Cosmetic Dentistry

     Cosmetic Dentistry can repair chipped, broken or missing teeth with tooth-colored Bonded or Porcelain restorations!  It can make yellow or gray teeth whiter with Professional Bleaching (Whitening) and/or Porcelain Veneers and can replace ugly silver fillings! 
     There are many factors that affect the quality of cosmetic dentistry.  For example, there can be nearly a dozen different   materials used in a single tooth-colored Bonded filling:  tooth etchant, which microscopically roughens the tooth surface for bonding; primer, which further roughens the tooth surface, dentin/enamel bonding resin with a light or dual cured catalyst, possible use of self-cured posterior composite and Premium bonding materials. The quality of each of these materials can vary tremendously.  The best brands benefit the patient by minimizing post-operative pain, resisting the recurrence of tooth decay and breakage, and maintaining color-fastness over time. Premium materials are also among the most expensive to buy and the most time-consuming to use.
     It is common to see patients who have had two, three or even four separate fillings, performed at different times, and placed within the same tooth!  'Patchwork' dentistry should not be done because decay is usually present under these older, adjacent fillings. It is silly, though less costly, to attach a new filling to an older, decaying one. When placing new bonded fillings in a tooth it is usually better to remove the old, adjacent fillings within that same tooth at the same time.  This takes more time, but being thorough now will save you from needing more work later.  Premium dental practices no longer use silver fillings.
     Cosmetic Caps (Crowns) should not show any metal. It is common to see caps that show dark metal on the biting or inside surface. The skill of individual dental lab technicians varies as much as the skill of individual dentists.  Premium dental lab technicians hand craft beautiful, well fitting caps. When necessary a porcelain ceramist should be present at the dental office for final color shading and characterization.
     The skill in preparation and impression-making of your teeth for caps is significant. Accuracy is important to tolerances less than 0.001 of a millimeter!  In addition to creating cosmetically beautiful caps it is also important to create them to minimize long-term gum problems (overly bulky caps irritate gums) and maximize cement retention (so the cap won't fall out).  Dental impression materials also vary in quality (and cost) so patients can learn about their dentists just from the brands used.
     All these factors allow premium dental practices to create exceptionally beautiful cosmetic dentistry that can last a long time.

--Dr. Jeffrey Dorfman, Director
The Center for Special Dentistry
NYC