A-List Smile

March 2006 Special Advertising Section

It’s no surprise that cosmetic dentistry is one of the fastest growing areas in the dental industry. As continually evolving technology is making a better smile easier to achieve, self-improvement shows like Extreme Makeover are visually driving home the notion that good teeth can make all the difference in one’s overall well-being.

Think your smile is in need of a makeover? Here’s a look at some of the most popular cosmetic procedures.

Teeth Whitening
What it is: Teeth whitening, or vital tooth bleaching, lightens teeth and removes stains. It can be done either during a dental visit or at home using a custom-fit tray that a patient applies daily; both employ various concentrations of a peroxide solution. Zoom and Britesmile are the brands to watch for.

Best candidates: The patients who get the best results are those whose teeth are free from crowns, veneers, and other restorative material. 

What you can expect: With the in-office procedure, dentists can lighten teeth up to fourteen shades in less than two hours, according to Walter Palmer, a cosmetic dentist with River Bluff Dental in Bloomington. The take-home procedure achieves similar results, but patients apply it at home daily for thirty minutes (for two to four weeks) using a tray that is custom fit to their mouth over two dental visits.

What it costs: $350 to $500 for take-home kits. In-office treatments range from $600 to $750.

Maintenance: Teeth whitening can last for months with proper dental hygiene and moderated use (if not complete avoidance) of stain culprits such as tea, soda, cigars, and coffee. Touch-ups, which can be done at home or in short office visits, are recommended every six months.

Tooth Shaping/Recontouring
What it is: “Tooth recontouring and reshaping is a very simple, non-invasive way to perform minor aesthetic improvements to the shapes of teeth,” says Steven Gorman, who heads up the Gorman Center for Fine Dentistry in North Oaks. “It’s best used to do things like even heights on teeth, make minor crowding situations look less crowded, reshape overcontoured dentistry, or even out or soften corners on teeth with uneven wear.”

Best candidates: Those looking for an economical (and quicker) alternative to more involved aesthetic procedures, such as veneers or crowns.

What you can expect: During a single appointment, the dentist will repair the problem areas.

What it costs: Anywhere from $100 to $500 per tooth, depending on the extent of repair required.

Maintenance: “The materials can discolor with time and do wear out even with normal chewing and home care,” Palmer says. And because the effects of the procedure last only about one to four years, Palmer regards it as a less-than-ideal option by today’s standards, particularly when durable materials such as veneers and crowns can be used instead.

Veneers and Crowns
What they are: Veneers are thin pieces of durable ceramic that cover the front and sometimes side of the tooth. Crowns are caps made of either metal, resin, porcelain-fused-to-metal, or ceramic, and cover a large area of the tooth. “We use veneers a lot here, to improve the position, color, shape, and length of teeth and to do minor rotations,” says Nancy Norling, a cosmetic dentist practicing in Minneapolis. “They are custom-designed to look like beautiful, natural teeth.”

Best candidates: “Anyone who has chipped teeth, broken teeth, discolored teeth not resolved by whitening, spotted or striped teeth, crowding, mismatched existing fillings or crowns, worn teeth, unsightly teeth in any way, or anyone who just does not like his or her smile,” says Gorman.

What you can expect: Several teeth or even a full mouth can be treated in two to three visits. During the first visit, the tooth is “prepped”—reduced slightly to make room for the new material—and a temporary veneer or crown is created for the patient to use until the permanent, more durable crown can be crafted. In the second visit, the dentist applies the new crown or veneer. Some dentists are now employing a computer-aided design technology called CEREC. Using a scanned model or a photograph of the prepared tooth, CEREC creates ceramic restorations using a milling machine right in the office, thus eliminating the extra step of sending the case to the ceramist—and also allowing your dentist to finish the work in one visit.

What it costs: $900 to $2,000 per tooth. Insurance may cover all or a portion of the procedure if it is necessary to retain the health of the tooth or if it is done to replace failed dentistry. If the procedure is purely elective and for aesthetic reasons only, it is not covered by most dental plans.

Maintenance: Caring for a crown or veneer requires only basic oral hygiene—regular brushing and flossing. Adult Orthodontics
What it is: Orthodontics realign teeth by moving them into position—either through the traditional bracket-and-wire variety or a computer-generated retainer known as Invisalign.

Best candidates: Many times, adults seeking orthodontics are having work done that has been postponed for decades. In addition, orthodontic care allows cosmetic dentists to complete further restorative work. “Other good candidates for orthodontics include those who want to be the most conservative and least invasive in their approach to a better looking smile,” Gorman says.

What you can expect: Orthodontic work is done over several visits and can take anywhere from a few months to two years.

What it costs: $1,000 to $7,000, depending on the extent of work needed. While many dental plans do cover orthodontics, check the fine print; some exclude adult orthodontics.

Maintenance: Once the work is completed, regular oral hygiene is usually all that is required.

Implants
What it is: The modern, more durable alternative to bridges and removable dentures, implants replace teeth that are missing or have been extracted. “The simplest way to think of them is that they are a replacement for the root of a tooth,” Gorman says. “In healing, the bone attaches to them, making them a solid base to attach a crown to.”

Best candidates: People who want to replace their missing teeth but do not want to deal with the impermanent nature of dentures.

What you can expect: Implants require the expertise of both a cosmetic dentist and an oral surgeon. Once inserted by the surgeon, implants must heal for three to four months. A cosmetic dentist then places a crown over the implant, creating a natural-looking new “tooth.”

What it costs: Costs vary depending on the complexity of the procedure, the experience of the doctor, and the expertise of the laboratory technician. Ballpark estimates range from $2,750 to $3,500 per tooth. Insurance has its limitations but may cover the procedure if the tooth has been lost because of traumatic injury or other qualifying condition.

Maintenance: You can expect periodic follow-up visits to monitor the implant. That said, it’s made of titanium, so it is designed to last for years—most likely, your entire life.

Gum Lifts
What it is: A repositioning of the gum tissue in the front of the mouth.

Best candidates: Those who have excess gum or bone issue or uneven gum lines but otherwise straight, healthy teeth. In many cases, gum lifts are a complimentary procedure performed in concert with other restorative work, such as implants or veneers.

What you can expect: Using a laser, the cosmetic dentist realigns the gum line to balance the level of tissue visible around the teeth. It takes just a few minutes in these simpler cases. In some instances, however, to prevent inflammation, part of the bone must be removed, often requiring the involvement of a periodontist.

What it costs: Fees for simple gum lifts hover around $75. More complex cases can cost several hundred dollars.  Dental insurance covers the procedure in some cases.

Maintenance:

For the Adventurous
Teeth Jewelry: This is bling for your teeth, whether it’s bonding a diamond or other gem to a tooth or placing gold facings. Costs vary widely depending on the extent and nature of the procedure and require extra vigilant oral hygiene to prevent tooth decay and plaque or tartar buildup.

Snap-on Teeth: These removable teeth—often modeled after a celebrity’s beautiful choppers—are “snapped on” to create a temporary stunning smile. Costs range from $100 per tooth to about $1,000 for a full set of upper front teeth. Because snap-ons are usually made of a less durable hard resin or plastic material, they’re not designed to be permanent; in fact, many dentists recommend that they be removed when eating, sleeping, or doing anything beyond smiling for a camera. “It’s a quick fix but is not practical for day to day use,” Norling says. “I am sure that snap-on teeth look nice for a photo, but I can’t imagine that their continued use is good for the real teeth underneath.”

Tom Cruise Dentists uniformly cite Cruise’s asymmetrical smile as needing some additional professional attention. “It drives us cosmetic dentists nuts,” says Steven Lorentzen.  Carol Burnett and Regis Philbin Who has the best teeth of these two? “Carol Burnett has had some veneers and crowns. Whoever did it did a great job. They look very appropriate for her age,” says dentist Ned Windmiller. “Regis has bad teeth not because they are bad looking but because they look too white for his age.”  Eva Longoria “Because it’s symmetrical, her smile looks good, but it’s not something that we would strive to accomplish as cosmetic dentists,” says Steven Lorentzen. “Her two front teeth are very prominent, but for her, they work.” Kirsten Dunst “She could use some cosmetic dentistry,” says Ned Windmiller. “Her laterals—the teeth on the side—project too much.” Kevin Costner “His teeth are crooked, especially his lowers,” says cosmetic dentist Steven Gorman. “Every time he speaks they rise up front and center.” Halle Berry A beautiful smile by all accounts. Says Ned Windmiller: “In a smile design, we try to aim for a smile like hers. The top edge of the teeth follow the contour of her upper lip, while the biting edge of the teeth follow the contour of her lower lip. The shape and color are very natural looking, translucent. Her two front teeth are dominant and symmetrical.” Madonna, Lauren Hutton, David Letterman, Ralph Lauren, Prince Charles All have gaps, even though all could certainly afford to get them repaired. But as dentist Nancy Norling argues, “It may be that the look of their teeth is so much a part of who they are as celebrities that they are reluctant to alter their appearance.” Reba McEntire Another cosmetic dentistry success story. “She had small teeth with gaps,” recalls Ned Windmiller. “Now she has a beautiful smile.” President Bush “His teeth are short and dark and they look very worn, probably because he is so stressed out,” says Nancy Norling.   Katie Couric Dentist Nancy Norling says Couric “would benefit from having her gum tissue taken up so that her teeth could be made to look a little more even.” Cosmetic Dentistry: Q & A Six Twin Cities cosmetic dentists weigh in on what’s new in their field and how best to shop for a great dentist. We asked local cosmetic dentists to ponder three questions about the rapidly growing field of aesthetic or restorative procedures. Participating in the discussion were Walter Palmer of River Bluff Dental in Bloomington; Ned Windmiller of Beautiful Smiles Distinctive Dentistry in Stillwater; Stephen Boger of Boger Dental in New Hope; Steven Gorman of the Gorman Center for Fine Dentistry in North Oaks; Nancy Norling, who practices in Minneapolis; and Steven Lorentzen, who works out of Golden Valley. What new procedures or trends in cosmetic dentistry are on the horizon but not yet available to patients? Gorman: One interesting area is research being done on stem cells to develop real tooth enamel that will be reinforced by fluoride and made into blocks that can be used by dentists and lab techs to fabricate restorations [instead of with] porcelain. Stay tuned. Windmiller: The core used for implants will continue to become more advanced, stronger. Hard-tissue lasers will be used more frequently to remove decay prior to putting in fillings and in a more comfortable procedure. Lab technicians and ceramists will continue to improve the way that they design porcelain crowns. Lorentzen: LED lights are now being used to cure bonding materials because they use less energy and generate less heat than the older halogen lights. Those are neat things for us, but they are not necessarily exciting for the patient. Boger: Dentistry is constantly evolving. I think in the future we are going to be using some new porcelains that we can do even more and better, stronger bonding with. In the arena of whitening, I am sure we will see new whitening products that will be more effective and long-lasting. And we are certainly going to be seeing an explosion in the growth and use of computer-aided design, which is what CEREC is. Laser technology is also evolving. Ultimately, I think we will get to the point where we are reshaping teeth with lasers, not drills. We will end up with quieter and noiseless hand pieces so you don’t hear the noise commonly found in today’s dental offices.

What is the best way for patients to shop for a good cosmetic dentist? Norling: I would encourage patients to review before and after photos of cases from the dentist, and to check out professional cosmetic dentistry credentials. Also, seek out a dentist who has extensive smile design experience. Find a doctor who is honest in his or her assessment of your needs and who conveys confidence that they can give you the best result possible. Gorman: An excellent way to choose an aesthetic restorative dentist is through the American Academy of Cosmetic Dentistry, aacd.com. It can tell you who in your area has shown expertise in these procedures. More important is to choose someone you feel comfortable and confident with. Windmiller: It is helpful to look for those dentists who have been accredited through the Academy of Cosmetic Dentistry. Their credentialing process is rigorous. You have to present case exams to their board of examiners to demonstrate that you have the knowledge and skills to do various cosmetic dentistry procedures. Before-and-after photos from the dentist can also tell you a lot about the quality of their work. Palmer: The best way is to ask friends, family, and coworkers who they go to. Patients who had excellent care and treatment are always excited to tell their friends and family. The Internet is also a very good option. Boger: I would be leery of going to a dentist who did not have a website. It’s a good way to see what their career has encompassed, what their awards and credentials are. You can also call their district dental society to see if they are a member in good standing. Then I would interview the dentist, interview the staff to see if you are comfortable with them. And, of course, I would request photos of their work from several cases. Lorentzen: The American Dental Association does not recognize cosmetic dentistry as a specialty, so it really is left to the patient to do his or her homework. Buyer, beware. Look for a dentist who will listen to you; a less qualified or experienced dentist is one who will tell you right off the bat what you should have done [to your teeth], without even doing an exam. Why are dental offices increasingly looking like spas? Palmer: Many dental offices are incorporating a spa-like atmosphere so patients can feel more relaxed during their time there. Everyone loves to be pampered, even at the dental office. Norling: If we are working on a patient for three or four hours, a lot of times we will have someone give them a seated chair massage. Dentistry doesn’t have to be stressful anymore with all the innovations we have. Gorman: Dentistry has worked very hard as an industry to overcome negative feelings in the public. The advent of elective, aesthetic dentistry has helped turn the offices that practice this kind of dentistry into much more positive places, where new smiles have literally changed people’s lives. The spa amenities are part of a natural evolution into the beauty industry and good for all involved. Windmiller: One of the reasons why people don’t go to the dentist is fear. Fear of the pain, of the needle, bad experiences as a child...all of this can come back to them when they walk into a dental office. Sedation dentistry helps alleviate some of this fear by relaxing them. But by offering music and television or other comforting amenities, it makes the procedure go much faster and seem more pleasant. And that makes them more apt to come back.