I want a perfect smile!

What patients are really after when they ask for a perfect smile.

James Taylor from Made in Chelsea, just finished his whitening treatment.

I get this every day at work, more and more people want to feel better about theirs smiles and very interestingly the search for the perfect smile does not have an age limit, so no matter if the patient is in their 20’s or 60’s they all want to smile more confidently!

But what it is actually a perfect smile? To answer this we need to consider a number of elements that together will visually create a perfectly aesthetic smile. Some of these elements include the position, the shape and the shade of teeth; if any of these is not right the smile does not look as good as it could…

Let’s think about the shape of the teeth now. We know that there are different shaped teeth in our mouth depending on their function, so the front and back teeth do not look the same. So having this in mind what we need to look for perfection is symmetry in the smile, the right and the left side have to look the same.

As we get older our teeth may chip or wear in different patterns and little by little we may be loosing the symmetry that nature gave us.

Bonding

The good news is that there is a dental treatment called bonding that can give back the right shape to your chipped or worn teeth. Bonding is very conservative, as we do not have to drill the tooth surface to do the treatment. Unlike veneers the treatment is reversible as the composite material we use can be polished off and the tooth will go back to how it was before the treatment.

Bonding consist on building up the tooth in layers, using a combination of shades to copy as close as possible the shade of your other teeth and carving the right anatomy of that tooth. The majority of the times you don’t even need anaesthetic to have the treatment done as, I mention before, there is no drilling involve!

Real case

Very recently I done this treatment to one of my lovely patients. Matt’s wedding was a few weeks away and wonder if I was able to help him smile more confidently for his wedding photos; he did not like the shade of his teeth and had always hated the shape of two of his front teeth and the gap between these.

Matt was looking for a time and cost effective treatment. We discussed thoroughly all his options that included:

  1. Whitening with Enlighten Evolution. With this option we would have only improved the shade of the teeth without changing the shape, an option that he discarded straight away.
  2. Bonding. This was advised because his front left teeth are thinner than the ones on the right and they are also slightly misaligned. Because of this the teeth did not look symmetrical and a gap between them forms; by applying composite material to the sides of the teeth we can then widen their size, making them look as wide as the right teeth and restoring the symmetry.
  3. Veneers. With this option we would have also restored symmetry by placing porcelain veneers on his anterior teeth; unfortunately with this treatment we needed to drill away some of his healthy enamel in order to create space for the porcelain. Matt was very keen to be as conservative as possible so decline this option.
  4. Orthodontic treatment with Invisalign. This consists of alignment of his teeth to place these in the right position before building them up; with this option we could have distributed and aligned all his 4 front teeth to create the ideal symmetrical spaces to then build up to the right width each tooth. Unfortunately for this options we needed at least 4 months and the wedding date was only 8 weeks away.

So having taken in consideration the time available before the wedding, his budget and his wishes we decided to do Enlighten Whitening followed by bonding.

It is very important to mention that every time we treat anterior teeth, we need to make sure that the patient is happy with the shade of their teeth; if they are considering teeth whitening in the near future we need to advice this to be done before any work is carried out at the front teeth. Imagine having invested time and money on your front teeth, a few years later you want your teeth to be whiter and your dentist turns around and says that you cannot have it done! The reason is that any filling, bonding, crown or veneer you have will not change shade, the whitening gel only works on natural teeth. This basically means that you either live with that teeth shade, or you have to change all the work previously done!

So, back to Matt’s teeth his whitening was very successful and only took a couple of weeks to achieve a great result.

Two weeks later I did the bonding treatment, these 2 weeks break between whitening and bonding is very important to achieve a better shade match (the teeth shade will be more stable) and better adhesion of the composite material to the tooth surface.

I started the bonding by choosing the right shade, matching it to his other front teeth, this is crucial to achieve very natural results; after this, I cleaned the tooth surface, apply some adhesive and started the build up by layers; I distributed the space available between the 2 teeth I was working on, coping the anatomy and features of the opposite teeth.

I finalised the treatment by polishing the surface of the fillings to remove any excess material and to make them shinny.

Matt was amazed with the results and felt really happy and confident to smile for his wedding.

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