Smile Makeover: A Guide to Cosmetic and Restorative Procedures

 

“Nothing you wear is more important than your smile.”        – Connie Stevens

 

As an outward signifier of confidence and temperament, your smile says a lot about you. That’s why, if your smile has imperfections, you may experience negative consequences. Fortunately, these days most smile defects are easy to remedy, thanks to innovative dental techniques and procedures. This process of correcting a defective smile is often referred to as a “smile makeover.”

A smile makeover may entail one or more of the following measures:

• Restoring missing teeth
• Repairing damaged, decayed or misaligned teeth
• Adjusting an uneven or disproportionate gum line
• Correcting an improper bite
• Replacing old, unattractive dental treatments

 

Cosmetic dentistry and restorative dentistry in harmony

A smile makeover may sound like a solely cosmetic enterprise, but it’s often more complex than that. In fact, smile makeovers are where the spheres of cosmetic dentistry (improving aesthetics) and restorative dentistry (restoring tooth function) often converge. In some cases, cosmetic measures like teeth whitening or recontouring are sufficient; in others, restorative measures like crowns or implants may be required. Often, a smile makeover involves both of these dental disciplines.

In this article, we’ll cover the wide range of smile makeover procedures available today. We’ve divided them into categories of “cosmetic smile makeover procedures” and “restorative smile makeover procedures.” Bear in mind that some procedures fall into both categories; however, we’ve attempted to classify them as accurately as possible.

 

 

Cosmetic smile makeover procedures

Cosmetic dentistry is primarily concerned with improving or restoring the aesthetic appearance of one’s teeth, gums and overall smile. In this section, we’ll cover the following cosmetic smile makeover procedures:

• Teeth whitening
• Tooth recontouring
• Veneers
• Braces/clear aligners
• Periodontic procedures

 

Teeth whitening

Timeline: 1 hour for in-office; 1 week for at-home

Cost: $400-$600 for in-office; $200-$400 for at-home

Longevity: Permanent; however, lifestyle choices may require further treatment

The simplest of smile makeover procedures, teeth whitening is an easy and affordable technique for restoring the natural color of your teeth. Over time, substances like coffee, wine, cigarettes and certain foods can cause teeth to become discolored. Teeth whitening utilizes chemical bleaching agents to break up the stained enamel and reveal your teeth’s natural hue beneath.

There are different levels of teeth whitening, including in-office and at-home treatments. At an in-office treatment, the dentist will insert a cheek retractor into the patient’s mouth to expose the teeth. The dentist will then apply the whitening product (typically a peroxide-based gel) to the teeth and activate it with a curing light or laser. Following activation, the gel will remain on the patient’s teeth for 15 to 30 minutes, then (typically) be reapplied. The number of reapplications (if any) during a given whitening procedure may vary depending on the particular type of treatment used. By the procedure’s end, the patient’s teeth should be roughly four to eight shades whiter.

Some people choose to do at-home treatments, using custom-fit trays cast by their dentists. While less expensive than in-office treatment, at-home whitening is far more time-intensive, as the person must perform the procedure for roughly an hour each day for a week. However, by the end, the person should see a substantial improvement in their teeth’s coloration.

There are also less expensive, over-the-counter teeth whitening treatments you can buy from your local drug store. However, these products are far less effective than professional treatment. In other words, you get what you pay for.

The effects of tooth whitening are essentially permanent. However, if you smoke or ingest food and beverages that stain the teeth, you may need additional treatments in the future.

 

 

Tooth recontouring

Timeline: 30-60 minutes (1 office visit)

Cost: $50-$300 per tooth

Longevity: Lifetime

Tooth recontouring (also known as enameloplasty) is a technique used to reshape slightly crooked or uneven teeth and give them a more symmetrical appearance. In some cases, this involves strategically altering teeth to create the illusion of straightness—for example, changing the way light hits them to create shadows. One potential disadvantage of tooth recontouring is that it’s irreversible. Additionally, its effects are limited—after all, you can only remove so much of a tooth before issues with sensitivity arise. However, tooth recontouring remains a viable and economical option for correcting minor aesthetic irregularities.

 

Veneers

Timeline: 2-4 weeks (2 office visits)

Cost: $900-$1,500 per tooth for porcelain; $500-$800 per tooth for composite

Longevity: 10-15 years for porcelain; 5-7 years for composite

Veneers provide a simple and efficient fix for discolored, chipped, worn, broken or misaligned teeth. A veneer is a thin, ceramic shell that’s bonded to the front of a damaged tooth to alter its color, shape, size and/or length. Veneers can be made from porcelain or a composite resin material; however, porcelain’s superior stain resistance and natural look make it the best option for a smile makeover.

Prior to installation, a veneer needs to be designed and manufactured. To begin, the dentist will remove an amount of enamel from the tooth surface roughly equal in thickness to the incoming veneer (usually about half a millimeter). Next, the dentist will take an impression of the tooth, which will serve as the basis for the veneer’s design. The impression is sent to a laboratory, where a technician will design and manufacture the veneer. The turnaround time for the finished veneers is typically two weeks.

At the time of installation, the dentist will roughen the tooth (to promote bonding), cement the veneer to the tooth and apply a curing light to harden the cement. Lastly, the dentist will remove any excess cement, assess the fit and make any needed final adjustments.

As with tooth recontouring, a potential drawback of veneers is the need for enamel removal, which is irreversible and may cause teeth to be more sensitive to cold and hot food and drinks. However, due to their durability and simple installation, veneers can be an ideal solution for the right application.

 

 

Braces/clear aligners

Timeline: Varies from a few months to 2.5 years

Cost: Varies considerably depending on the style and extent of treatment

Longevity: Lifetime

Orthodontic measures like braces are commonly used by younger patients to straighten uneven adult teeth. However, they aren’t just for kids—many adults also utilize braces and clear aligners to correct problems with crooked/overcrowded teeth or an uneven bite.

These days, there are several orthodontic smile makeover options to choose from, including:

• Traditional metal braces
• Ceramic braces (white in color to blend in with the teeth)
• Lingual braces (cemented to the backs of the teeth to minimize visibility)
• Clear aligners (a series of clear, removable trays worn in the mouth and replaced successively every couple of weeks)

Not surprisingly, clear aligners (such as Invisalign®) have become the most popular orthodontic option among adult patients. Similar to a mouth guard, a clear aligner is worn throughout the day but can be removed for eating and oral hygiene. Every few weeks, the patient upgrades to a subsequent aligner that’s slightly altered from the last. Following the last of the prescribed aligners, the teeth will have made the desired transition.

Depending on the extent of the desired effect, a clear aligner treatment can take anywhere from a couple of months to a couple of years. Regardless of the timeline, the advantages are, like the treatment itself, clear: it requires no cementing, brackets or metal wires and no eating restrictions. Additionally, what little aesthetic impact the aligners have is made up for by their removability.

However, these conveniences come at a price—one that greatly exceeds the cost of traditional braces. Additionally, clear aligners have their limitations: they can only be used for minor cases of misalignment and cannot correct major malformations.

 

Periodontic procedures

Timeline: 1 office visit

Cost: $1,000-$2,000 (per area of the mouth)

Longevity: Lifetime

A smile makeover sometimes involves going beyond the teeth to address other areas of the mouth. For example, gums play an important role in the appearance of one’s smile. Gum enhancement procedures are the domain of yet another dental sphere, known as periodontics.

There are several ways the gums can be improved to enhance one’s smile. For example, a “gummy” smile (where the teeth appear too short) can be made to look more proportionate by removing excess gum tissue (a procedure known as gingivectomy) and reshaping the remaining tissue (gingivoplasty). Additionally, the effects of gum recession can be amended via gum grafting, wherein gum tissue is removed from other areas of the mouth and used to supplement recessed areas. Furthermore, laser gum contouring is a cutting-edge procedure that can both remove excess gum and optimize the appearance of the gum line. These types of periodontic procedures provide an effective means of correcting gum-related smile defects.

 

 

Restorative Smile Makeover Procedures

Restorative dentistry is primarily concerned with restoring tooth function through repair or replacement of damaged or missing teeth. Due to their inherent cosmetic effects, restorative procedures are commonly incorporated into smile makeovers. In this section, we’ll cover the following restorative smile makeover procedures:

• Composite restorations
• Ceramic crowns
• Dental bridges
• Dental implants
• Implant overdentures

 

Composite restorations

Timeline: 1 office visit

Cost: $200-$450 per tooth

Longevity: 5-10 years

Composite restorations involve the use of a bonding agent (usually a composite resin) to repair damaged teeth. The most common application is cavity fillings. While silver amalgam fillings were once the standard for repairing cavity damage, today’s composite fillings match the natural color of the teeth. Whether you need first-time fillings or have old silver amalgam fillings that you want replaced, composite fillings are affordable and effective.

Prior to application, the dentist will roughen the surface of the tooth and, if needed, apply anesthesia. After applying the composite resin to the damaged area, the dentist will mold and smooth it to the desired shape. Once everything looks correct, the dentist will use a curing light to harden the resin. After a little additional trimming and shaping, the dentist will polish the composite resin to match the rest of the tooth surface.

 

Ceramic crowns

Timeline: 2-4 weeks (1-2 office visits)

Cost: $1,000-$1,500 per crown

Longevity: 10+ years

As a dental procedure, ceramic crowns fall directly between cosmetic and restorative dentistry. They’re often used to protect weak or damaged teeth, but they may also be used to cover misshapen or discolored teeth. Additionally, crowns may be used to supplement other dental prosthetics like bridges or implants. While crowns are available in a few different materials, ceramic is the most commonly used, due to its similar coloration to natural teeth.

Getting a ceramic crown typically involves two visits: one for examination, fitting and preparation, and one for installation. Some dental offices have the capability to fit, manufacture and install crowns the same day, using digital impressions and an in-office milling machine. Others prefer to have crowns manufactured at a lab, where more time can be allotted for achieving the desired shape and coloration.

Compared to most other restorative procedures, crowns represent a fast, simple, and affordable way to restore a tooth’s function and appearance. However, there are some potential drawbacks. Crowns can become loose and fall out; in such cases, they can typically be cemented back in place or replaced. Additionally, unlike dentures and bridge work, dental crowns leave your nerve endings in place, which may lead to gum pain or heat and cold sensitivity. There’s also a small potential for bacteria to get under the crown and damage the tooth underneath; this can usually be avoided with good oral hygiene.

 

 

Bridges

Timeline: 2-4 weeks (2 office visits)

Cost: Varies depending on size and type; $1,000-$1,500 per artificial tooth

Longevity: 10-15 years for conventional; 5-7 years for resin-bonded

Bridges are dental prosthetics used to fill in gaps created by missing teeth. A conventional bridge consists of one or more “pontics” (false teeth), supported on both sides by crowns capped onto existing teeth or surgically installed implants.

Bridges typically require two office visits to complete. At the first visit, the supporting teeth (called abutment teeth) will be prepared for the incoming crowns. The dentist will drill these teeth down, using local anesthesia to minimize discomfort. Next, digital impressions are taken and sent to a lab, where the crowns and bridges will be manufactured. The patient will receive a temporary bridge to wear during the interim. When the permanent bridge is ready, the patient will return to have it cemented in place.

A less intensive option is a resin-bonded bridge. In this instance, the replacement tooth is supported on thin metal plates glued to the insides of the adjacent teeth. While not as durable as a conventional bridge, the upside of a resin-bonded bridge is that the adjacent teeth don’t need to be shaved down.

While a dental bridge can effectively restore the practical function and cosmetic appearance of missing teeth, there are a couple of potential drawbacks to be aware of. For conventional bridges, the main drawback is the fact that healthy teeth need to be shaved down to accommodate the incoming crowns. Additionally, since a bridge is permanently fixed into position, flossing between the adjacent teeth can be challenging. However, when it comes to restoring a missing tooth, a bridge represents an economical alternative to the far costlier measures of getting a dental implant.

 

Dental Implants

Timeline: 5-10 months

Cost: $4,000-$5,000 per implant/crown

Longevity: Lifetime

Dental implants represent a permanent solution for restoring one or more missing teeth. An implant consists of a titanium post that’s surgically installed in the jawbone, onto which an artificial crown or dental appliance can be fastened. Implants may be installed to restore individual teeth or to support bridges, removable overdentures, or fixed dentures.

Dental implants improve upon the functional shortcomings of other tooth replacement prosthetics (like bridges). Since they’re drilled into the jawbone as free-standing teeth, they don’t require support from adjacent teeth like bridges do; thus, no additional teeth need to be altered for installation.

The time frame for getting dental implants depends on a variety of factors, but in general, it requires multiple office visits and procedures over the course of several months. At the initial consultation, the dentist will take x-rays (and possibly a CT scan) to assess the patient’s jawbone density/quantity and locate sinuses and nerves. The dentist will use this information to determine the best placement for the implants and whether bone grafting is needed.

Installing the implants requires two separate surgeries. First, implant posts are installed into the jawbone. The second surgery takes place once osseointegration (the process wherein the post becomes integrated into the bone) has occurred. The implant posts are re-exposed and healing caps are applied. A few weeks later, the healing caps are replaced by abutments, upon which the artificial crowns or dental appliance will be affixed.

Dental implants are designed to last a lifetime. Even if a crown is damaged, a replacement crown can be made and affixed to the implanted post. Naturally, the biggest downside of dental implants is the extremity of the procedure, which includes an extensive treatment timeline and high cost, as well as potential risks and complications involved with surgery (infection, nerve damage, sinus problems). Additionally, dental implants occasionally fail, usually due to peri-implantitis (a form of gum disease that attacks dental implants) or failed osseointegration. However, such failures are rare, with more than 95 percent of dental implant procedures resulting in success.

To learn more about the benefits of dental implants, watch this informative video by Dr. Alfred dela Cruz:

 

 

Implant overdentures

Timeline: 6-12 months

Cost: $7,000-$9,000 (2 implants, 1 denture); $14,000-$18,000 (4 implants, 2 dentures)

Longevity: Lifetime for implants; 5-8 years for dentures

Implant overdentures are removable dentures that use implant technology for improved function. Unlike traditional dentures, implant overdentures are snapped into place upon surgically installed implant posts, which provides greater stability, among other advantages. Since functional issues are more common with lower dentures, implant overdentures are most often applied to the bottom jaw. They can, however, be applied to the upper jaw as well.

Implant overdentures entail virtually the same process as regular implants, which includes an extensive timeline and multiple surgeries. Additionally, if the patient doesn’t already wear dentures, temporary dentures will need to be designed and manufactured. While these will help the dentist determine the best position for the teeth in the final overdentures, this additional step adds at least a month to the timeline.

Like traditional dentures, implant overdentures need to be removed nightly and as needed for cleaning. Additionally, while a set of overdentures typically lasts five to eight years, the attachment inserts need to be replaced every six to 12 months.

The main advantage of implant overdentures is the elimination of common problems associated with traditional dentures. Since they’re fastened by implant posts, overdentures won’t slip out of the mouth, and they make eating and talking easier. On the upper jaw, an overdenture’s horseshoe shape is a major advantage, as it allows the palate to remain exposed for optimum eating, tasting and speaking.

 

An outcome worth smiling about

As you can see, whether you need extensive restorative work or minor cosmetic adjustments, there are numerous options available for completing your smile makeover. Talk to your dentist about which options will work best for your needs, as well as the costs and timeline involved. By working closely with your dentist to plan and implement your smile makeover, you’ll surely achieve an outcome worth smiling about.

Special thanks to Dr. Josh Hammer of Landeros & Hammer Cosmetic & Family Dentistry for his input.

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