Bleaching
	Bonding
	Veneers and laminatesInlays/Onlays
	Cosmetic recontouring
	Cosmetic surgeries
	Tooth Jewelery

                                        
Tooth Whitening (Bleaching)
The term ’whitening’ strictly speaking is a misnomer. This is because natural color of teeth is never perfectly white. It is a combination of white and yellow in varying proportions. Broadly, the procedure aims at restoring the natural white color of the teeth.

Bleaching can be done By the dentist in the dental clinic or at home by various commercially available bleaching kits. However, before directly jumping to the home bleaching, it is important that a dentist be consulted. This is important since home bleaching product may not be effective or indicated for every individual. Generally, the first bleaching is done at the dental office, with the follow up being done by the home bleaching products. However from a safety point of view and for best results both home and office bleaching should be monitored by the dentist. 

Teeth presents with 2 types of stains:

Extrinsic Stains: These stains are caused by tea, coffee, cigarettes, pan masala and other tobacco products, spicy food containing lots of red chillies and turmeric. Since these stains are of exogenous origin, they can be removed by bleaching.

Intrinsic stains: These stains are of developmental origin being incorporated within the structure of the tooth. These stains are caused by factors which operate at the time when the tooth is being formed. Common factors responsible for intrinsic staining include drinking of water with high fluoride content, ingestion of tetracyline medication, and injury to the tooth. Bleaching does effect these stains too but the effect varies depending on the severity of the clinical condition.

AQ's on bleaching:

Am I a candidate for bleaching?

Yes you definitely are a candidate for bleaching if you have tea, coffee or cigarette stains. Today, whither teeth are no longer a monopoly of film stars and models. Even you can get your teeth bleached provide you have a desire for a bright smile with whiter teeth.

Is bleaching associated with any side effects?

Bleaching of teeth in some cases causes temporary sensitivity of teeth and slight irritation to gums. But both these problems are transitory in nature and might probably be avoided if the manufacturer's instructions are followed.

How long does the whitening lasts?

Tooth Whitening may last up to 5 years depending on your food habits, personal habits and your oral hygiene. Food habits which effect bleaching are spicy food with red chilies and food with turmeric. Personal habits include tea. coffee and smoking. Lastly and most importantly, how you maintain your teeth after bleaching with regular brushing will decide the time the whitening stays.

What can I expect after treatment?

Bleaching of teeth is generally associated with unrealistic expectations. It is a very common misunderstanding that teeth become perfect white after bleaching. Generally the shade of the teeth gets light by 2 to 3 shades. Nobody can predict with absolute certainty the result before the start of the procedure. Individual results varies depending on the types and intensity of the stains and the quality of the enamel in the tooth. Sometimes, within the same tooth some areas respond to treatment in a better way than other areas depending on the thickness of enamel.

Bonding

A natural tooth does not grow like natural hairs or nails. So, the only way to effectively fix the appearance of a chipped tooth is through bonding of certain tooth-colored materials to the tooth. These resins are a paste to begin with, so they can be shaped and colored to look like the rest of the tooth. Once exposed to a certain wavelength of light, the resin hardens into a permanent plastic. These materials are exactly similar to the materials used for tooth-colored fillings.

Bonding is among the easiest and least expensive of cosmetic dental procedures. The composite resin used in bonding can be shaped and polished to match the color and shine of the surrounding teeth. Most often, bonding is used for cosmetic purposes to improve the appearance of a discolored or chipped tooth. It also can be used to close spaces between teeth, to make teeth look longer or to change the shape or color of teeth. Sometimes, bonding also is used as a cosmetic alternative to amalgam fillings, or to protect a portion of the tooth's root that has been exposed when gums recede.

Besides the procedure has other advantage of getting completed in a single appointment.

However, bonding procedure has its own limitations. After receiving a composite, a patient may experience post-operative sensitivity.  Besides composites have a tendency to pick up stain with time. They can chip or break over time if they are abused.  It is therefore essential to follow proper home care instructions and get regular professional cleanings  to keep the restored teeth healthy and beautiful.

Proper home care and regular professional cleanings are essential to keep the restored teeth healthy and beautiful.

Veneers and Laminates


Veneers and laminates are another conservative approach to enhancing the look of your teeth. They are a thin shell made of porcelain or composite resin that is cemented to the front surface of the tooth. Like bonding, veneers are used to cover up discoloration, cracks and chipping, and to change the shape or size of your teeth. However, porcelain veneers outperform bonding with greater resilience and a greater resistance to stains and dulling. Also, they tend to look more natural than a bonded tooth.

Indications treatable by veneers include

	stained/ defective restorations
	gap between front teeth
	fracture lines
	wearing of teeth
	discolored teeth
	malformed teeth
	slight malposition
	gum recession exposing the roots
	Erosion/ abrasion of teeth
	in case of children teeth (with large pulp}

Comparison of veneer systems

Composite resin veneers
Composite resins (same as used for tooth -colored fillings) can be used in a direct chair side technique to form a veneer. Advantages of these direct composite veneers are:

• Only one appointment is required

• cost to the patient is less

• composite resin veneers are reparable

• color and form can be controlled by the dentist

Porcelain veneers:
These veneers promise" the highest esthetic potential to date for restoration of anterior tooth defects." Porcelain is the optimum material for its color stability, esthetics, wear resistance and tissue compatibility. But unlike composite resin veneers these are constructed in labs from dies made from patient's impression. Porcelain veneers

• Frequently do not require anesthetic and are less stressful to the patient.

• does not usually cause sensitivity

• maintains natural contacts between teeth

• eliminates display of metal at the gum margin

• does not usually require temporization

But these veneers are expensive. These are extremely difficult to repair if fractured and the technique involved in placement of veneers is extremely delicate. Some commonly used veneer system are the PROCERA and IPS Empress.

Ultra-Thin-Veneers

They represent one of the greatest advances in cosmetic dentistry. They are ultra thin veneers (as thin as contact lenses). They utilize ultra-modern state-of –the-art technology to create extremely strong, durable, thin veneer from porcelain. They are placed on the existing tooth structure so that means in most cases there is no drilling of extremely sensitive tooth enamel is required unlike traditional veneers.No injections! No pain! No Drilling! No temporaries!

With THINEERS you can:

• Whiten teeth Permanently

• Re-shape Teeth

• Straighten Teeth

• Repair Chipped and Stained Teeth

• Place over existing Crown or Bridge work without having to replace them.

• Close gaps and spaces in between teeth

In cases where orthodontic problems are not very severe, THINEERS ULTRA THIN VENEERS™ will change the alignment and shape of your teeth, making them look whiter, straighter and more uniform.Moreover, this type of restoration has been proven to last for up to 20 years with proper maintenance and care. This would include your regular Dental Check-up and Cleaning.

Inlays / Onlays
Porcelain inlays and onlays are state-of-the-art, conservative dental restorations. Traditional fillings can reduce the strength of a natural tooth by up to 50%. As an alternative, inlays and onlays, being bonded directly onto the tooth using special high-strength resins, can actually increase the strength of a tooth by up to 75%.

Dental Inlays and Onlays can be thought of as dental procedures that are midway between a dental filling and a dental crown. They are normally used when there is not enough tooth structure to support a filling, yet there is also not enough damage to support a dental crown.

Materials for inlays and onlays

Dental inlays lie within the cusps on the chewing surface of teeth. A dental onlay, on the other hand, is more extensive than an dental inlay, and tends to cover multiple cusp areas. Both can be composed of gold, resin or ceramics. These pieces are bonded to the damaged area of the tooth. Traditionally, gold has been the material of choice for inlays and onlays. In recent years, however, porcelain has become increasingly popular due to its strength and color, which can potentially match the natural color of your teeth. Inlays and onlays are applied in two dental visits. At the first visit, the old filling, or decay, is removed, and the tooth is prepared for the inlay / onlay. The dentist will then make an impression of the tooth, and send this impression to a dental laboratory. This impression will be used by the laboratory to construct a custom-made porcelain, or gold inlay / onlay. At this time the dentist will place a temporary sealant on your tooth and schedule a second appointment.

Cosmetic recontouring
If the esthetic problem is limited to the contour of the teeth, mere reshaping of the tooth might suffice. Although the technique is invasive involving grinding of enamel, it is safe and gives immediate results.

Cosmetic surgeries
Excessive Gingival Display: This can be a significant esthetic dilemma for many patients. The condition usually presents as incomplete exposure of crown portion of the tooth and a high lip line, which causes a "gummy smile".  The cause is delayed migration of the gum margin apically during eruption. When full exposure of the crown portion of the tooth is achieved surgically, there is dramatic improvement in esthetics by the concomitant lengthening of the teeth and reduction of the gingival exposure.    

Gingival depigmentation: If you are conscious of your smile due to the blackish appearance of the gums instead of the normal coral pink color, consider yourself to be a candidate for this cosmetic procedure. The condition is caused by excessive presence of certain pigment producing cells called melanocytes in the gum tissue. The treatment simply involves scraping of the superficial layer of the gum to remove the pigmentation. The results are evident within 7 days of healing.

Receding gum tissue: Worried about your receding gum tissue? Relax. With the recent advances in dentistry it is now possible to cover the tooth area exposed by recession. (For details see section "Gum Diseases and Recession")

Tooth Jewellery
The beauty of a dazzling white smile can be further enhanced by use of “Tooth Jewellery”. These jewels are made of crystal glass and are available in two different colors- crystal and sapphire blue. They are glued to the front surfaces of the upper anterior teeth. Placing these stones is a very brief procedure but it goes a long way in satisfying the dental cosmetic needs of the patient.

Any of these procedures either singly or in combination can improve your smile remarkably!