Wake up, look at yourself in the mirror, smile and love what you see! Is there a better way to start your day?
The perception of beauty starts in our eyes and goes to our soul with a process involving feelings, knowledge and experiences. The smile is responsible for 60 up to 70% of the esthetics of the face! What the eye sees depends mainly on: contrasts of colors, perspective of objects and the overall composition.
The whiteness of teeth, in contrast with the lips and their movement during speech and smile, drives the eye to look first at the lower part of the face, and then to the eyes. A white smile, with beautiful teeth, makes the person look healthy and attractive: this is the reason why bleachings and esthetic dental treatments are more and more requested to enhance beauty. The aim of modern dentistry is to reach beauty with minimal invasiveness, trying to keep the biologic value of the patient as high as possible.
The first thing to consider when approaching a new treatment is the biologic value of the patient: it should be preserved as it is (whenever possible). Modern dentistry has many tools in its hands, starting from the “simple” hygiene, to bleaching techniques, to orthodontics, and so on: the hardest part of the treatment planning is to choose all the options available and to combine them in order to achieve “functional esthetics” without being invasive. Sometimes esthetic dental treatments are a little aggressive: the reason is the exasperate tendency to perfection. In our daily work we all should remember what Hegel said: “beauty, being a product of imagination and sensations, cannot be an exact science”!
There are “golden rules” in dentistry to refer to, but they should be considered and kept as a starting point: a basis to start from, but nature doesn’t follow precise rules of symmetry or composition. We should, instead, aim for harmony and balance. The rule that should always be followed is the same one that we find in general medicine: “primum non nocere” (first don’t harm). And this goes back to the previous concept of respecting and preserving the biologic value of each patient.
As dentists we live in an “golden era” where people are more aware of the importance of dental care and of the value of a nice smile, but we also live in a period in which materials have reached a very high standard of quality and give us the chance to achieve wonderful results with very little treatment: we live in the era of minimally invasive dentistry.
Implants, bridges, full crowns, full ceramic crowns, full veneers… all wonderful tools in our hands, but only if they are really needed. Esthetic dentistry, nowadays, could be just bleaching and adhesion: we don’t always need the use of a handpiece and burs to give a nice smile to our patients.
Composites, ceramics and adhesives are the esthetic materials to be used to change forms and colors, helping us to preserve the health of our patients.
The treatment philosophy? Add instead of reducing whenever possible.
The treatment option? Additional veneers.
Additional veneers: the minimal invasive ceramic esthetic treatment.
CASE PRESENTATION
– Male, 30-years-old. (fig. 1)
– Trauma with fractures of teeth #1.2, 1.1 and 2.1.
– Teeth are vital.
– Treatment needs: restoring function and esthetics.
– Treatment planning: partial veneers with minimal tooth reduction.
The only real preparation needed has been on tooth number 1.1: a circumferential chamfer has been done to have a better seating both for the ceramist to do the veneer and for the clinician to seat the ceramic during the luting procedure, the other reasons have been to have a positive cut of the enamel prisms to achieve a higher adhesive potential and to better mask the transitional line from the tooth to the ceramic.
On teeth 1.2 and 2.1 only a rubber point has been used to round sharp edges of the teeth: the aim has been to have a smoother surface for the ceramic and avoid cracks both during firings and cementation (Fig. 2). After the impression has been taken, the ceramist carves the missing parts of the teeth in feldspatic ceramic. The result are partial veneers that match teeth color and form to restore what has been lost. The treatment of the ceramic and the luting procedure are similar to conventional full veneers. At the end of the treatment, the patient has ceramic restorations that function as natural teeth with mechanic behavior that are pretty similar to natural enamel, without the problems of discoloration and lack of resistance that can be found in direct composites (Fig. 3).
The advantage of such a treatment, if compared to full veneer coverage, is that the biologic value of the patient has been respected, with very minimal tooth loss due to the preparation. Furthermore, the adhesion has been almost only on enamel (except those spots of dentin exposed by the fractures). In case of re-intervention, a similar treatment will be possible again: the life of these teeth has been elongated if compared to a full preparation.
The final result is a restoration that matches the surrounding sound tooth: if we compare this kind of treatment to the “classic” veneers, for each tooth at least 50% of sound structure has been preserved.
Not a lot has been written in the literature regarding this technique, primarily because it is really hard to standardize the specimens for an in vitro study that is scientifically valid, but we are sure that this will be the future (if not even the present) in many dental esthetic treatments. Assuming that a prosthetic treatment is supposed to last around 10 years (for example), with this technique we can elongate the life of these teeth. If anything will happen in the future, we will be able to do additional veneers again, or the next step can always be a full veneer. The point is that additional veneers can provide us the chance to keep many doors open for future re-interventions.
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Dr. Gregory P. M. Brambilla maintains a private practice in Milan, Italy. He is an international member of the Canadian Academy for Esthetic Dentistry.www.CAED.ca
Dr. Dalloca received his dental degree from Tufts University Boston, and from the University of Pavia (Italy). He is trained in advanced education in prosthodontics at U. C. L. A. He has a CDT certificate from the dental technology institute in Orange, CA and from the school of Dental Technology Casati of Milan (Italy).
The authors would like to thank the ceramist Dt. Mr. Roberto Brambilla for his meticulous work. Oral Health welcomes this original article.
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The first thing to consider when approaching a new treatment is the biologic value of the patient
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There are “golden rules” in dentistry to refer to, but they should be considered and kept as a starting point
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The point is that additional veneers can provide us the chance to keep many doors open for future re-interventions
