Part 1 of this series on smile design gave an overview of the many facets involved in beautifying smiles by design and the many ways of interpreting what is normal or ideal. Our first article discussed the role of the dentist as diagnostician, artist and scientist in meeting you the patient to decide the best course of action for your particular situation. A detailed analysis of your smile is critical to the correct assessment and the appropriate procedures for change or enhancement.
Porcelain veneers within reason allow for the alteration of tooth position, shape, size and color. They require a minimal amount of tooth preparation – in this case reduction (approximately 0.5 mm of surface enamel) and are, therefore, a more conservative restoration than a crown, which requires significant removal of sound tooth structure. Although not the only alternative for all esthetic abnormalities, they are truly a remarkable restoration when they are the treatment of choice.
WHAT IS A VENEER?
Simply stated, a veneer is a thin covering over another surface. In dentistry a veneer is a thin layer of dental restorative material, usually porcelain that replaces enamel. Porcelain was named after its resemblance to the white, shiny Venus-shell, called in Old Italian “porcella”. The curved shape of the upper surface of the Venus-shell resembles the curve of a pig’s back (from the Latin porcella – a little pig). Properties associated with porcelain are high strength, hardness, glassiness, high durability, translucence and high resistance to chemical attack.
Dental porcelain is a type used by dental technicians to create bio-compatible life-like crowns and bridges for dentistry. As you will note from the cases shown, dental porcelains in the right hands can make for spectacular tooth imitations by mimicking tooth enamel perfectly. This is also a testament to the artistic skill of the laboratory technicians with whom the dentist partners in producing life-like precision veneers to create your enhanced smile. The dentist will usually specify a shade of porcelain, corresponding to a set of mixtures in the laboratory containing the porcelain powder. The powder corresponding to the basic tooth color is mixed with water, and then placed in an oven for “firing.” Further layers of porcelain are built up to mimic the natural translucency of the enamel of the tooth.
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For more information on learning more about aesthetic dentistry and continuing your dental education, contact Aesthetic Advantage in New York, NY at 212-794-3552. Visit their website at www.aestheticadvantage.com.
The Rehabilitation of a Smile
One of the dilemmas facing today’s restorative dentist is how to rehabilitate the severely worn, mutilated dentition. Excessive wear generally is a prelude to occlusal, functional, and aesthetic instability. “The challenge to the dental profession, as a whole, is when to restore, how to intercept the problem it presents and what treatment modality will best accomplish the most stable and best aesthetic result.”
We have undertaken what we consider to be a severely unstable dysfunctional occlusion. With the help of the master ceramists at Frontier Dental Laboratories, all ceramic Empress restorations have given us the ability to restore an almost hopeless situation to virtual functional and aesthetic health in less than two weeks.
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Aesthetic dentistry has created its own niche in today’s world. The value of dentistry, more importantly the perceived value of dentistry, and has taken on greater meaning. Aesthetic procedures now range from the “extreme” makeover to the “simple” makeover, both of which use various principles of the “Smile Lift.”
The “Art of Facial Aesthetics” is a routine phrase and approach in many contemporary dental practices. This phrase has even greater meaning when one considers the expansion of the whitening market and the increased use of aesthetic orthodontics (ie, Invisalign, Align Technology, Santa Clara, CA).
Certainly, the use of porcelain veneers and conservative crowns has enabled dentist to become a major player in the development or restoration of facial aesthetics. This role utilizes the basic principles of smile, preparation, and facial designs in the dentist’s armamentarium. The purpose of this article is to incorporate all these modalities into achieving a predictable aesthetic result.
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The single most important factor in creating a beautiful smile is the ability to visualize the final result before you begin. Laboratory communication, including photographs and models of the approved temporaries, is key to success. A thorough lab prescription detailing shade, texture, central length, incisal translucency, and any other pertinent information helps to facilitate a predictable result.
To develop properly proportioned teeth, it is essential to properly address many characteristics, such as contours, shade, size and length of centrals, phonetics, and occlusion. This leads to a key artistic technique—the art of recontouring—with both temporaries and, if necessary, the final restorations.
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Using facial landmarks to dictate tooth position can enhance esthetics and conserve tooth structure.
By Michael Apa, DDS of Aesthetic Advantage in New York
In order to create individual smiles that compliment patients’ facial features and enhance their overall facial beauty, clinicians can adopt a technique that uses facial landmarks to dictate tooth position. This method not only can enhance the esthetics, it can also ultimately allow the practitioner to be more conservative in tooth reduction.
Where Symmetry Comes In
To understand this type of procedure, it helps to have a general understanding of the word “beauty,” which is defined as the phenomenon of the experience of pleasure through perception of balance and proportion of stimulus. In short, something is perceived as beautiful when some type of harmony or balance exists. During the last decade of cosmetic dentistry, “smile design” has focused mainly on modifying the position and restoring the teeth of patients seeking a better-looking smile.1 This approach became the foundation for laboratories and practitioners communicating in the design process. It also resulted in perfectly symmetrical smiles’ being duplicated for each individual patient. However, if carefully analyzed, it is apparent that patients’ faces are not symmetrical,2 and that delivering or creating complete symmetry in an asymmetrical environment creates a disharmony that can be easily visualized. Therefore, it is of utmost importance to analyze the facial features or “the frame” in which the smile is being created. Within this process, the objective is to design the smile creating symmetry with features and, in a sense, tying the features of the face together by balancing them with the smile.
The challenge for educators in this situation is teaching something that is abstract in a clinical, methodical way. It is important to understand that esthetic dentistry combines both an artistic component along with a comprehensive dental approach.
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Learn from the expert Dr. Larry Rosenthal of Aesthetic Advantage, pioneer and internationally respected expert in the principles of smile design. Below is our most recent enrollment information.
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Head Start Program (recent graduates)
Attend lectures both weekends and observe over the shoulder in clinic.
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