Smile Solutions

March 2007 Special Sections

When you meet someone for the first time, what do you notice right away? Chances are, it’s the smile. “A smile is such an important piece of how we look and our opinion of someone else, right or wrong,” says Stephen Boger of Boger Dental in New Hope. “A smile is like a window into somebody.”

And for people who dislike their smiles, that window is often shut, or at least hidden from view. They’ll do whatever it takes to detract attention from their dark, crooked, or missing teeth. Thanks to advancements in cosmetic dentistry, almost anyone—even those who think theirs is the worst case a dentist has ever seen—can have a natural-looking smile.

The options for smile enhancement are seemingly endless; treatments such as veneers, whitening, and implants are becoming household names. “There are many different ways to go about treating teeth,” Boger says. “Ultimately, it comes down to what patients think will best solve their concerns. My job as a dentist is to help them learn those different ways.”

With the help of leading cosmetic dentists in the Twin Cities, we list some of the most common smile concerns that patients have, followed by methods available to create beautiful, healthy grins. But remember—these are just general categories. An experienced cosmetic dentist will thoroughly examine your teeth to analyze their function and overall health, then make conservative treatment suggestions based on what’s appropriate for your situation.

1. Dim Grins
Stained, yellowed, or shaded teeth is the number-one complaint that dentists hear in their offices. Discoloration can range from stains caused by years of coffee- drinking to dark “bands” formed by the use of tetracycline, an antibiotic given to babies that can darken permanent teeth.

Regular dental cleanings are an effective way to keep teeth looking their whitest. Consumers also have access to a variety of options to whiten their teeth. The simplest, and least expensive, is an over-the-counter treatment along the lines of Crest Whitestrips. The product works best for someone who has mild surface stains.

Tray bleaching is a popular choice for those who need something stronger that gets between the teeth and not just on the front of them. A dentist creates trays that are custom fit to your teeth and sends you home with a bleaching gel. Depending on the strength of the gel, trays should be left in the mouth anywhere from one to eight hours a night. Results can be seen anywhere from a few days to a few weeks.

If you want your teeth whitened even faster, consider using your dentist’s in-office whitening system. The most common of these systems is Zoom!, which uses three twenty-minute sessions of intense light to brighten teeth. The latest generation of the technology, Zoom! Advanced Power, shortens the sessions to fifteen minutes each. The convenience factor has continuously driven the popularity of this technology.

“Ever since the first generation of Zoom! came out, we have patients who just don’t like doing any of the bleaching stuff at home,” says Steve Lorentzen, a dentist in Golden Valley. “They think it’s putzy. They’d rather come in, spend some time in the chair, and have it done for them.” The effects of a system such as Zoom! can last for many years. Some patients extend the life of their whitening by using a bleach tray once every few months and avoiding regular consumption of dark-colored beverages.

Before proceeding with teeth brightening, “the cause and the degree of the discoloration has to be determined first,” says Nancy Norling, a Minneapolis-based dentist. “If the staining is from extrinsic sources such as cola, coffee, red wine, or tobacco, bleaching may be all that is needed to give you back those pearly whites. If the stain is intrinsic, or inside the tooth, then chances are that bleaching may not be as effective, and you may opt to have porcelain veneers or composite bonding to correct the color.”

2. Crooked Choppers
Not all crowded, crooked, or rotated teeth require braces. For minor crowding, dentists might be able to use veneers, made of a strong porcelain material that is bonded to the existing tooth. Crowns work similarly, except the material surrounds the tooth, whereas a veneer is typically on the tooth’s facial. “Hundreds of times a year we use veneers instead of orthodontics,” Boger says. “Sometimes we call veneers ‘instant orthodontics’ because they help teeth to look perfect in a quick way. The teeth are now all made of porcelain, and the teeth might not have been that color or shade, even if you did have orthodontics.”

If patients’ teeth are mildly to moderately crooked or crowded, a product called Invisalign may be suitable for them. Invisalign is a clear, removable retainer worn all day except for meals. The retainers are switched out every two weeks to keep up with the shifting teeth.

For those who choose the braces route, options include the traditional metal brackets or ceramic brackets, designed to more easily blend with your tooth color. “The trend, and this has been for many years, is to make it look like there’s less stuff there,” Lorentzen says. “Metal brackets are so small now that they’re not as obvious. We’ve had patients do ceramic brackets, but they’re not quite as strong [as the metal].”

Veneers, Invisalign, and orthodontics are suitable for teeth with gaps as well.

3. Excess Wear
“A lot of people’s bite patterns are dysfunctional in nature,” says Steve Gorman of the Gorman Center for Fine Dentistry in North Oaks. “The wrong teeth are hitting and biting on each other at the wrong time, which can cause excess wear on teeth. Much of the aesthetic characterization gets worn away.”

Veneers are appropriate for teeth that are worn down over time. “Adding back length and proper contours with porcelain veneers can help turn back the clock on your smile and make you look years younger,” Norling says. “As with any dental condition, it is important to first ascertain what caused the teeth to wear down and address that problem before treatment begins.” If the wear is caused by teeth grinding, for example, your dentist might suggest an occlusal guard to wear at night.

Most teeth require some preparation before receiving veneers or crowns, meaning that a very small part of the tooth structure is altered in order to make them fit. In select cases, such as people with small teeth, teeth may not need any preparation and are good candidates for prepless veneers, such as Durathins or Lumineers. For the most part, though, dentists will send the veneers or crowns to a ceramist. The dentist works closely with the ceramist to create realistic-looking teeth. “A good ceramist can actually mimic nature under the dentist’s instruction,” Norling says.

4. A Malformed Tooth
A malformed tooth is a relatively easy fix. “Sometimes a tooth is overlapped or pointed,” Boger says. “You can change the shape and make it look more pleasing without having to do a more invasive procedure.”

If you’re comfortable with your smile and your teeth are healthy except for one tooth, you have a few choices. “Tooth contouring is appropriate for a number of different applications,” Boger says. “In general, when a relatively small change to the tooth can help achieve an aesthetic goal, we often can do that by changing the shape of the tooth. If that’s totally within the enamel of the tooth, you won’t hurt it. You can polish it and make it look like it’s always been that way.”

Another option is to get a temporary veneer. “For an individual tooth, we use a composite material that is tooth colored for reshaping the tooth and masking dark or light areas, all in one visit,” Lorentzen explains. “We use a special light to harden the material and polish it, as opposed to doing something to the tooth or making a veneer of porcelain.”

Lorentzen has performed this type of treatment on children and adolescents, since the change doesn’t affect their tooth structure at such a young age. Additionally, this type of veneer is less expensive than a porcelain one. Although the short-term veneers aren’t designed to last as long as the porcelain ones, calling them temporary may be a misnomer of sorts: Lorentzen reports that the material has lasted up to fifteen years in some cases.

5. Gummy Grins
A “gummy” smile is when too much of the mouth’s gum tissue is showing. A laser gum lift is a minimally invasive method that’s used to remove excess gum tissue around the teeth. “It acts like a scalpel, but it’s such a clean cut and painless,” Boger says. “There is very little to no bleeding, and it usually can be done in one session.” Veneers can also be used to lengthen the tooth.

If the problem is severe, a gummy smile can be addressed surgically. One procedure is called crown lengthening, in which bone and gum tissue are reshaped surgically to expose more of the tooth. In the most severe cases, an uneven facial height may be the cause of the problem. Surgery can normalize an uneven facial height. “This problem can be corrected through a surgical procedure where the upper jaw is lifted and made more proportionate with the lower jaw,” Norling says.

6. Old Dental Work
It’s common for “baby boomers [to] have a hodgepodge of dentistry in their mouths,” Gorman says. Oftentimes this generation has old dental work, which can include metal, white, or stained fillings; gold or porcelain crowns; off-colored bridges; and old porcelain crowns with metal understructures, in which the metal that is used in the crown displays a black line around the gums.

Gorman recommends porcelain restorations throughout the entire mouth. “We’ll say to patients, ‘Let’s have everything match and do all the things that can make teeth look real,’” he says. “Once we evaluate their options, they can decide at what pace to make the changes.”

7. Missing Teeth
In the past, bridges were the gold standard in replacing a missing tooth. The problem, however, is that the adjacent teeth also need work done on them to make the bridge effective. “If someone loses a tooth and the teeth right next to it are perfectly fine, that’s a great spot for an implant,” Lorentzen says.

Titanium implants replace the roots of the former tooth in the bone. The implant eventually becomes one with the bone, a process that can take several months. Until that occurs, a permanent restoration cannot be placed on the implant. In the meantime, an oral surgeon or periodontist will attach a temporary abutment, which supports a temporary crown until the implant location heals completely and a permanent abutment and crown can be placed.

Because these advances help make the teeth look more natural, implant dentistry is coming into its own aesthetically. “Implant dentistry really has not been considered part of cosmetic dentistry because it was so difficult to get the crown to look like the natural tooth because of the contours of the gum tissue,” Gorman says. “But that’s changed over the last few years.”

Although they’re less frequently used, bridges still have a place in cosmetic dentistry. “If the teeth on the other side of the missing tooth are candidates for having crowns in the future anyway, sometimes just doing a bridge in those spots is a viable option,” Lorentzen says.