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“Cosmetic” Dentistry

confessions_molar_jockeyI’ve always been kind of amused by ads that emphasize “cosmetic” restorative dentistry.  Restorative dentistry does what it says it does; it restores what’s been broken down or lost.  The parameters range from a filling to an entire dentition.  But shucks, unless we have way more vision than we really need, most molar jockeys use nature as our guide and work at mimicking what looks right.
So hopefully, we all do cosmetic dentistry.  The alternative would be dentistry that looks like the bruins on offense.  I don’t think so.
What’s really exciting about the way we do things these days is the distinction between getting a flat tire on your new ride and tooling around town on one of those funny little donut spares, as opposed to matching the three surviving tires and having the car detailed.
Dentistry today is more about the big picture; it’s comprehensive and built on long-term relationships.  It isn’t about fixing a flat; it’s more like keeping the car looking good and running well for 200,000 miles
When I was a student, a patient would walk in with tooth decay visible only on an x-ray and walk out with a silver filling that could look like a black hole within months if it wasn’t polished like Mr. T’s ear rings.  The filling would create risk for tooth fracture because it wasn’t temperature stable and was packed into a hole that undermined the structural integrity of the tooth.
These days, we can detect early tooth decay using a laser and be only invasive enough to get access to and remove the decay.  Often, we restore the tooth with an adhesive agent and flowable resin that looks like tooth-colored liquid paper.  The result is something that’s cosmetic/strong/natural looking because the care has been so conservative and the newer materials are so cool.
My dental materials guru who happens to have a PhD in Engineering to go with his DDS and a Masters in Materials calls the conservative approach “Tooth Bank Dentistry.”  The less invasive we are in restoring mouths, the more we leave in the bank for the future as things wear down over time.
So today I’d root for the powder puff blue bruins before I’d do a crown on lower incisors or the upper laterals that flank the two front teeth; I’d restore ‘em with veneers.  Why reduce small teeth to little stubs and cover ‘em up when sometimes a totally non-invasive 0.5 millimeter thick Durathin veneer can preserve strength and beautifully restore a natural appearance.
Posterior teeth that are fractured or are restored with big silver fillings and are at risk for fracture most often do not need crowns that cover the whole tooth.  A better option is an onlay (covering only the top two millimeters.)  If your head was a tooth, crowns fit like a bag; an onlay fits like a baseball cap.  Tooth-colored onlays are beautiful, do not disturb the delicate environment at the gum line, and leave plenty of tooth structure in the Tooth Bank.
Restoring missing teeth with natural-looking implants means not having invasive procedures on neighboring teeth as is the case in a traditional fixed bridge.
Moving teeth into position with Invisalign can eliminate or diminish the need for veneers or crowns to create a beautiful smile…while creating an environment that is more conducive to sustained gum tissue health.
In dentistry, just doing the right thing produces the most cosmetic dentistry.  Listening to the patient and understanding their vision, being conservative, and going for results that lean toward the norm and look right produces truly cosmetic dentistry.  And hopefully, we’re all cosmetic dentists.

By Dr. Jack Von Bulow

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