Creating Healthy, Natural Smiles
February 19, 2020
What is a Prosthodontist?
When people ask me what I do, I tell them, “I’m a prosthodontist”.Then they invariably ask me, “what is that?”. I reply: A prosthodontist is a dental specialist, who specializes in complex dental cases. This could be a full mouth reconstruction for someone losing their teeth to disease (e.g. periodontal disease, severe grinding or bulimia) or someone who has gotten into a car accident or had oral cancer. However, prosthodontists also treat what may seem like a simple case: the replacement of a single front tooth. These cases are difficult because we are using something that is hand crafted out of porcelain to match a natural tooth. These require a good esthetic eye and an understanding of the different available materials. These are my favorite cases, because I am doing minimal treatment to maintain and enhance my patients’ natural smiles.
In residency and in the years since then, I did a lot of traditional, large prosthodontic cases. Mostly older patients requiring full mouth reconstructions, using implants crowns and dentures to replace multiple missing teeth. However since I have started practicing in Brooklyn, my patient population is younger. For many of my patients who require cosmetic treatment, we can get a great result with just one or a few veneers, usually combined with teeth whitening and invisalign. This gives them a fresh and healthy look, while maintaining the unique appearance of their natural teeth.
What is a Veneer?
A veneer or porcelain laminate veneer is a thin porcelain facing. They are about the thickness of a fingernail (0.3-0.5mm) and can be used to fix teeth with fractures and large fillings, irregular shapes (e.g. chipping or peg laterals) and abnormal surface textures and colors. They are bonded to the front of your teeth using a high strength adhesive. In addition, you can function with your veneers the same way you would with your natural teeth. However, you should not do things that you would with your natural teeth (i.e. open bags of chips, chew on bones or ice, cut off tags, zip up jackets (hmm-hmm, you know who you are).
Sometimes patients need a full mouth of veneers or crowns to achieve the desired outcome (and I’ll show some of those cases in another post), but here I will focus on the people who had a great result with one or just a few veneers.
This patient had trauma to her lower tooth when she was younger and got a veneer. Often teeth that have had trauma will seem ok for a while and then 10+ years later will become discolored. We both liked the natural texture and shape of her teeth and wanted to maintain that, so we just made her a new veneer.
Here is another trauma case. She banged her tooth as a child and in the last few years it started to discolor. She had attempted internal whitening (a procedure where whitening gel is put inside the root canal access for about a week), but did not get the desired results. The rest of her teeth are perfect.
This woman was about to get married and hated the large bonding she had had on her teeth for years. While composite is a good restorative material, it does not have the translucency and shine of a natural tooth or porcelain. It also tends to stain. I like her prominent canines and wanted to perform invisalign so she would show more teeth on the right side, however we did not have enough time before her wedding. We whitened her teeth and made veneers for her two front teeth. She looks gorgeous and told me that her veneers were “the star of her wedding photos.” Somehow I doubt that. She promised me she would get invisalign in the future.
This patient had a large fracture in her front tooth which was repaired with a large filling. She also had a size discrepancy. She was not interested in orthodontics. We whitened her teeth and placed two veneers on her front teeth.
This final patient had “peg laterals,” which means that the teeth on either side of her central incisors were small. In many cases they are pointy. She was also missing her canine on the right side, which caused an asymmetry. We whitened her teeth and placed 5 veneers.
Every patient’s history, needs and desires are different. I love working with my patients and extremely talented lab technicians to enhance their already great smiles. A small change to one or two teeth can make a huge difference.