local anesthetic. The dentist prepares the surrounding teeth by cleaning any plaque or decay that remains and reducing them so that the crowns can be fitted. The dentist makes a mold of the teeth and sends it off to a dental lab where the customized impression is prepared. The customized mold takes one to two weeks to return to the office. In the interim, patients are fitted with a temporary bridge constructed of acrylic resin. When the patient returns to the dental office, the dentist removes the temporary bridge and replaces it with the permanent one. The dentist then adjusts the bridge for the proper bite and fit, and the bridge is permanently cemented.


Types of Bridges
There are several different types of bridges. The first is the fixed bridge, which consist of a filler tooth or teeth that is attached to two or more crowns. The crowns fit over the existing tooth to hold the bridge in place. The fixed bridge is the most popular bridge.

Another bridge design is a bonded bridge, known as a Maryland‰ bridge or an Encore‰ bridge. The Maryland bridge has metal on the lingual. The Encore bridge is all tooth-colored material. This type of bridge is commonly used to replace a front tooth. The pontic is a front tooth attached to the abutment teeth.

A cantilever bridge is often used when there are teeth only on the side of the span. A typical three-unit cantilever bridge consists of two abutment crowns that are positioned side-by-side on the same side of the missing tooth space. The pontic is then connected to the two crowns, which extend into the missing tooth space.

If the missing tooth space has no surrounding teeth, the dentist may decide an implant is the most appropriate choice. Please refer to Dental Implants in the Patient Library for more information. When a series of teeth are missing, the dentist may suggest a partial removable denture as the most effective way to maintain the structure of the jawbone and teeth.

Proper Maintenance
Special care must be given to ensure that the gumline and area surrounding the new structure is kept clean. This is especially true because the pontic and crowns are constructed as a single piece. Special floss is often necessary to clean the underneath teeth and maintain strong, healthy gums. With proper dental care, bridges are healthier and last longer.

 
 
 
  This information was compiled for you by the Academy of General Dentistry. Your dentist cares about long-term dental health for you and your family and demonstrates that concern by belonging to the Academy of General Dentistry. As one of the 37,000 general dentists in the United States and Canada who are members of the Academy, your dentist participates in an ongoing program of professional development and continuing education to remain current with advances in the profession and to provide quality patient treatment. Visit the AGD's website at www.agd.org.  

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