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Bonding vs. Porcelain Veneers
Michael C. Goldman, DDS
Cosmetic Dentistry deals with that wonderful and immensely important part of your body that is NOT listed in any of the anatomy books....
Bonding vs. Caps and Veneers
I am often asked something like:"Can my teeth just be bonded instead of getting caps or veneers?"
Well, the answer to that question is a bit complicated.... the short answer is often "yes". The better and longer answer is sometimes yes and sometimes maybe and sometimes no... Sorry you asked????
Let me explain some differences... When bonding is done, a hard plastic-based, tooth colored filling material is chemically bonded [think "glued"] to the surface of the tooth. It's really much more than just "glued" but that's sort of the idea. The added material can make the tooth longer, or wider, or defects in shape or color can be corrected. Almost always this is an "additive" change....that is, the tooth is still there mostly as it was, but material is added in certain spots essentially making it bigger - even if only a tiny amount bigger.
For veneers, while they are sometimes done with no tooth grinding, most of the time some grinding away of tooth structure is necessary. "No grinding veneers" are often advertised as a way to attract patients because, of course, nobody wants their teeth ground! Also, if no grinding is done, no anesthetic [spelled "needles"] is needed. Sounds great, right? Well, sometimes it can be that way. If your teeth are too small and short, the veneers are mostly or entirely "additive" like I described in the previous paragraph about bonding.
In reality, however, most of the time, with relatively normally sized teeth, if veneers are ADDED to the normally sized teeth, the end result is that the teeth look too big. We dentists refer to this artificial look as "chicklet teeth". The reason bonding doesn't have the same result is that the bonding material can be made very, very THIN, feathering it out to less than the thickness of paper and it still works. The porcelain veneers or caps, however, are hand made and have to have a certain thickness just so they don't break in the technician's hands. They are quite fragile until they are bonded onto the tooth surface. So in most cases some of the tooth is removed so when the veneer or cap is added, the end result is still within the size limits that look normal - sometimes larger and sometimes smaller than the tooth was before. In fact it is very often the case that a specific tooth is changed with the cap or veneer so that the end result is bigger is some places and smaller in others!
Most of the time bonding is done for small changes. However, sometimes I push myself and the boundaries of what can be done with bonding if there is a compelling reason.
In the following photo you see a pretty, young teenage girl that hated her smile. Her parents brought her from out of state for my opinion. Orthodontics and veneers had been suggested. I felt that she was too young for veneers and even if the bonding began to break down after several years, it could always be done again with longer lasting porcelain veneers. Bonding looks great but it does not last nearly as long before it starts to discolor and wear. Usually it will last about 5 or more years. I should also mention that bonding is MUCH less costly than caps and veneers.
Bonding and re-shaping only
Here are some patients I treated with veneers and caps. As you can see the kinds and amounts of changes are much greater and these changes could not be accomplished in a predictable and long lasting way just with bonding. I expect these results to last for many more years than bonding. Essentially, caps and veneers do not wear out very much. They can break - but not easily - and new decay can form where the porcelain ends and the tooth begins, so good home care and regular checkups are essential.
Caps and Veneers only Before After
Some dentists have always been artists.
To these progressive men and women, no tooth was "restored" unless it looked very natural and as attractive as possible. Gradually they and their followers used newer materials and techniques to create very natural substitutes for teeth and parts of teeth. They then began to look at more than just the tooth that needed fixing; they began to see how entire smiles and faces could be enhanced by paying attention to nature's rhythms and harmonious proportions. They began to see with the eyes of artists and saw ...the natural beauty in smiles. Cosmetic dentistry did not yet have a "name"!For most of my dental career ( since 1968...I started when I was three...! ) I have been fascinated by the potential for not just fixing, but improving the appearance of smiles. Until recently it was often not possible because of the limitations of the materials and techniques available. Often, even where technically possible, it was too difficult or expensive for patients to consider.
Here you can see a before and after of what has become known as a "Cosmetic Makeover". Only the teeth were treated .... but that changed her attitude and self-image. She changed her life, along with her makeup, weight and hairstyle ! She felt young and excited about life again! This is an example of a difference that "POPS"!
*********************************In the last several years remarkable breakthroughs have been made in materials and techniques that finally give dentists the tools to repair and modify teeth so that they look natural and more attractive.
But that is only the beginning! While individual teeth can be bleached and whitened, lengthened or shortened, straightened or made more angled, and spaces and chipped places corrected with relative ease, Cosmetic Dentistry uses these individual skills the way a graphic artist uses lines and colors. Fixing one chipped place is like an artist placing a dot of red on a canvas. It's only one part of the whole picture...
We have learned that there are several major and minor ingredients to what is generally seen as an attractive smile. Interestingly, there are significant differences between what tends to look attractive for a man as compared to what looks attractive for a woman. Also, it has been a surprising finding that individual teeth do not always need to look perfect for the overall smile to look great.
Cosmetic Dentistry has matured!
Cosmetic Dentistry was first approached in a logical and systematic way which has given way to a more fluid, but more artistic blend of art and science. Rather than a static picture of what a healthy, attractive smile should look like (a "one smile fits all" approach...) , we have come to appreciate the perfection of nature's irregularities, which nonetheless always seem to merge and blend with certain esthetic harmonies. While no two faces are alike, for example, there are definite characteristics that they share, and if they are both attractive faces, there are certain qualities of proportion and balance and line that are further shared.
As a dentist concerned with cosmetic considerations, I tend to look at overall facial form and balance, paying special attention to the way the lips, teeth and gums interact with the rest of the face. Are the teeth too dark? Are they "crooked"? Are they protruding, or "pushed in" looking?
Do the gums show too much in a big smile? Do the teeth show enough when talking, or does it look like there might not be any teeth there? Does the smile look masculine or feminine? Might the overall appearance be improved if the lips had a little more or less support from the teeth underneath? Does the lower jaw jut out too far or is it too small for the rest of the face? These and other considerations are all within the realm of modern cosmetic dentistry to modify and improve. Many of them are areas I work with directly, others would involve specialty skills like orthodontics or oral-facial surgery or plastic-surgery.
It can be simple or complex...
Many patients are quite pleased and comfortable with their overall appearance, but there is just "one spot" that they feel could be nicer looking. A single tooth might need to be made longer or shorter or otherwise modified. Another patient may have always wished to have a better looking smile but didn't know what it is that might be needed.
If you have feelings about how you would like your smile, let me know. If you just wonder if there is any way it might be made better looking let me know that, too. Often very simple and easy things can be done resulting in considerable improvement.
In my office reception room, you will find two three-ring notebook photo-albums titled Cosmetic Dentistry which show many before and after photos of patients I have treated. Albums like this are available from dental supply companies in which the dentistry was done by an anonymous dentist and the photos taken by a professional photographer. They are nice but they wouldn't show you what I have done or what I might be able to do for you. This album does! It is only a sampling which I have selected not because they are the most impressive and best, but because I thought they illustrate some point in particular. I have included commentary in the album to describe and explain what was done in each case. It is my hope that you will find it interesting and enlightening...perhaps even motivating.
Ugly old techniques have been improved !
If you need fillings (new ones or old fillings replaced), I would encourage you to have natural, tooth-colored, bonded composite fillings placed. They not only look good, but in addition, they strengthen your teeth and make them less likely to need much more expensive caps later. Silver fillings look bad, weaken your teeth and contain mercury and other metals which have become the subject of considerable controversy as to whether they could be bad for your health. There is no completely adequate answer to that question in my opinion, but you should be aware that there is the question about it out there. The official position of organized dentistry and NIH is that it is OK (although they concede that certain individuals may have a problem with it...). Generally, the holistic movement and alternative treatment groups are essentially universally opposed to the use of mercury containing fillings - or the use of most of the non-gold metals of almost any kind, for that matter. There is another pamphlet I have written devoted to the specific subject of Silver Fillings / The Mercury Controversy.
I DO NOT provide silver/amalgam fillings in my practice at all ... and have not since about 1980.
Other helpful Cosmetic Dentistry techniques
Other specific techniques used in cosmetic treatment often include simple reshaping of the teeth ( quick and painless with no anesthesia ). Bonding is a kind of tooth-colored filling material used to fill cavities or to change the shape or color of part of a tooth ( as replacing a chipped part of a tooth or changing the color of a dark spot on the enamel ). Larger, more major modifications of a given tooth usually are best accomplished with porcelain caps or veneers (partial caps). Caps, no longer need to show a dark line at the gum line as you may have seen in the past. Caps can be made now that are all porcelain (contain no metal) and are almost as strong as the metal-containing type of caps.
As is demonstrated in the photo album section of this website ( Click Here ), it is often possible (and advisable) to create a temporary "preview" of what the modified teeth could look like by sometimes using tooth-colored wax and other materials. More complex changes can be simulated on my computer by taking a "Before" photo as you are now and modifying it with programs like Photoshop. A very realistic simulation can be created to visually illustrate what you would look like after making cosmetic changes - improvements - to your smile. It helps me know what can be done and it helps you know what you would look like after the changes. While not always possible to do, it is helpful and takes some of the anxiety out of making the decision. Sometimes the simulated improvement looks nice but no big deal... other times you see the difference between the "before" and simulated "after" and the "after" just POPS! .... the whole face just comes alive and it's amazing what the difference is!
Computer Imaging Takes it to the next Level
Now the ability to "Preview" cosmetic treatment is much better! By using digital photos of your smile, I can enhance that image in the computer to get a look at what you might look like with certain changes to your smile. To see more info and photos on Cosmetic Dentistry Computer Imaging, Click Here.
There are many other topics contained in the area of Cosmetic Dentistry which cannot be dealt with here, but I hope this simple discussion has given you an increased awareness and understanding of how we may be able to help you. If it has raised questions for you, please feel free to ask. It is a favorite topic for us! Cosmetic treatment results in such excited and pleasurable feedback from patients, that it truly makes our days enjoyable!
Just Ask Me!I invite you to ask questions about Cosmetic Dentistry, Holistic Dentistry, Root Canals and many other topics .... even ones I don't specifically talk about ! I have tried to make this site a "living" site, interactive and fluid. I answer all emails and try my best to answer all questions sent to me. Just click on the "to e-mail me" button!
On this website
This pamphlet was written in the hope that it will increase understanding about a topic that seems important from time to time. Obviously it is only part of the whole story, so if you have questions after reading this please do not hesitate to ask. Also, if there is a topic that you think would be helpful, please suggest it.
General and Cosmetic Dentistry in a Biologically Friendly practice
Michael C. Goldman, DDS
3815 East-West Highway
Chevy Chase, Maryland 20815
Phone (301) 656-6171
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Cosmetic (Aesthetic) dentistry is about doing quality , esthetic dentistry in a way that looks natural to begin with, and furthermore, can even improve one's attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more. It can be like "instant orthodontics" in correcting crooked, twisted or misplaced teeth in many instances. Dark or misshapen teeth can be restored. Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..
Holism in dentistry is an approach to dental treatment, primarily caring for patients' health and safety from both a conventional as well as "alternative healthcare" point of view. It is sometimes called "biological" dentistry or "biocompatible" dentistry. In it's fullest sense, I believe it acknowledges and deals with the mind, body and spirit of the patient, not just his or her "teeth". See Topics / Info.....
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...