Wednesday, 11 August 2010

Kinder Than Porcelain Veneers, Faster Than Orthodontics?

There is a new idea catching hold in main stream cosmetic dentistry and to be honest, it is a change that is long overdue. In my  career to date as a  preventive dentist and a cosmetic dentist I regularly have had to balance my patients desire for a lovely smile versus my own personal view that we should always treat healthy tooth tissue as precious. For more than 15 years the team at Craigentinny have taken the view that that we should avoid  drilling away tooth  if at all possible. As a result  I have on many occasions declined to carry out treatment that patients have requested when it  would involve grinding away significant quantities of  a  tooth and lead to what I believe is  long term damage or complications.

You see,  when a tooth is prepared for a crown  there is a 5 - 15% chance that the nerve in that tooth will die at some point in future. And if the nerve dies then a root treatment becomes necessary. So when an alternative exists that is kinder to the  tooth  its seems to me a no brainer that we should look seriously at this option. As a result in the last 10 years I have carried out a lot of resin bonding rather than place veneers or occasionally crowns for my patients. Resin Bonding  usually requires little or no removal of the underlying healthy tooth and as such is completely reversible. Indeed resin bonding is so conservative that very often we are able to complete it with no need for injections or anaesthetics. A real winner for my more nervous patients.

As a treatment Resin Bonding or Composite veneers as they can be known, matches crowns or porcelan veneers for speed as they can usually be completed in one or two visits. Resin bonding does not suit everyone. It is a bit more prone to gathering stain so smokers probably should consider alternatives, that said in normal use any minor staining is easily polished away. This simple before  and after series  from a few years ago shows just what can be achieved. The cost was significantly less than using poreclain veneers to achieve a similar result and my patient was delighted.  Better still the natural teeth were completely untouched. Today we  may well treat this lady differently as we have fast orthodontics available with  the  Inman Aligner  or 6 Month Smiles however as the resin bonding can be stripped off back to the natural tooth at any time this patient  still has these options available to her. If we had chosen to place 6 veneers that flexibility would have been lost. Don't get me wrong veneers and crowns are still a great option for the right patient, and I still provide a lot of these treatments  but  if you do nothing else before having some cosmetic dentistry carried out, please do make sure that you consider all of your options, their advantages and disadvantages before starting.
What do you think is the best way to enhance a smile?

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