The Egg shows both the Gothic shape (top) and Roman shape (bottom)
It is important to have this condition diagnosed so as to attend to this condition early.
Preventative measures include:
There are functional appliances that can be worn to reverse the shape of the jaw
Teach good habits early, as good habits start young for a lifetime of healthy teeth and gums
Co-Planning
At Sydney Aesthetic Smiles what we call Co-Planning involves:
- Comprehensive Systemized Examination
- Full Diagnosis
- Complete Education of any Conditions Present
- Discussion of Options
Complex Reconstructions
See Make Overs
Complex reconstructions refers to the restoration of the mouth as a whole involving many teeth and usually attends to Function and/or Aesthetics
This is especially the case where there has been a large amount of tooth material loss:
- Missing teeth from extractions
- Excessive wear of teeth from grinding see Bruxism and Vertical Dimension
but could also be where teeth have erupted into a less than favourable position
COMPOSITE CROWNS
Composite crowns used to restore a smile and protect the teeth.
At Sydney Aesthetic Smiles we are big fans of Minimal Intervention Dentistry (MID) and prefer to use Composites to mould and bond onto teeth rather than traditional drilling and cementing of Porcelain Crowns
When placed by skilled dentists composites are extremely Aesthetic and totally undetectable
But how Strong are Composites?
University research and over twenty years experience placing both composite and porcelain has shown that composite fillings and crowns can last just as long if not longer than porcelain depending on the experience of the clinician and the material used
Also, composites are extremely Versatile and are able to be altered in shape, size and colour plus they are much Gentler on the opposite teeth whereas porcelain is known to wear away enamel and dentine
Figure 1 when composite is placed by skilled dentists it is an ideal restoration
Figures 2, 3 & 4.Removal of amalgams show vertical cracks in a very weak molar tooth. Rather than drilling yet more of the tooth away for an expensive porcelain crown (requiring further visits and possible Root Canal Treatment), the placement of bonded composite means that the patient benefits from MID in one visit
In general, the huge advantages of composite crowns are:
- Their conservative nature. Use of tough and wear resistant nano composites means less drilling and more retention of tooth structure which means a stronger final tooth
The side walls of a tooth which are normally drilled back in the traditional crown are generally left far more intact with the resin composite crown. The use of a fully bonded material in restoring the heavily broken down tooth can also mean less of a need for Root Canal Therapy saving on financial and biological cost as drilling into the deadened root system to place posts is avoided
- The financial saving as Porcelain crowns cost 3 to 5 times as much as composite crowns.
Note that material science research shows that porcelain is quite a delicate material see Porcelain Fractures and Toughness that the recently introduced nano hybrid composites exhibit many superior physical properties.
COMPOSITE RESIN
(Correct terminology is Resin Composite)
Composite Resin is the most popular white filling material used in dentistry
It is composed of a mixture of glass particles embedded in a resin matrix
The newest composites use extremely small silica nano particles which make these composites extra tough, hard wearing and Aesthetic see Toughness
Composites are more difficult to place than Amalgams, requiring greater attention to detail
How strong is composite?
University research and experience has shown that Composite Fillings and Composite Crowns can last just as long if not longer than Porcelain depending on the material and technique used. See images of Porcelain Fractures.
In addition to this, there are other advantages to using composite over porcelain namely:
- The ability to easily repair fillings, veneers and crowns
- The ability to alter shape, size and colour without complete replacement
- Less or no drilling of tooth substance
- One visit not two
- Bonding not cementing to tooth
- Less chance of restoration not fitting
- Less chance of colour mismatch
- Much easier to get the bite right
- Composite does not wear away and damage opposing teeth
- Greatly reduced cost
This diagram shows that while ceramics and porcelains are strong they are very brittle. Resin composites are able to absorb the stresses on them better and are tougher materials
COMPOSITE VENEERS
- Composite Veneers are similar to Porcelain Veneers in that they are placed over the surface of teeth to alter a tooths appearance but are also very different
- They are made of Resin Composite though and are bonded Directly onto the tooth surface which usually means less drilling than Porcelain Veneers see Minimal Intervention Dentistry
- Because of this they can be placed in one visit
- Also because of this they are much more difficult to perfect and require very experienced and well trained dentists. Porcelain Veneers are made in a Lab at a distant site by a technician who is given models and instructions by the dentist. This is in our opinion the main limiting factor
- With regards to Strength, Porcelain is generally regarded a stronger but much more Brittle material with Composite being able to elastically absorb forces much better see Toughness
- Because the Composite material is chosen at the same time as placement of the veneer any refining of colour or translucency or shape can be done on the spot whereas Porcelain may need to be returned to the laboratory for reshaping and reglazing or redoing alltogether
- Because there is no lab fee they are much less expensive ranging from $250 to $750 compared to Porcelain $1000 to $2500
- Composite veneers are much more versatile. Veneers do not change colour but if the surrounding teeth do then Composite veneers can be resurfaced or reshaped whereas Porcelain veneers need to be replaced or the other teeth Whitened
- Also, Veneers rarely fail but if they chip Composite Veneers can be repaired whereas Porcelain Veneers must be replaced
- Good Oral Hygiene is always recommended with or without Veneers
- Common sense applies with regard to Function and Parafunction and hard objects and food such as finger nails and bones should be avoided
Cosmetic Dentistry
Dentists who primarily focuses on creating beautiful smiles are
regarded by the public as Cosmetic Dentists
Stained teeth, dark teeth, chipped teeth, crooked teeth can be restored and teeth that are missing altogether can be replaced
Cosmetic or Aesthetic dentistry is the broad heading under which many dental procedures that improve the appearance of teeth may be described
Cosmetic dentistry is a combination of the art and science of creating an attractive smile and may involve:
- Whitening
- Crown Lengthening/ Gum Lifts
- Veneers
- white fillings
- tooth coloured Crowns and Bridges
- Implants and
- minor tooth movement
At Sydney Aesthetic Smiles we use state of the art materials, techniques and equipment in order to achieve great smiles. It may involve changing the colour, shape or length of only one tooth or many teeth
Dr Shouha is our cosmetic dentist. He likes working with his hands and has a strong artistic inclination. He initially designed the dental clinic and did much of the finishing himself. He currently works with sandstone, aerated concrete and wax.
CROWNS
- Generally speaking a restoration could be considered to be a crown if it involves greater than 50 % of the tooth and covers all of the biting surface. It is thus much more complicated than a filling
- Dental crowns (also referred to as ‘caps’) cover over and are fixed on either:
- the natural tooth or
- an implant
- Crowns are used to:
- Rebuild and strengthen broken or decayed teeth especially if they have had Root Canal Therapy (see No 7) and
- Improve the cosmetic appearance of a tooth
- Crowns include:
- Porcelain crowns – two visits
- Porcelain bonded to metal crowns – two visits, combine the appearance with strength
- Gold crowns – two visits, strongest and longest lasting
- Composite crowns – one visit, conservative (MID), inexpensive and versatile and
- V. Acrylic crowns – generally considered temporary
- Porcelain and gold crowns are manufactured outside of the mouth by a dental technician using moulds of your teeth and instructions provided by the dentist
This adds to the cost as additional laboratory fees are incurred. As additional stages are involved there is also a greater chance of errors in fit and colour
- If Aesthetics is not a priority the best possible material for crowns is gold:
- Gold is extremely tough even in thin sections. Therefore, much less drilling (MID) is required than for any other material (0.5mm for gold compared to at least 1.5mm for porcelain)
- Porcelain (see Porcelain Fractures) and composite can fracture but gold will not
- Same cost or less than porcelain
- Is somewhat bacteriostatic
- Fractures of Root Canal Treated teeth increase considerably in the posterior teeth when protection is not provided by a crown. Torbjorner A, Karlsson S, Syverud M, Hensten-Petterson, A: Carbon fibre reinforced root canal posts. Mechanical and cytotoxic properties, Eur J Oral Sci 104:605, 1996.
Laser Crown Lengthening
- Crown Lengthening involves the reshaping of Gum and Bone tissue around a tooth
- Crown Lengthening is performed primarily for two reasons:
- For structural integrity in damaged or shortened teeth:
in order to expose healthier tooth structure and provide a stronger foundation for the placement of restorations
"the difference between an effective, long-term restoration and a failure can be as small as 1 mm of additional tooth structure”Galen & Mueller: Pathways of the Pulp, 8th Edition. St. Louis: Mosby,pg 771
and
- For Aesthetics to:
- Remove a “gummy Smile”
- Harmonize uneven gums
- There are three methods of doing this:
- Scalpel blade and bone drill - Traditional (see figs 1,2 and 3 below)
- Electrosurgery and bone drill or
- Laser – Minimal Intervention (see figs 4 & 5)
- At Sydney Aesthetic Smiles we use and recommend option C Laser as it invariably:
- Results in little or no bleeding and does not require sutures (see figs 4 &5)
- Requires the least Anaesthetic
- Is the most gentle method with little or no post operative trauma, pain or swelling
- Results in the fastest healing
- Gives the most predictable results
- Costs much less
See Minimal Intervention Dentistry
- In addition to the above advantages:
- The laser sterilizes the treatment area as it works Also
- We use Purified and Ozonation water, a very bio compatible disinfecting liquid
Figures 1 and 2.: Traditional crown lengthening procedure involving gum flap and bone drilling.
Figure 3. Sutures required for traditional crown lengthening procedure
Figures 4 & 5.: Laser crown lengthening procedure. Note minimal to no bleeding
Figures 5 & 7.: Laser Crown Lengthening before and after. Note minimal bleeding and no need for sutures
Cracked Tooth
Old amalgams
Crack found under old amalgam filling
Restoration of teeth with resin composite
Crack found under old amalgam filling
If you're not happy with your smile,
why not get a new one?