The term bonding is used to describe procedures where tooth-colored dental resins and composites are used. Direct bonding techniques can be used to change the shapes and colors of teeth as well as to close unattractive spaces. It can also be used to repair
chipped or broken teeth or even to cover up unsightly stains. Unlike crowns or caps, direct bonding requires only a minimal amount of tooth reduction thus making it a very conservative procedure.

02) How does Bonding work?

After slight preparation, the tooth is etched with a weak phosphoric acid solution to create a more porous and rougher surface for increased bonding strength. Next, a composite (plastic) resin in placed on the tooth and shaped, contoured and hardened with a special curing light. It is then further shaped and highly polished creating a very natural appearance. The procedure usually requires only one visit and is not painful.

03) How long will Bonding last?

The bonded composite has an average life of four to eight years, and often lasts depending how and where in the mouth it is applied and how it is maintained. The area can be touched up and even re-bonded over time as necessary.

04) What is Cosmetic Contouring?

Cosmetic contouring (or recontouring) is the reshaping of a patient's own teeth. This process involves removal of a very small amount of tooth structure to help achieve a more desirable appearance. Chipped or fractured areas are smoothed out and specific angles or edges can be rounded or squared to alter the way your smile looks.

05) What can Cosmetic Contouring do for me?

Contouring can create better alignment or create a more feminine or masculine appearance. It is sometimes done to prevent chipped areas from getting worse. Recontouring of the teeth is generally done with no discomfort to the patient and no anesthetic. Often it is done in conjunction with bleaching as a very conservative and inexpensive approach to a beautiful smile.

06) What are Implants?

Dental implants are metal anchors placed in the jaw bone underneath the gum tissue to support artificial teeth where natural teeth are missing. Unlike other types of tooth replacements, such as removable dentures or fixed bridges that are cemented to remaining teeth, dental implants are actually placed ("implanted")into the jaw bone under the gum tissue. These implants are usually made from a space-age metal called titanium, which is readily accepted by the body, and artificial teeth that look like natural teeth are then attached to the implants. Accepted by the American Dental Association, dental implants have been used for many years, and hundreds of thousands have been placed. Due to a phenomenon known as "osteointegration" meaning that bone actually attaches itself to the implant, these anchors provide a strong foundation that allows people with missing teeth to chew efficiently and comfortably.

07) Who needs Implants?

Anyone who is missing teeth and can benefit from increased chewing efficiency, and improved appearance or speech, is a candidate for dental implants. Implants can be the solution when it has become difficult or impossible to wear a removable denture. Portions of the jaw that are missing due to an accident, disease, or birth defect can often be reconstructed using implants.

08) Am I a candidate for Implants?

You are a candidate if:

you have enough jaw bone, and dense enough bone, to secure the implants

you do not have a disease or condition that interferes with proper healing after implant surgery (e.g. uncontrolled diabetes, or radiation/chemotherapy for treating cancer)

A discussion with your oral and maxillofacial surgeon and restorative dentist (the dentist who will make your new teeth) will determine if you are a candidate for dental implants. As a rule, age is not a barrier to implant treatment if you are in good health. In fact, thousands of people of all ages are turning to dental implants to replace a single missing tooth, several teeth, or all teeth.

09) What is a Bridge?

A missing tooth or teeth can create an unhealthy situation over time. It is very important to restore these gaps. When one or more teeth are lost or missing, the neighboring teeth can shift, tip or even "super-erupt" into the space. Teeth that have drifted from their normal and healthy position are often more susceptible to decay and gum disease. Further, this movement can lead to changes in a patient's bite that can ultimately put stress on the jaws, muscles, teeth and temporomandibular joints (TMJ). Over time this can affect a patient's ability to chew and may even change the facial appearance depending on the location and number of missing teeth.

10) Is a Bridge permanent?

There are two ways to replace a missing tooth or teeth: fixed and removable. A bridge is a permanent or fixed replacement, while a denture is a removable replacement. A bridge consists of replacement teeth (one or more) that are attached to crowns on the adjacent teeth. The replacement teeth are shaped and contoured to blend in with the natural teeth in the mouth.

11) How long does this procedure take?

This procedure takes two or more visits to complete. At the first visit, the adjacent teeth are reduced, an impression is taken and sent to a dental laboratory for fabrication. At the second visit, the bridge is fit and placed permanently in the mouth. Like crowns, bridges can be made from variety of materials for strength and esthetic appearance. While it should always be discussed with your dentist before treatment, a fixed restoration is generally considered to be the favored solution for tooth replacement.

12) Silver fillings are too visible, what are my other options?

Natural tooth-colored fillings have become widely accepted and are often used in place of metallic restorations where aesthetics is a primary concern. There are even studies that show that in some cases, use of certain tooth-colored materials can strengthen a tooth, making it a better choice than the metallic predecessor - amalgam. Two basic types of tooth-colored restorations are used: composite and ceramic.

13) What is a Composite Restoration?

Composites have been used for many years however their chemical make-up has changed and improved exponentially. The bonding agents used to make the composites adhere to the tooth have improved just as dramatically. Because of the improvements, the use of composites has become widely accepted by dentists and the indications for their use are more numerous. They are being used to close undesirable spaces, improve the shape, size and color of a tooth, replace an unsightly amalgam restoration, cover abraded or worn areas of a tooth (usually at the gum line) and to cover stains. Composites can also be used to protect thermally sensitive areas and to repair and strengthen broken teeth.

14) How They Are Placed?

Once the tooth has been prepared and all decay removed, chemicals and materials are placed on the tooth to increase bond strength and to protect the tooth. Next, the composite material is placed incrementally into the tooth and hardened by exposure to a special curing light. The restoration is then contoured to fit the bite and then is highly polished. These fillings require a bit more time than the silver fillings because of the number of steps involved. Composite fillings can also be a bit more sensitive, at first, to extreme hot and cold and they may discolor over time if the patient smokes or drinks a lot of coffee, tea or cola. They can also be more expensive and some composites may wear faster than silver fillings; however, they yield a much more natural and aesthetic result.

Ceramic fillings, like composites, come in several different types that can be used for different situations. Ceramics are typically used for the larger and more broken down areas. In these cases, an inlay or onlay to cover more of the tooth's surface may be indicated. These restorations are indirect because they require two visits and fabrication by a dental laboratory. The ceramic restorations are considerably more expensive and therefore simple, one-visit composite fillings are typically used instead. Ceramic restorations are much more durable and will not stain. Naturally speaking, the final result with ceramics is spectacular.

15) What are Veneers?

Veneering a tooth means to cover its facial or front surface. It is actually very similar to placing acrylic fingernails on top of natural nails. Veneers are used to enhance shapes and colors of teeth as well as to close spaces between teeth and to cover up significant stains such as those caused by tetracycline.

16) What is the difference between direct and indirect Veneers?

There are two types of veneers: direct and indirect. Direct veneers are done in a single visit and with a composite or plastic material. Indirect veneers are usually done in two visits and require a dental laboratory to fabricate the final restoration. The indirect veneer can be either a composite material or more commonly, a porcelain material. Due to the advancements in the porcelain substrates and the bonding materials used to place them, they are often used in place of crowns for a more conservative and natural looking smile.

17) What does Veneering a tooth involve?

First Step
During the first visit, a local anesthetic is used and the tooth or teeth are reduced by approximately 0.5mm - 2.0mm. An impression of the teeth in this state is then taken and sent to a dental laboratory for fabrication of the veneers. This usually takes one to two weeks to complete. A temporary restoration may or may not be placed depending on the amount of reduction necessary. There may or may not be slight sensitivity to hot and cold during this period.

Second Step
At the second visit, a local anesthetic may be used for the patient’s comfort in seating the veneers. After thoroughly cleaning and preparing the teeth, the veneers are placed with a resin material and cured or hardened with a special curing light.

18) How long will Veneers last?

There are many different variations of porcelains used today and this should be discussed with the dentist ahead of time. Typically, the porcelains should last about 15 years, however, with proper care and maintenance, they can last longer. Porcelain veneers resist staining, reflect light and are among the strongest and most natural looking restorations available.

19) What is Tooth Whitening (Bleaching) and is it safe?

Bleaching is a very conservative and non-invasive approach to creating a brighter and more appealing smile. Teeth can often take on a darker and unattractive appearance with age or from contact with staining substances. The discoloration can be caused by tobacco, coffee or tea, juices, poor hygiene, genetics, and natural aging.

20) How is it done?

There are two commonly used methods for bleaching: at-home and in-office. Both begin with an office consultation to determine if the patient is a good candidate for the bleaching process. The at-home technique is the most popular and least expensive. The in-office method allows the dentist to place a higher concentration of bleach over the teeth.

At-Home Method
A custom mouth piece or "tray" is made to fit your teeth by the dental office. The tray fits over the patient's teeth and holds the bleaching material against the teeth for a specified period of time. There are different concentrations of bleach that are worn via the tray for one to five hours per day for an average of 10 to 14 days. The regimen will be determined by the dentist and may differ for each patient. If the teeth become more sensitive to hot and cold, a "desensitizing" material may be used in the same tray on alternating days. Results are usually excellent with this method.

In-Office Method
The gum tissues are covered to protect them from being irritated by a higher concentration of the bleaching material. The bleach is then activated by a high intensity light or a laser to accelerate the process.

21) What About Over-The-Counter Options?

Both at-home and in-office treatments are considerably more effective than the whiteners available at retail. The over-the-counter products have much lower concentrations of peroxides and ill-fitting trays that can cause damage to the teeth and gums.