Cosmetic Treatments

Using advanced cosmetic dental treatments and materials, your San Antonio, TX cosmetic dentist, Dr’s. E. Wayne Simmons or Bryhn Simmons, can make a real difference. The skill, experience, and commitment of our practice — using a unique combination of science and artistry — can literally redesign your smile. Even a subtle change in your smile helps you to project an image of self-confidence and high personal esteem. When you feel good about yourself, it shows in your appearance.

Cosmetic dentistry has the ability to transform a person’s appearance and confidence. It can truly be a life changing experience.

What is cosmetic dentistry? Cosmetic dentistry is the restoration of teeth or modification of teeth using materials and procedures that can enhance the appearance of a smile.

When “treating” the smile there are many aspects to evaluate. Symmetry, shape, color, brightness, and relationship to other facial features. Patients often have aspects they are unhappy with, and while all of these aspects have an “ideal” goal that helps create a beautiful smile, that doesn’t necessarily be for everyone. To make this point, I tell a story about a study where a picture of a smile (smile only) was shown on a big screen to a large group of dentists. The dentists were instructed to evaluate the smile and they did. On the same screen were numerous critical comments regarding gingival height, tooth proportion, too high lip line (gummy smile), open embrasures (tiny spaces between the edges of teeth). This study was presented by a fellow resident when I first saw it. After reading all the comments, he proceeded to the next slide which was a zoomed out picture of the person smiling. It was Nicole Kidman and she was on the cover of a magazine. She had been selected as having “the prettiest” smile.

So what does cosmetic dentistry really have to offer? Well, sometimes it offers more than it should obviously, but it can be understandable as we we are always striving for “perfection”. The principals used in cosmetic dentistry are merely guidelines. Sometimes trying to achieve perfection in every aspect doesn’t always add up to an aesthetic smile. As we like to say, ” the art is in concealing the art”. This is what separates cosmetic from aesthetic. Putting a nice white veneer on one tooth while all the other teeth are dark and stained is cosmetic for that one tooth, but not aesthetic. Aesthetic is looking as nice as possible and still blending in with everything else.

We will try to break down some of the more common complaints for patients seeking cosmetic dentistry:

Shade or Color
Patient that wish to have a whiter and brighter smile usually have two options, whitening or veneers/crowns and sometimes both. It is always important to realize that any existing crowns, veneers, or fillings will not change shade with whitening which may require replacement of these restorations after whitening in order to match the new shade of teeth.

When placing veneers in order to correct shade of teeth, it is important to evaluate the smile to see what teeth show when smiling, talking, and laughing. When making a significant shade change, contrast between the veneered teeth and untreated teeth may be visible from front to back or top to bottom. This can often lead to the need to veneer additional teeth in order to conceal any significant differences. This can lead to additional expense and irreversible treatment (shaving down) of possibly healthy teeth not need of restorative procedures.

Size and Shape
Changing the size and shape of teeth most always requires restorative procedures such as bonding, porcelain veneers, or crowns. This is where the function of occlusion must be properly evaluated. Changing the length of any tooth can create a significant and likely detrimental effect on how the teeth come together and work together (occlusion). Evaluating this requires a clinical exam as well as looking at diagnostic models of the patient mounted on an articulator (artificial jaw). From these models, a wax up can be produced. This is the use of wax to shape the teeth aesthetically but to not interfere with proper function. This wax up provides crucial information that shows what can and CAN NOT be done. It also may reveal issues that may involve other teeth in order to meet patient expectations. Proper occlusion is important in that it will help minimize greatly any injury to teeth and or damage to veneers or crowns. Chipping of veneers or crowns are common problems when the bite is not properly restored.

Crooked teeth
Although we do not provide orthodontic treatment, it is highly recommended to seek orthodontic evaluation (braces) to correct any malposition of teeth. Crooked teeth, excessive spacing, or misproportion can be corrected using crowns and veneers, however there are significant advantages to orthodontic treatment. It may minimize or eliminate the need for restorative treatment. Severely malpositioned teeth may need excessive amounts of tooth structure removed in order to crown/veneer and achieve proper aesthetics. This may result in the possible need for endodontic therapy (root canal) or weakening of a tooth.

When teeth are overcrowded or spaced apart, this can also result in a malocclusion or improper bite. Orthodontic treatment can help resolve these issues and eliminate the need to restore many teeth that are in no need for restorative treatment.

It must be understood that restorative aesthetic dentistry is not simply placing a “pretty face” on a tooth. It requires a good understanding of the patients goals, limitations, function, and expectations. Proper planning and communication is key in developing a plan that has a good outcome and prognosis as well as help the patient develop reasonable expectations.

The smile is framed by the lips, cheeks, eyes, ears, and chin and symmetry with these structures is important and used to help create a nice smile. As we are all aware, noses aren’t always straight, eyes and ears are not always even, and chins may not be centered. This is important to understand, because the edges of the top front teeth should normally be parallel with a line connecting the pupils of the eves, but also follow the curvature of the lower lip. Again, these are not hard and fast rules, but simply guides to creating a smile. Sometimes you shouldn’t depend on the nose and upper lip to determine the midline of the front teeth, well, because they may not be in the center either. Imperfections can be better hidden when blended. Any drastic difference may draw attention to one or another.

Patient education is always critical. Without a good understanding of these factors, there may be expectations just are not achievable

Cosmetic Treatments