The Tooth, The Whole Tooth and Nothing but the...

Posted Friday, September 14, 2007 to PROCEDURES > Smile

Posted by The Original Anti-Aging & Cosmetic Surgery Magazine

Orange County cosmetic dentist Patrick Yoshikane DDS explains to Tony Norton the differences between bonding, veneers and crowns.

Cosmetic dentistry has a variety of available options. To decide if you want to undergo a procedure, or which specific treatment you require, you should be well informed. There has been much confusion in the past about what different procedures achieve, how long they last and how they differ. Through the process of bonding, or having porcelain veneers or jacket crowns custom fitted, you can achieve that ideal smile, but first you should sink your teeth into the logistics, limitations and details of each procedure.

The main function of bonding is mainly for closing spaces between teeth, reshaping, or replacement of silver restoration. Cosmetic dentist Patrick Yoshikane DDS explains: "Bonding is the application of a polymer (composite) resin material to the front surface of the teeth, primarily to restore the shape or coloration of the teeth". While bonding can be used in this way, it can also function as a transitional material for cosmetically shaping teeth. The white-filled resin does not have the same level of durability or strength as veneers or crowns, which are made from porcelain, but at least the process is reversible. "If a patient is unsure about the decision to have porcelain crowns or veneers, then bonding is ideal; it can act as a preview, and it is totally reversible, unless the natural tooth shape has been altered to accommodate the bonding material (eg. in the case of a chipped tooth)."

The bonding procedure involves a number of steps in order to first build a base for the modeling material. The selected tooth or teeth must first be cleansed with a pumice like substance. The tooth is then etched with acid, and a primer resin and unfilled resin are applied. The unfilled resin acts as the matrix between the natural tooth and the composite filled resin. The resin is then sculpted to achieve the desired shape. Light-curing takes place to activate or harden the resin, then contouring and polishing follows. This is, in fact, the application of a resin veneer, but the procedure is known commonly as bonding. Resin veneers last 3-7 years depending on how vigorous you are on your teeth, however, bonding is least resistant to staining.

"Resin veneers are durable but not as long term as porcelain veneers, which have better color stability - its physical properties are resistant to acid or staining," notes Dr Yoshikane. But he warns: "Porcelain veneers are good for cosmetic reasons but excess pressure or vertical compression, like eating, can cause shearing". There are certain foods that veneered teeth must stay away from (eg. bagels, chips or hard and sticky candy).

Veneers are beneficial for teeth with fractured corners, discoloration, or when you want to reshape or close a gap. The procedure for fitting porcelain veneers involves part of the bonding process. The teeth are prepared in the same way, then about 1mm of enamel is reduced from the surface of the tooth. An impression is then taken to make a model for the lab to fabricate porcelain laminate veneers, which takes about 10 days. In the meantime a provisional temporary veneer is fitted on your natural teeth (consisting of bonding material) - this is used as a guide for the new smile. There is the option of employing "instant orthodontics" which involves the preparation and application of the new porcelain in two treatments - but you are looking at 45 minutes per tooth. Porcelain veneers lasts 7-10 years, again depending on how the individual treats their teeth, and the location of the veneers.

Porcelain jacket crowns are definitely the strongest, most reliable and durable option within the realm of cosmetic dentistry. But the risk, according to Dr Yoshikane, is that "Any porcelain application is a permanent transition, as we have to reduce a portion of your teeth (up to 75%)to accommodate the porcelain". If you are unhappy with the results of jacket crowns, there is no way to revert back to your old teeth. The procedure for jacket crowns is much the same as the veneer, except more of the tooth must be reduced in order to accommodate the crown. Jacket crowns fit around the whole tooth up to the gum line. They are suitable for decayed or injured teeth, or as a means of attaining your ideal smile. They have a perfectly natural look, as different shades are selected to match your other teeth. They don't discolor with age, and you clean them as you would clean natural teeth. "Porcelain jacket crowns are my choice for achieving the ideal smile, " states Dr Yoshikane.

Dr Yoshikane stresses the importance of being realistic with your expectations of cosmetic dentistry. He suggests using photographs, digital imaging or mock-ups as much as possible to get an exact idea about what you are looking for. "A good idea is to use a preview; either digitally imaging your teeth, or diagnostic waxing - where a model of the teeth is molded to show a pattern of your smile lines. Open communication between patient and dentist is vital in obtaining the smile you have dreamed of."

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