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Issue Date: July 2005 Issue


Dental Details

From simple whitening to advanced neuromuscular techniques that could finally cure those headaches, what advances in cosmetic dentistry mean to you.
Karen Fuller

The extreme makeover is no longer shocking. Now that smiles (and everything else, for that matter) are being revamped on television in the span of 60 minutes, more and more people are considering cosmetic dentistry as a way to freshen their look or help boost their self-esteem. But this spike in interest also means cosmetic dentistry patients demand excellent results in the shortest time possible.

Technological advancements in the field make both possible, but most potential patients are filled with questions. So we turned to a handful of local experts to help you understand what options are available, so you can decide what's right for you.

Of course, the most important first step is finding the right dentist for the results you hope to achieve. Consider training, equipment and your own comfort level with the doctor. Ask to see before-and-after photos and even ask to talk with satisfied customers. Your dream smile may be closer than you think.

White Out

By far, the most common cosmetic dentistry procedure is tooth whitening. As procedures have changed over the years, the process has become predictable and safe with excellent results. Plus, the price keeps dropping. Many dentists offer one-hour tooth whitening for $500 to $600 -- a price comparable to many do-it-yourself, take-home whitening kits.

There are two common methods of tooth whitening used in the field of cosmetic dentistry. The most popular, because it provides immediate results, is BriteSmile. The procedure can achieve in one hour what used to take weeks. During three, 20-minute segments, a patient's teeth are coated with gel and exposed to a special light.

"It's very, very effective and safe," says Dr. Stuart Katz, who has a practice in Beachwood. "Results last many years -- especially in patients who are careful not to abuse the teeth with coffee, cigarettes and bad brushing habits."

The second method involves a custom-made tray that fits over the teeth. Patients wear the trays filled with whitening gel every day for two to three weeks, or until the desired result is achieved. Katz says the popularity of the BriteSmile process is decreasing the demand for this at-home tray method.

"Tooth whitening makes a huge difference in a person's overall appearance," Katz says. He says he's had patients come in hoping to get veneers to correct crooked teeth, but after whitening, they were pleased enough with the results to cancel the veneers. "It really does make people look younger."

Crowning Achievements

Being fitted for crowns used to be a laborious process that took weeks to complete. Then came the CEREC machine, which allows for tooth restorations such as crowns and veneers in a single visit. The Chairside Economical Restorations of Esthetic Ceramic machine creates ceramic tooth restorations that are long lasting, durable and virtually impossible to tell from an actual tooth.

But the machine is expensive -- about $100,000 -- so not all dentists have one. Dr. Daniel Koplow, whose practice is in Lyndhurst, is one area dentist who has the machine.

"Using CEREC, I can save the good part of the tooth and build around it like a puzzle piece," he says. "I can do in one visit what used to take weeks to complete. And there are no temporary teeth involved."

The CEREC machine's computer takes a picture of the tooth and sends it to the milling area of the machine, which sculpts a piece of ceramic to fit. What's more, it costs a little less than a traditional crown and the process is covered by most dental insurance policies.

"You can't beat it," Koplow says. "In my opinion, there's nothing better."

Dr. Scott L. Rose of the Center for Aesthetic and Restorative Dentistry in Solon agrees.

"Our patients love it," he says. "They love the technology of it, the immediate results and the quality of the final product -- extremely strong and lifelike with no use of metals."

Very often, Rose uses the CEREC machine to replace a patient's old mercury fillings.

"There are very good reasons to replace the fillings," he says. "Appearance -- a white, bright smile should include the entire mouth, not just the front teeth -- and tooth health. Metal can sometimes block out decay alongside the filling where deterioration may be spreading."

CEREC machines can also make veneers -- thin films that bond directly onto the front of the teeth, covering any imperfections -- in a single appointment.

"With this procedure, patients who walk in with yellow, crooked teeth, can walk out with teeth that are straight and white," Koplow says. Another type of veneer is Lumineers, which Koplow compares to contact lenses for the teeth. "They're popular because they're so thin -- they don't feel thick and foreign in the mouth."

Lumineers do take two appointments to complete and are a good choice when getting a veneer on only one tooth, because they can be shaded to exactly match the color of surrounding teeth.

Beyond the Surface

Dentists are trained to treat hard tissue -- teeth. But another branch of the practice, neuromuscular dentistry, deals with the soft tissue that supports a smile -- the muscles that hold everything in place.

"Your facial features contribute heavily to the outcome of your smile," says Dr. Rose of the Center for Aesthetic and Restorative Dentistry. "Some people have great teeth, but suffer from TMJ, head pain or an unattractive overall smile. Neurological dentistry offers a way to fix those conditions."

Rose uses sophisticated equipment to track a patient's jaw to determine the position it would like to be in as determined by the muscles.

"We can find the way that the muscles feel most happy," explains Rose. "When we create a smile in that position, the muscles relax, resulting in facial harmony and balance."

Adjustments are made using a combination of crowns and veneers created on site with a CEREC machine.

"I actually had the procedure done myself for cosmetic reasons and for help with headaches I was having regularly," Rose says.

Most headaches have a muscular component to their root cause, and in many cases, relaxing the affected muscles can treat the problem, according to Rose.

"It's kind of like having plastic surgery without the surgery," he says.

Neurological dentistry really personalizes the cosmetic dentistry experience because it takes into account a patient's unique muscle structure, says Rose, who also considers the patient's age, sex and personality when improving a smile.

"Cosmetic dentistry needs to be personalized," says Rose. "People don't want teeth that look like pieces of Chicklets gum."

Mouth Makeovers

A "smile makeover" can include anything from simple tooth whitening to fixing crooked, overlapped, worn, chipped and broken teeth. Even a "gummy smile" can be repaired as part of a smile makeover. Television shows such as "The Swan" and "Extreme Makeover" usually employ this involved procedure to provide such dramatic changes.

But only about 2 percent of the dentists in the United States and Canada are trained at this level of expertise, having undergone intense, hands-on training at the Las Vegas Institute and Rosenthal Institute for Aesthetic and Cosmetic Dentistry. Dr. Anthony Heibili, whose practice is in Rocky River, is one of them.

He explains that he works exclusively with labs that have undergone the same training, as he has to ensure quality work. "We work hand-in-hand with the labs to achieve the results we want for our patients," he adds.

"Occasionally, if a mouth is in very poor condition, we have to rebuild it entirely," Heibili says.

Depending on the severity of the case, a complete smile makeover using an institute-trained dentist can take two to three visits or up to about three weeks. During the process, Heibili says, a patient will wear temporary teeth, which look great and provide dramatic results.

"A smile makeover can dramatically enhance appearance to the point of changing your life," he says. "It boosts confidence and self esteem."


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