While many dentists advertise that they are “cosmetic dentists,” most patients do not realize that a true ADA-recognized specialty in this area does not exist. Cosmetic or esthetic dentistry is a discipline whose foundations originated within the specialty of prosthodontics, and as such, prosthodontists receive the most intensive formal training and experience in this area. All cosmetic treatments require careful planning and are often technique-sensitive procedures, also requiring careful execution to provide the most predictable result. Our doctors typically mock up the planned changes for the patient to evaluate ahead of time, and make provisional restorations that reflect these changes. The patient is able to wear these temporary restorations home to “live with” the changes to their teeth before the final restorations are completed. Restorations are often custom characterized for the patient in the dental laboratory on the premises.
Our doctors are very experienced in all procedures used to enhance a patient’s smile and function such as the following:
This is a simple and conservative technique to lighten dark or discolored teeth. While many over-the-counter products are effective, the procedure is best monitored by a dentist to make sure cavities do not exist in teeth to be bleached, and to promote safe use of the bleaching agents. Also, because tooth-colored fillings, crowns, and other restorations will not change color with the rest of the tooth they may require future replacement for an optimal esthetic result. The safest and most effective way to bleach teeth is generally to administer it with a custom carrier tray made by the dentist, but the technique chosen should be selected to suit the individual patient’s needs and is best discussed first with the dental professional.
Image 1: Patient's teeth prior to bleaching.
Image 2: Patient's teeth after two weeks of home bleaching with custom bleach trays.
Restorations without a metal substructure have become very popular and several technologies have been developed to allow the fabrication of very esthetic and durable all-ceramic crowns, onlays, and veneers. This most predictably prevents the unsightly “dark line” that can appear at the gumline adjacent to a crown.
There are many different ceramic systems on the market today, each with its own appropriate use. This can be confusing to some dentists and can lead to the wrong product being used in the wrong situation, with the end result being poor esthetics or fracture of the porcelain.
The doctors of Orchard Park Prosthodontics are experienced and knowledgeable in these ceramic systems, and all are active in the education of students, residents and practicing dentists on their proper use.
Image 1: This patient's teeth are damaged by wear and chemical erosion.
Image 2: An assortment of all-ceramic and metal ceramic restorations provides a better functional and cosmetic result.
Veneers are thin porcelain facings that when bonded to the surface of the tooth provide a conservative, strong, and highly esthetic restoration. Porcelain veneers are used to make small alterations in tooth color, shape, size and position. Although a very conservative type of restoration, it usually does require the removal of a small amount of tooth enamel from the tooth. A predictable result can be difficult without proper planning and scrupulous attention to detail during the execution of treatment.
Image 1: This patient wished to improve the appearance of her front teeth.
Image 2: The use of porcelain veneers provides a natural-looking result.
Crowns, or “caps,” are restorations that cover a tooth entirely, and are usually made for teeth that have fractured, have very large fillings in them, have had root canals, are very darkly stained, or are severely worn down. They can be made of porcelain, metal and porcelain, or gold, depending on the situation and patient preference.
A bridge is a restoration that restores a missing tooth by connecting it to crowns that are cemented to adjacent teeth. With the advent of dental implants, fewer bridges are made now, especially in situations where teeth adjacent to the missing tooth do not need crowns.
This patient had a number of failing restorations and severe wear of dentition. Treatment required reestablishing his occlusion with crowns and fixed bridges for a better functional result.
Onlays are restorations that can take the place of a large filling on a premolar or molar tooth.
They are more conservative than crowns, covering mostly the top of the tooth, and can be made of porcelain or gold.
Other specialty procedures
Treatment of “peg” laterals, congenitally missing teeth,
and other hereditary or environmental anomalies:
A significant number of young people do not develop all of their teeth, or develop teeth that are undersized or otherwise malformed. We work closely with area pediatric dentists, orthodontists, and surgeons to properly coordinate treatment than may take years to complete. Because most of these patients are adolescents and will continue to grow, we typically utilize conservative techniques such as bonding that can be easily modified. Careful planning is necessary to contour teeth to the right form and size, as well as to leave the appropriate amount of space to replace missing teeth definitively when the patient is old enough.
Image 1: This young patient's incisors are proportionally too small for his arch form and face. An orthodontist has properly aligned his teeth.
Image 2: Teeth appear in better proportion and spaces are filled using conservative composite bonding.
We treat many patients with genetic anomalies that cause dental malformations such as amelogenesis and dentinogenesis imperfecta. Because these patients often require significant dental interventions at an early age, our philosophy is to provide conservative yet protective restorations to better preserve the child’s dentition through adulthood.
This patient has a cleft palate and is congenitally missing her lateral incisors. Multiple surgeries were needed before implants could be placed and restored.
Image 1: This patient has dentinogenesis imperfecta. Enamel chips easily and the underlying dentin layer wears away quickly. The teeth are darkly discolored.
Image 2: Bonding is a conservative way to improve the patient's appearance and protect the teeth until she is old enough to consider a more long-term restoration.
Treatment of teeth extensively damaged by wear or acid erosion:
Some people grind their teeth, which over time wears the teeth down to make them look too short and flat across the edges. Acid erosion from medication and conditions such as gastric reflux and bulimia similarly damages the teeth, thinning down the tooth enamel until the sharp edges chip and break. Eventually, the back teeth wear down too, and restorations and teeth break. The bite changes, and after a point, teeth cannot be restored without restoring the proper relationship and contour of the teeth. The “full mouth rehabilitation” that becomes necessary is a costly endeavor that requires careful planning, management and execution. The prosthodontist is the clear choice for such work, for he is only dental professional specifically trained to carry out this type of rehabilitation- and does so routinely. Because we plan these types of treatments so frequently, at times, we are able to space it out over time when finances are limited and the patient is unable to make the large financial commitment all at once.
Image 1: This patient has a grinding habit and has worn his dentition.
Image 2: His treatment involved a conservative approach, using a combination of crowns, onlays, and resin restorations. He now wears an appliance at night to protect his teeth.
All photos are of patients treated by the doctors at Orchard Park Prosthodontics.