Cosmetic Dentistry

1. Tooth Whitening

Before having a discussion on the whitening process, we need to know the causes of discolouration. Normally, discoloured teeth derive from many factors.

Discolouration at the dentine: Dentine discolouration is caused by many reasons. For example, excessive intake of fluoride usually from drinking water can cause fluorosis. A child whose mother having antibiotics tetracycline during pregnancy can also develop dentine discolouration. Amalgram restorations and dead nerve tissue caused by trauma, decayed teeth, or root canal treatment can make the teeth turn dark or brown. Whitening might not work well with dentine discolouration, but veneer or facing should help.

Discolouration at the enamel: Scale, saliva, tea, coffee, soft drinks, red wine, and curry as well as smoking leave stubborn stains on your teeth. Poor dental hygiene even makes the situation worst. The yellow stains caused by bacteria and scale that are accumulated on teeth surfaces can be easily removed by dental scaling, teeth polishing, or air flowing. Avoid drinking coffee and tea, stop smoking or brush your teeth properly can help prevent stains on your teeth.

Discolouration caused by aging: When getting older, the outer layer of teeth enamel will be worn away. As a result, the natural yellowish colour of dentine is revealed. In this case, the colour of your teeth can be lightened by using some dental whitening gel. Your dentist will examine teeth and gum conditions to find and fix broken or chipped teeth, check the filling materials, clean your teeth, get rid of scale and treat infected gum before giving treatment.

Tooth whitening can be categorized as follows:

In-office Bleaching

• Laser Tooth Whitening
  High efficiency light with low heat that can activate chemical reaction in the whitening gel is used in laser whitening. The light does not only bring out colour pigments effectively but its direction can be appointed more accurate than normal UV teeth whitening which has a wide beam and high heat. Therefore, laser tooth whitening is safe and does not irritate the gum. The procedure should be completed within 45 minutes.
  

  Advantages of laser tooth whitening

  1. The result can be seen immediately after a one-hour treatment
  2. Laser reduces working time and decreases tooth sensitivity after treatment
  3. More comfortable since there is no tray-based teeth whitening overnight
  4. Certified by FDA and CE

  
  Disadvantages of laser tooth whitening

  1. Expensive
  2. Sensitivity may be developed occasionally
  3. The result may not last long
  4. A home whitening is needed after receiving the laser treatment
  5. Suitable only when an immediate result is required
  
  
  
• Cold Light
  Low temperature cold light with special whitening formula is applied in this method; therefore, the process is more efficient and faster (approximate treatment time: 30-60 minutes). The cold light bleaching will not destroy teeth enamel and cause no harm to your teeth.
  
  
• UV Whitening (Blue Light)
  This whitening method uses heat energy with a wide beam to activate chemical reaction in the whitening gel. Side effects such as searing pain, inflammation, and sensitivity may develop in some patients. The occurrence of side effects is related to the intensity of chemical substances and time spent in the whitening process. However, the symptoms only appear during the whitening process and may not last long.

Home Bleaching

Whitening kits can be taken home and you can do it yourself under occasional supervision of your dentist. Patients need to have their impression tray individually make in order that it fits their gum perfectly and allows enough empty space for putting the whitening gel. The gel will be left overnight for 10-15 days. Normally you have to revisit the dentist once a week to let him estimate the result and adjust the intensity of chemical substances and treatment time.

Advantages of at-home whitening

1. The long lasting result
2. Less expensive

Disadvantages of at-home whitening

1. Time consuming
2. Some patients may experience sensitivity

After receiving teeth whitening treatment, you should

- Avoid smoking
- Avoid drinking tea, coffee, cola, red wine and other strong colour food
- Avoid drinking extreme hot and cold drinks
- Avoid eating sour food in the first two weeks
- Avoid using strong colour mouthwash or toothpaste
- Use recommended whitening toothpaste instead of the regular one

Please note that the treatment result varies considerably according to the nature of dentine.

2. Veneers

Veneers are a thin layer of semi-translucent material that are placed over the front surface of teeth to solve problems such as grayish-coloured teeth caused by tetracycline, or to restore teeth that are decayed, abrasive, worn, or chipped to their natural colours and sizes. Veneers also strengthen and add durability to your teeth. As ceramic enamels used in veneers resist stains from food, cigarette, tea, and coffee, wearers do not have to worry about these problems anymore.

Types of materials used for veneers

We selected the latest developed IPS Empress II System and IPS Empress Esthetics from Ivoclar Vivadent for veneers. The opalescent IPS Empress II has been developed in both quality and aesthetic to be a special translucent and shiny material that closely resembles the surfaces of human tooth enamel.

Benefits

1. Cannot decay like natural teeth
2. Create a more confident smile
3. Provide a natural tooth appearance
4. Close the space between teeth
5. Restore the shape and aesthetic of teeth
6. Restore and protect damaged teeth

Inlays and Onlays

Inlays and onlays can help restore a decayed molar that requires a large portion of filling. Inlays and onlays are usually made from porcelain, gold, or composite resin. To make it fit perfectly into the natural tooth, an impression of the decayed tooth is made in a dental laboratory. Inlays and onlays are suitable for different needs.

An onlay is the filling placed on top of the tooth.
An inlay is a large filling placed inside a hole in the tooth. It is more durable.

Types of Inlays and Onlays

• Inlays and onlays made from gold are more durable
• Inlays and onlays made from porcelain give the natural look
• Inlays and onlays made from composite resin are the most popular because they give more natural looking and long lasting result than the porcelain.

Problems that require inlays and onlays

• Inlays and onlays are used to restore a cavity in the tooth.
• Inlays and onlays are used when a long lasting result is required.
• Inlays and onlays help conserve more tooth structure.

Treatment Processes

• Remove part of the decayed tooth and create a proper shape for putting an inlay or onlay.
• Make an impression of the tooth.
• The impression is sent to a dental lab to create the inlay or onlay.
• The inlay and onlay will be placed on the tooth. Your dentist will check and adjust the position for the esthetic result.

Benefits of Inlays and Onlays

• Composite resin has a wide range of tooth-coloured tones to choose from, so it creates high esthetic and durability similar to the natural tooth.
• Gold material is the most long lasting material.
• Inlays and onlays are very strong since they are made in a laboratory.
• Inlays and onlays can prevent the tooth from breakage and help strengthen the tooth.
• The impression provides a suitable size that matches the natural tooth.
• With a minimum space between the tooth and inlay and onlay, it decreases a chance for cavities.

Disadvantages

The cost for inlays and onlays are quite high since it depends on the expense of the laboratory work. However, the treatment is good for the tooth and it can conserve more of the natural tooth structure in the long run.

3. Crowns

Crowns are a kind of dental restoration to teeth which are damaged, broken or have received root canal treatment. Dentists will place a dental crown made of different materials over the damaged tooth to restore its original shape and make it work effectively.

Types of crowns

1. Porcelain-fused-to-metal dental crown (PFM)
2. All porcelain dental crown
3. All metal dental crown (gold dental crown)

PFM and all porcelain crowns have colours that reflect natural teeth. Usually PFM crown is recommended for molars, which perform a main task in chewing, while all-porcelain crown is used for front teeth due to its very natural appearance. All-metal dental crown is the most durable material because it rarely chips or breaks.

Benefits

1. To protect and strengthen the broken or decayed tooth or tooth that has received root canal treatment
2. To prevent tooth cavity
3. Help the tooth maintain its position and function
4. Help preserve severely decayed tooth or cover and support the tooth with a large filling in titanium implants

4. Dental Bridges

Dental bridges are an option to replace a missing tooth. It is also known as a pontic, an artificial tooth that is fused between two porcelain crowns and attached onto adjacent teeth.

Types of dental bridges

1. Traditional fixed bridges Fixed bridges consist of crowns (types of material used depend on individuals’ needs) that are fused and clung to the adjacent teeth on both sides of the open space. This is the most common type of dental bridges used in dentistry.     2. Cantilever bridges Cantilever bridges are used when there are teeth on only one side of the empty space to attach dental bridges.     3. Maryland bridges Maryland bridges or resin-bond bridges consist of a metal framework and metal wings which are bonded to the back of adjacent teeth.

Types of materials used for dental bridges

1. Porcelain-fused-to-metal dental bridge (PFM)
2. All-porcelain dental bridge
3. All-metal dental bridge (gold dental bridge)

PFM and all porcelain bridges are in natural tooth colours. PFM bridge is usually recommended to replace molars where chewing and grinding take place, meanwhile all-porcelain Bridge is used to restore front teeth where aesthetic and natural look are important. Gold or all-metal bridge is considered the most durable because it rarely chips.

5. Dental Fillings

Dental Fillings are a treatment for patients with a decayed or chipped tooth. Dentists will fill a portion of the tooth with materials such as amalgam or composite resin tooth-coloured fillings.
Types of fillings

  

Fillings can be divided into 2 types depending on filling materials:

1. Traditional amalgam filling
2. Composite resin tooth-coloured filling

Our clinic chooses the 3M ESPE Filtek for composite resin tooth-coloured filling since its nanotechnology, which is considered highly effective and powerful in filling, is well accepted.

A comparison between the traditional amalgam and the composite resin tooth-coloured fillings:

Amalgam filling is a metallic silver filling material, which contains tiny amount of mercury.

Advantages

1. Last at least 10-15 years
2. Withstand grinding forces
3. Less expensive than composite filling

Disadvantages

1. Colour does not match natural teeth
2. A large space to hold the amalgam filling is needed, so some healthy parts may have to be taken out
3. Amalgam filling can cause a grayish hue to the nearby teeth’s surface

Composite resin tooth-coloured filling is a natural look tooth-coloured filling material

  

Advantages

1. Colour shade can be matched with the natural teeth
2. Can be used as filling material to restore chipped, broken, or worn teeth

Disadvantages

1. May not last as long as amalgams
2. Longer treatment time due to more complicated process
3. Chipping may occur (depending on positions)

6. Dental Restoration

Dental restoration with composite resin tooth filling is a process in aesthetic dentistry in which tooth-coloured materials are applied to make cosmetic improvements. The cost for dental restoration is quite affordable.

Benefits

1. Restore decayed teeth
2. Repair teeth that have minor fractures
3. Fix colour problems of teeth
4. Close gaps between teeth
5. Improve uneven teeth
6. Being an alternative to amalgam filling
7. Cover the neck of the tooth and protect root surfaces

Dental restoration with resin filing such as gap closures can avoid grinding tooth surfaces. Thus, it can effectively reduce sensitivity that may occur during the process.