November 9, 2016
by Chuck Maragos, CDT and Jenny Wohlberh, AAACD
If you’ve ever seen vintage photography, you’ll notice an absence of toothy grins. Somber, tight-lipped portraits ruled the day well into the early 20th century. This was probably for the best, since most smiles were not photogenic.
Before the 1920s, dentists were hard to find. Cosmetic dentistry was nonexistent. Extraction – today’s treatment of last resort – was often the only remedy available. It was not a pretty picture.
Such aggressive treatment methods seem primitive to us today because of our improved preventive care and multitude of new restorative dentistry options. The esthetic dentistry profession has evolved in another important way, too: We are moving toward a more conservative, whole-person treatment approach.
Today, more patients and professionals are seeking minimally invasive treatments and procedures because we now understand that physiological systems are interconnected. Compromising any part of the body – including gums and tooth structure – can affect the health of the whole person.
Fortunately, innovations in dental lab technology, ceramic materials and bonding techniques mean that dentists and patients can now achieve esthetically superior porcelain veneers with less preparation, tooth loss and pain.
For example, our technicians use operating microscopes at 10-20x power magnification, ensuring a precise marginal fit to within 10-15 microns of accuracy. We also custom-shade each tooth with the latest all-ceramic materials selected specifically for each patient.
When it comes to bonding, the more enamel left intact, the better. Ceramic restorations cannot bond to dentin. Patients with restorations bonded to a greater surface area of enamel experience higher functionality and esthetic survival rates; again, underscoring the benefits of a minimal- to no-prep approach.
My son, Dean Maragos, is the patient of Dr. Holger P. Meiser whose restorative case study is featured in this issue. Dr. Meiser successfully used a minimal-prep technique to help Dean achieve the outstanding, natural-looking smile he was hoping for.
In partnership with Dr. Meiser, Jenny Wohlberg, AAACD and senior vice president of Ceramics at Valley Dental Arts, meticulously measured, shaped and handcrafted each of Dean’s 20 feldspathic veneers. Because of Dr. Holger’s minimal-prep approach, the integrity of his teeth was preserved and the fact that all margins were supragingival helped achieve a perfect fit and natural look in one visit.
While Dean’s results are exceptional, the path to achieving them is accessible to any dentist willing to learn. We have successfully guided many dentists in this technique, reducing patient chair time while helping practitioners ensure precise – and minimal – tooth reduction.
In summary, I recommend minimal-prep veneers for the following reasons:
1. Preserves tooth structure and enamel
For most restorative and esthetic treatments, proper veneer-to-enamel bonding can be achieved with minimal or no removal of tooth structure or enamel using either feldspathic porcelain or lithium di-silicate (E-Max) porcelain – both premier esthetic materials for custom veneer restorations.
Leaving the surface area of the enamel intact enhances bonding and reduces the already low failure rate for porcelain veneers: less than one percent.
2. Reduces patient pain
Grinding down tooth structure involves more patient chair time – and more patient discomfort. With less aggressive preparation, patients experience less pain. Numbing is not required. Patients are often pleasantly surprised at the ease of treatment with minimal-prep veneers.
3. Protects gingival health
The recommended margin placement for minimal-prep veneers is a supragingival finished margin. Using supragingival margins for veneer placement protects the integrity of the gingiva, eliminating the potential for tissue damage, bacterial growth and infection. Supragingival margins also allow for easier removal of resin, avoiding the need to scrape underneath the gum line (irritating the gum). It also reduces the risk of resin remaining under the gum, which can inflame the tissue and lead to tissue recession.
4. Saves chair time
Minimal-prep veneers require little, if any, tooth grinding and no patient numbing. In addition, this technique seldom requires provisional restorations. The result: fewer and shorter patient appointments, leaving practitioners with more time to treat other patients.
5. Produces outstanding esthetic results
Today’s porcelain materials are natural looking and beautifully translucent. With lab guidance on the right bonding materials and contouring techniques, practitioners can expect to produce “the contact lens effect” – a seamless transition from porcelain to enamel. In my opinion, it is the epitome of dental artistry
6. Accommodates future restorations
No restoration lasts indefinitely; most require replacement after 20 years or so. The beauty of minimal-prep veneers is that the process is essentially reversible. Because their original smiles are left unaltered, patients have more options in the future when additional restorations may be needed.
While minimal-prep veneers are an ideal solution for a variety of restoration needs, one treatment plan does not fit all cases. Patients who may not be candidates for this approach include those with misaligned teeth, large or protruding teeth or badly stained teeth that require more than two shades of whitening.
Esthetic dentistry has come a long way in a short time. Progressive practitioners can tap a growing armory of high-performance materials, advanced techniques and qualified labs. Today, we have more to smile about than ever before.
About the Authors
Mr. Maragos founded Valley Dental Arts in 1974 to create a new standard of excellence in aesthetic and cosmetic dentistry. Mr. Maragos” heritage is family-centric. Whatever the need or concern, it has always been “family first,” and he was determined to extend “family status” to every one of his dentist clients. His relationship-focused model of doing business worked as he grew Valley Dental Arts to become a national leader in delivering uncompromising quality, not only in craftsmanship, but also in customer service.
Known as “The Father of Contemporary Diagnostics”, Mr. Maragos is one of only three dental artisans in the nation to be accredited through membership in the American Society for Dental Aesthetics (ASDA), where he also serves on the board. A member of the internationally renowned Oral Design Group, Mr. Maragos has lectured globally on laboratory communication, aesthetics, computer-aided design and computer-aided manufacturing (CAD/CAM) systems. He received the best design award and letter of appreciation from the Leading Dentist Association (LDA) in Japan. He is co-author of “Aesthetic and Restorative Dentistry: Material Selection Technique” (1st ed.), and has served as a clinical instructor at Baylor University.
Mr. Maragos has lived his vision for aesthetic excellence every day for more than 40 years. His team of like-minded professionals treats dentists like family and provides unequalled quality to dentists and their patients every day.
Mrs. Wohlberg’s career started in 1990 with a singular focus on excellence in ceramics. The quality of her work and unwavering commitment to craftsmanship and artistry led her to Valley Dental Arts. Here she is able to share her expertise and craft with clients and continue to develop her understanding of smile design and natural aesthetics.
Mrs. Wohlberg learned her intricate, ceramic-layering techniques from masters in Sweden, Japan, Italy and Switzerland. She has co-authored several papers on ceramic material selection and veneer preparation design, and has lectured and given numerous hands-on courses to dentist and technicians around the world. She is one of a handful of accredited technicians of the American Academy of Cosmetic Dentistry, and is an accredited member of the American Society of Dental Aesthetics.
Mrs. Wohlberg’s skilled craftsmanship is rivalled only by her dedication to Valley Dental Arts’ clients. For more than 25 years, Mrs. Wohlberg has lived the Valley Dental Arts mantra of building lasting relationships with dentists to position them for success, in their business and with their patients.
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