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Giving teeth a face-lift.

GIVING TEETH A FACE-LIFT

As a teen-ager, Eric Davidson* was proud of his chipped front tooth--the result of an ice-hockey stick grazing his mouth during a high-school game. "I considered it a badge of honor,' he explained. "Besides, my girl friend thought it was cute.'

* His name was changed, but Eric Davidson's story is a true one.

Ten years later, Eric, a stockbroker, learned that "cute' didn't cut it in the business world. "I found when I was talking to potential clients, their eyes would keep shifting to my mouth,' he said. "They weren't seeing me, or my face; they were seeing my chipped tooth! It made me very self-conscious. What was worse, I thought I was stuck with it.'

Eric's self-diagnosis was wrong. On the recommendation of a friend, he saw Dr. Robert Dolgow, a Ft. Lauderdale, Florida, dentist, who used a simple, one-visit procedure known as composite resin bonding to re-form the missing part of Eric's left front tooth. Eric was amazed at the result. "It looked like the tooth had never been chipped,' he explained.

Friends, co-workers, and family members immediately noticed a difference in his appearance. "Everyone kept telling me how great I looked,' Eric said. "But they thought I had lost weight or changed my hair style. In fact, no one except my mother guessed that it was may smile that had changed. My own brother even complimented me on my "new' eyeglass frames!'

Bonding is actually a catchall term used to describe the process of attaching tooth-colored, moldable plastic or porcelain laminate veneers to the surface of a tooth. Here's how it works: The dentist primes the tooth's surface with a mild acid that creates shallow grooves and fissures. Then he applies a composite resin, molds it into the shape of the tooth, and hardens it with a high-intensity light. The process, developed in the mid-1950s, has revolutionized dentistry.

"Before bonding, patients like Eric, with a healthy tooth that was broken, chipped, or fractured, had only two choices: file down the tooth in order to cap it with a porcelain crown or live with the disfigurement,' Dr. Dolgow explains. "Bonding literally filled the cosmetic gap in dentistry.'

Bonding is also used to whiten stained or discolored teeth, close gaps or spaces, lengthen short teeth, widen narrow teeth, and sometimes make certain crooked teeth look straight. The procedure is painless, and no anesthesia is needed.

The dentist can apply composite resin directly to the tooth, or he can attach, like a false fingernail, the composite resin or porcelain laminate veneer sculpted by a laboratory. "Direct application requires the dentist to have a fair amount of artistic skill, because the resin must be carved or molded to the shape of the tooth,' explains Dr. Ronald Goldstein, an Atlanta dentist and a clinical professor of restorative dentistry at the Medical College of Georgia's School of Dentistry. The better the artistic nature of the dentist doing this process, the better the result will be.

A new generation of composite resins allows dentists to mix and layer color tints and "opaquers' in much the same way that highlighters and other facial cosmetics can be blended to achieve various effects. Layering takes extra time, but an artistic dentist can reproduce the translucency of natural teeth.

Direct bonding is considered a conservative restoration. "Little to no enamel is removed,' Dr. Dolgow explains. "This means the patient still has the option of taking advantage of future technological developments.'

Indirect bonding using porcelain laminate veneers is more radical, but it is often the bonding of choice when teeth have been badly discolored by such medications as tetracycline, because the layering of color can be more precise.

In indirect bonding, the enamel on the front of the tooth must be reduced slightly so the tooth will not appear bulky when the porcelain shell is bonded into place. The chief disadvantage of this system, Dr. Goldstein says, is that the composite resin used to bond the laminate to the tooth can alter the veneer's color. "It can either lighten or darken the shade of the porcelain,' Dr. Goldstein says. "The problem is, once the laminate is affixed to the tooth, it is impossible to remove it without literally cutting it off and redoing the process.'

Nevertheless, porcelain laminate veneers have grown in popularity. "Porcelain can look closer to tooth enamel over an extended period of time,' Dr. Goldstein says. "The reason is, the surface of porcelain is highly glazed while the surface of composite resin bonding can only be highly polished. Over a period of time, the polish will dull, but the porcelain will retain its glaze. Porcelain laminates are also less likely to chip or stain--the two faults of direct bonding.'

All bonded teeth require special care. "You can't do everything you might do with your natural teeth,' Dr. Goldstein says. "I recommend patients quit smoking, avoid large amounts of coffee and tea, not chew ice, and avoid biting bonded teeth directly into hard foods such as ribs, apples, and carrots.'

The aesthetic uses of bonding continue to grow. Bonding is now used to:

--anchor fixed bridges for missing teeth;

--fill cavities on highly visible tooth surfaces;

--attach orthodontic braces to teeth;

--cover and protect the exposed roots of teeth where the gum line has receded;

--seal the pits and fissures on the biting surfaces of children's back teeth to prevent decay.

The bottom line, Dr. Goldstein says, is that bonding has made it possible for many to have better looking teeth and therefore a better self-image. Eric Davidson agrees. "It's made a tremendous difference in the way I act around friends and customers,' he says. "Now I smile with confidence.'

Photo: Porcelain laminate treatments gave Kathy Payne's tetracycline-mottled teeth (above) a movie-star sheen.

Photo: Dr. Goldstein makes a perfect match using his new color-corrected high-intensity lamp.
COPYRIGHT 1987 Saturday Evening Post Society
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1987 Gale, Cengage Learning. All rights reserved.

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Title Annotation:dentists using resins and porcelain laminates to repair teeth
Author:Senz, Laurie S.
Publication:Saturday Evening Post
Date:Oct 1, 1987
Words:973
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