Cosmetic Dentistry

Cosmetic dentistry includes a variety of dental treatments aimed at improving the appearance of the teeth.

Metal-Free Dentistry

Some holistic dentists don’t believe in using metal for any dental restoration,
including metal onlays, crowns, and bridges (most onlays and crowns used today
are gold or other metal alloys). Today, the most prevalent material used in metalfree
dentistry is based on the same composite material that’s used for fillings,
but reinforced with interspersed translucent fibers. When these fibers have been
added to a composite, it can be as strong as the traditional porcelain-to-metal
crown (described later in the chapter), and has the added advantage of being an
excellent replacement for metal crowns and onlays.
Many metal-free dentists believe that any metal dental restoration, aside from
being a possible allergen, will interfere with the normal flow of energy along the
body’s meridians. This belief is based on an eastern philosophy of healing that says
that every organ and every part of the body is directly linked to a specific tooth
via meridians, or energy highways. Not everyone will exhibit a health problem
directly related to having metals in their teeth, but those who are very sensitive,
or whose health has been severely compromised, will be more susceptible.
At the date of publication, metal-free dentistry is still relatively new and
the life expectancy of metal-free onlays, crowns, and bridges is still unknown.
However, one of the positive aspects of this approach to restoring teeth is that
the restorations can be easily repaired.

Want Whiter Teeth?

Our doctors can treat discolored, stained or aging
teeth with our state-of-the-art whitening process. The
treatment can be completed in just
over an hour in our office, or you
can choose at-home treatments.
The ZOOM!@ Chairside
Whitening System is a
scientifically advanced, tooth
whitening procedure. It’s
safe, effective and fast, very
fast. In less than an hour your
whiter. A dazzling smile isn’t just for
celebrities any more. It’s for you, because
you’re worth it.

Suffer from Chipped or

Badly Stained Teeth?

Bonding can yield dramatic results in a single office
visit. We use dental bonding to sculpt individual teeth
with a special tooth-like material that looks, acts and
feels like the real thing. Bonding is an affordable,
quick and painless way to repair many cosmetic flaws
or injuries.

Composite Fillings

The composite filling is the material used most often to replace amalgams. Of
course, you’ll always find there are exceptions. For example, the composite should
only be used ifthere’s still enough tooth structure left to support the filling, and if
there isn’t, an onlay or crown is the best choice. I’ll start with composites because
they’re so widely used and questions about their safety have recently been raised
by some dentists and researchers.

Composites have truly revolutionized modern dentistry. Composite material

has been available since the late 1950s and, due to the ever-increasing demand
for it, it’s constantly being improved. The latest generation of composites are
far superior in regard to strength, durability, and adhesion to the tooth surface,
than those used just 5 years ago. They’re not only a vast improvement on earlier
ones, but are also a far better filling material than mercury fillings in terms of
function, aesthetics, and most importantly. . . safety.

Another important quality ofcomposites is that preparing a tooth for a composite

filling is far less invasive than preparing it for an amalgam filling, and
significantly less tooth structure is lost in the process. A composite is also easy
to repair if a piece chips off. Unlike amalgams, which don’t bond to the tooth,
the more recent generations of composites will strongly bond with the tooth
structure, literally gluing the walls of the tooth and filling together, making the
tooth a lot stronger than one with a comparable mercury filling.

However, placing a composite takes more skill, experience, and time than

putting in a mercury filling, plus special equipment is needed. The additional
time involved is due to the fact that a composite has to be placed in layers, and
each layer has to be cured by a special light to harden it. As a result, the cost of a
composite can be 25 to loo percent more than a comparable amalgam. The lifespan
of a composite varies from about 7 to 12 years-similar to an amalgam-and
generally speaking, the smaller the composite, the longer it will last. But, most
importantly, composites don’t release mercury vapor.

Direct composites are placed in one appointment and will shrink slightly

during the curing process and, unless properly placed, the integrity of the margin
(where the filling meets the tooth) can be compromised. (I’ll discuss the difference
between “direct” and “indirect” composites later in this chapter.) Like
any dental filling, composites need to be well cared for to prevent redecay. So if
you are decay prone, you’ll have to make sure you’ve established a good dental
hygiene program.

Any filling material placed in, or over, a tooth can cause it to be sensitive to
heat and cold, and composites are no exception. Sensitivity usually doesn’t last

more than 7 to 10 days but can last for up to 6 weeks. The key here is that the
newly filled tooth should get progressively less sensitive each day. If the sensitivity
doesn’t decrease over time, or intensifies, make sure you immediately bring it to
the attention of your dentist. Sensitivity is more likely to be experienced with fillings
that are large, deep, and placed close to the nerve-rich dental pulp. If you’ve
been sensitive to the placement of any dental restoration in the past, be sure to
let your dentist know ahead of time, as there are ways to minimize sensitivity.
Most dentists do this routinely, but it can’t hurt to remind yours.

Composition of Composites

Composites consist of monomers (also referred to as a matrix or a binder) and
fillers. In addition to monomers and fillers, composites also contain initiators and
stabilizers. Initiators are light sensitive substances that promote the polymerization
of the composite when cured with a light source, and stabilizers provide strength
to the composite resin. Polymerization is a process where the same monomer is
layered together many times to form a larger structure of the same material. Calcium
carbonate, also know as limestone, is an example of a stabilizer.

The most common fillers are a combination of quartz, zinc glasses, lithium aluminum
silicate, barium, and strontium. The most commonly used monomer is Bis-GMA, a
compound composed of Bisphenol A (BPA) and glycidyl estermethacrylate (GMA).
The chemical name for Bis-GMA is bisphenol A diglycidylethermethacrylate.
(Bisphenol A is an industrial chemical used primarily tomake polycarbonate plastic
and epoxy resins, including food packaging containers, plastic bottles, plastic toys,
and water pipes.) In addition to Bis-GMA, you’ll find a few other monomers used in
composites-the Bisphenol dimethacrylates (Bis-DMA), ethylene glycol dimethacrylate
(EGDMA), and triethylene glycol dimethacrylate (TEGDMA). When these materials
are mixed together they form a paste-like substance. The paste is then applied to the
tooth’s cavity in layers. Each layer is then hardened, or “cured,” by using an
ultraviolet (UV) light, or a visible light source.

I know that these terms are quite a mouthful and I’ll make every effort to simplify.
Although I feel it will be helpful to those who want to do their own research on
composite fillings, I fully understand if you decide to skip through this section and
decide take the advice of your mercury safe dentist.

CEREC Restorations

CEREC is the acronym for a pretty fancy-sounding process-Chairside Economical
Restoration of Esthetic Ceramic. Now say that five times fast! But don’t worry if you can’t because CEREC refers to a process where the dentist uses a patented computer-assisted technology to make a ceramic dental filling. The dentist first takes a three-dimensional (3-D) photograph of the prepared cavity. This image
is then stored in the computer, which uses 3-D CADICAM software to refine the 3-D digital model. (CAD is the acronym for Computer Aided Design and CAM
is the acronym for Computer Aided Manufacturing.)

Once the software has analyzed the cavity size and approximated the shape of the tooth and filling needed, a milling machine, controlled by the computer software, carves a finished restoration from a solid ceramic block. The filling is refined, fitted, the occlusion is adjusted, and then finally it’s bonded and cemented to the tooth just like an indirect composite, inlay, or onlay would be. The big
difference is that you get the equivalent of an indirect composite in just one visit
to the dental office.

The CEREC system was developed in 1987 and in the hands of a skilled dentist,

there’s no doubt that the latest generation of composites and CEREC ceramics
are far superior to amalgam fillings-and are a very safe filling material. The
development of composite material, both direct and indirect, and the CEREC
system of tooth restoration, makes the ADA’s argument that amalgam is a better
filling material impossible to sustain.
Replacing Your Mercury Amalgam (Silver) Fillings 95

CEREC is truly an example of space age dentistry with the additional advantage

of having a harder, better-fitting, and longer-lasting filling than amalgams
or direct composites. Also, X-rays can penetrate a CEREC crown, allowing the
dentist to see what is underneath. This is useful for detecting redecay or determining
if any amalgam was left behind. Plus, CEREC has the advantage ofbeing
free of Bis-GMA. To date, not all dental offices have the CEREC system.

Aesthetic Dentistry of Lake Oswego