The smile makeover: how to get the perfect smile without the need for crowns

Within dentistry, cosmetic surgery has certainly come a long way. Traditionally, to achieve the perfect set of straight, natural-looking teeth it involved a dentist cutting and shaping your real teeth down to ‘pegs’ so that crowns could be fitted over them. These crowns act like a ‘cap’ which are placed over the original tooth to approve its appearance and shape. No matter how well they are fitted, they normally have a lifespan of possibly 10-15 years and approximately 20% will require a root canal, so the less that is done to your natural teeth to achieve the desired results, the better, especially if the teeth have not had any restoration treatment before. Dr David Bloom, a leading restorative and cosmetic dentist in London, shares with us some treatment options that require minimal or no drilling.

How do I know what treatment I need?

The starting point for this is a thorough discussion with an experienced cosmetic dentist. This is usually aided by taking high quality dental photographs and together discussing your wishes. The dentist will give you the various treatment options that they think best suit your needs and will restore any damaged teeth with minimal drilling and tooth removal.

What treatments might be offered to me?

Depending on your situation, the dentist will offer one or a combination of the following treatments:

• Tooth whitening – this can very often enhance the appearance of your teeth and is minimally invasive. It’s possible to get an idea of the shade that’s expected beforehand. ‘B1’ is a shade which is about as light as natural teeth can be. A shade guide can demonstrate this against your natural teeth. Sometimes, we are able to get even lighter than ‘B1’ – known as the bleach shades.

• Cosmetic tooth alignment - this can be achieved using aligners or fixed braces. Aligners need to be worn 22 hours a day, and may need refinement after the last predicted aligner is worn. These are usually very discreet. The alternative to aligners is fixed braces. These can straighten the front teeth in as little as six months. On the outside these are the same colour as teeth but can often be fitted to the inside of the teeth which mean they can’t be seen at all. After alignment, retention is essential long-term. If greater tooth movement is required, braces will still be an option but this would involve comprehensive orthodontic work. Overall, comprehensive orthodontics would generally take one year to 18 months to finish treatment.

• Composite bonding (edge bonding) - This can be used often with no tooth preparation to adjust the edges of the teeth and restore any small chips, fractures and cracks. This is often required after cosmetic orthodontic treatment to correct differential tooth wear.

• Veneers – generally, these don’t involve a lot of tooth preparation. Years ago, composite veneers were difficult to do, but with a product called ‘SmileFast’ this process has been simplified allowing excellent composite veneers at approximately half the price of porcelain. Porcelain will always last longer, around 10-15 years in comparison to 5-7 years for composite. Please ensure you discuss the possibility of having porcelain veneers in an additive fashion. This involves an additive wax-up (a wax replica of a proposed treatment) to try before. This will confirm if the veneers are too bulky and allows for minimal tooth preparation. Planning beforehand, with the end in mind, ensures that only the minimal amount of tooth tissue is removed. A ‘trial smile’ (temporary veneers to allow the client try their smile) should still be fitted to allow a preview of the final result. After this, it can be modified in terms of shape and size so that the client is happy with how the final result will look.

• Bridges – these are still widely used and a viable option, but if the teeth are virgin teeth, meaning free from decay or restorations, implants will often be a more conservative option so that your teeth do not need to be prepared.

• Implants – these can replace missing teeth and do not involve your own teeth at all.

Crowns are still an option, even for heavily filled teeth but my advice is to avoid them if this is purely for cosmetic reasons, especially if the teeth are 'virgin' untouched teeth, as they involve too much natural tooth removal (unless the tooth has previously been heavily restored). Recently, I saw a patient who had undergone a ‘smile make-over’ abroad (dental tourism) and had ten of her top teeth cut down for full-coverage crowns. She was in a lot of pain and needed at least two root canals. She also received splint therapy to improve her bite as it had been changed and she was in a lot of discomfort. If you are considering any dental treatment in another country, ensure you do proper research beforehand and find a reputable dentist.

If you are interested in any of these treatments, please visit Dr David Bloom’s profile and make an appointment to see him.