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Cosmetic Dentistry Frequently Asked Questions
Provided by Dr. Suzanne Popp of San Diego


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Lumineers Porcelain Veneers


If the demands of cosmetic changes in the mouth are too great for simple bonding Lumineers porcelain veneers may be the perfect alternative!

Lumineers porcelain veneers can change an entire smile. Quick, painless, and dramatic they can change the shape, color, size, and arrangement of teeth or any combination of these factors. They can even be used as an alternative for orthodontic treatment.

Dr. Popp can apply these contact lens-thin "smile shapers" to teeth without any grinding or shaving, transforming teeth into a naturally beautiful smile that looks perfect for every individual. Lumineers can even be placed over existing crown or bridgework without having to replace them.

Lumineers are contact lens-thin and are placed over existing teeth without having to remove painful tooth structure (unlike traditional veneers.) Also, since your natural tooth structure is not altered they are completely reversible. Lumineers is the painless, permanent cosmetic solution for stained, chipped, discolored or misaligned teeth.

Treatment Time: Two office visits. The teeth will be prepared and an impression made on the first visit, which can take from one to four hours. The laminates will be fitted and inserted at the second visit, which may take the same amount of time. Expect to spend more time for more extensive treatment.

Patient Maintenance: The teeth should be professionally cleaned about three to four times yearly. Some precautions: as with bonding and crowning, take special care when chewing hard foods or biting into foods with your laminated teeth, to avoid chipping or potential fracture.

Results of Treatment: A polished, natural-appearing result that can make teeth appear straighter, whiter.

Average Range of Treatment Life Expectancy: Ten to fifteen years.

Cost: Approximately $900 to $1400.

Advantages:

Tooth is not altered with drilling or removal of tootj structure
No shots required for application
Quick, painless procedure with minimal prep tim
Less chipping than with bonded restorations
Etched porcelain provides an extremely good bond to enamel
Wears less than the composite resin laminate
Do not stain - does not lose color or luster
Can make more proportional results because they are constructed in lab
Gum tissue tolerates porcelain well

Disadvantages:

More costly than conventional veneers
More difficult to repair if the laminate cracks or chips
May eventually need repair or resealing of the margins if the cement washes out or debonds


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Porcelain Veneers


Porcelain dental veneers are a beautiful way to correct stained, chipped, or crooked teeth. By placing modern ceramic porcelain on the surface of teeth, Dr. Popp can provide you with a bright, straight, and natural looking smile.

Modern porcelain veneers are thin shells of tooth-colored, translucent porcelain custom made to fit over your teeth and improve their color, shape and overall appearance. With porcelain veneers Dr. Popp can can dramatically improve your smile and appearance.

Placement of dental veneers is sometimes referred to as "instant orthodontics" because they can be used to cover a variety of dental problems involving teeth in the "smile zone" including:

· Spaces between the teeth.
· Poorly shaped or crooked teeth.
· Broken or chipped teeth.
· Permanently externally stained and/or internally stained teeth.
· Unsightly or stained fillings.

Porcelainl veneers can improve the appearance of the teeth but they cannot realign the jaw or correct overbites and underbites.

Treatment Time: Two office visits. The teeth will be prepared and an impression made on the first visit, which can take from one to four hours. The laminates will be fitted and inserted at the second visit, which may take the same amount of time. Expect to spend more time for more extensive treatment.

Patient Maintenance: The teeth should be professionally cleaned about three to four times yearly. Some precautions: as with bonding and crowning, take special care when chewing hard foods or biting into foods with your laminated teeth, to avoid chipping or potential fracture.

Results of Treatment: A polished, natural-appearing result that can make teeth appear straighter, whiter.

Average Range of Treatment Life Expectancy: Ten to fifteen years.

Cost: Approximately $1400 to $1800.

Advantages:

Porcelain veneers create a very life-like tooth appearance
Do not stain - does not lose color or luster
Can be used to correct slight misalignment, “instant Orthodonitcs”
Gum tissue tolerates porcelain well

Disadvantages:

A small amount of enamel needs to be removed before a veneer is placed resulting in a change of your natural teeth’s look.

Once you’ve undergone this procedure it’s irreversible and your teeth will not look pleasing without the veneer

Porcelain veneers can chip or come off if not cared for properly. To improve their durability and longevity you need to maintain consistent good oral hygiene and have regular dental examinations and cleanings at least twice each year. In addition, you must avoid using them to bite or crack hard objects like nuts and ice.


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Porcelain Crowns or Bridges


When there is not enough tooth structure left for veneers or inlays or onlays, or the chewing demands in the mouth are too great for veneers, a stronger, more extensive restoration is needed. Typically the best alternative is porcelain crowns. Porcelain crowns are placed on a fully prepared tooth. They are the most life-like of full crown type restorations. The technique initially consists of preparing the teeth. Next, an impression is taken and then sent to the dental lab where the porcelain crown is fabricated. Finally, they are placed in the patient's mouth and permanently cemented onto the teeth.

Porcelain Fused to Metal Crowns or Bridges

When biting pressure is too great for all-porcelain crowns or gaps from missing teeth must be filled in, metal alloy is placed under the porcelain for strength. This is the porcelain fused to metal crown technique. In these cases more tooth structure is removed to accommodate both metal and porcelain. Once an impression is taken, a metal coping is made on the prepared tooth. This is then covered with porcelain. Porcelain fused to metal crowns does not have the translucency of pure porcelain crowns. Therefore, aesthetics may be slightly compromised in some situations. However, a talented ceramist with experience in custom staining can usually overcome these limitations, thereby creating life like restorations. When teeth are loose due to periodontal bone loss, this technique is used. Here the crowns are splinted together by joining the metal substructure of the crowns so they are tied together like a small fence in the mouth.

Treatment Time: Usually two appointments of approximately one to four hours for up to four teeth. Expect to spend more time as additional teeth or more extensive treatment is included.

Patient Maintenance: Care in biting hard objects to avoid fracturing the crowns. Fluoride treatments once yearly along with the use of fluoride toothpaste and flossing every day.

Results of Treatment: Crowning can achieve the ultimate esthetic results in reshaping overly crowded teeth.

Average Range of Treatment Life Expectancy: Ten to twenty years. Life expectancy is directly proportional to problems with tissue, fracture, and the danger of decay.

Cost: Approximately $1200 to $1500.

Advantages:

Teeth can be lightened to any shade
Takes less time than orthodontics
Crowns don’t stain
Long life
Offers greatest latitude in improving tooth form

Disadvantages:

Can fracture
Requires anesthesia
Altered tooth form
Is not permanent; may need to be replaced after five to fifteen years
More costly than contouring or bonding
Is irreversible
May trigger pulp irritation in rare instances
May include tooth sensitivity for a short time


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Composite Bonding


When teeth are chipped or slightly decayed, bonded composite resins may be the material of choice to restore the damaged tooth. First, the tooth structure is cleaned and etched. Then a clear adhesive is applied to the area needing bonding. Once applied, a tooth colored bonding material is placed on the tooth. It is permanently hardened and fused to the tooth with a hand held white light gun. This process is called photo curing. Bonding makes a great tooth colored filling for small cavities and broken or chipped surfaces. It can also be used to close spaces between teeth. Additionally, it is used to cover the entire outside surface of a tooth to change its color and shape. For the latter two applications, bonding has its limits. It may not be strong enough, aesthetic enough, or durable enough for certain individual situations. When these problems occur, the next choice would be porcelain laminate veneers.

Treatment Time: One to two hours per tooth.

Patient Maintenance: Professional cleaning three or four times yearly. Avoid hard foods on front teeth. Bonding to fill in a space is more susceptible to chipping. Proper use of floss daily is required. One problem with most direct bonded restorations is that they can stain or chip. Expect to have some repolishing or repair as necessary.

Results of Treatment: Most spaces can be filled in to look very natural.

Average Range of Treatment Life Expectancy: Three to Five years. Professional refinishing once every year or so.

Cost: Approximately $400. to $800

Advantages:

Little or no reduction of tooth structure
Anesthesia not always required
Reversible procedure
Economical, more so than crowning
Teeth can also be lightened

Disadvantages:

Can chip or stain more easily than crowns
Has limited esthetic life
Treatment may involve extra teeth to obtain proportionate space closing
Teeth may appear somewhat thicker


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Composite Fillings


When smaller areas of decay or old worn silver fillings are present, tooth colored filling material can be used. Composite resin material has been used in the mouth for over 20 years. Decay, old filling material or unsupported material is removed first. Like bonding, the tooth is cleaned and etched. Then a clear adhesive is applied and finally the material is placed into the tooth and cured with a white light gun. Usually these restorations are used on smaller restorations. If the area to be restored is too large, a Porcelain inlay or onlay or crown would be used.

Treatment Time: Usually 30 minutes to an hour is needed. Additional time should be allowed for more than one tooth or if extensive treatment is needed.

Patient Maintenance: Care in biting hard objects to avoid fracturing. Fluoride treatments once per year are recommended along as well as daily flossing and brushing.

Results of Treatment: Composite resin tooth colored materials work extremely well for smaller restorations.

Average Range of Treatment Life Expectancy: Five to ten years. Life expectancy is directly related to problems with gum tissue, fracture, and the danger of decay.

Cost: Approximately $200 to $400 per tooth.

Advantages:

Tooth colored restoration
One appointment
No mercury
Bonded to the tooth

Disadvantages:

Can fracture
Requires anesthesia
Can have transient sensitivity
Comfortable bite may be more difficult to achieve


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Porcelain Inlays & Onlays


When individual back teeth are broken down but some good healthy tooth structure remains, porcelain inlays and onlays are the material of choice. There are many different tooth colored materials today. This is a beautiful and conservative lab fabricated procedure. Only the unstable and decayed areas of the tooth are removed. An impression is made and sent to the laboratory. The temporary filling is in place for about two weeks. Then the inlay or onlay is bonded into the remaining tooth with the curing light.

Treatment Time: Usually two appointments of approximately one to two hours for up to four teeth. Expect to spend more time as additional teeth or more extensive treatment is included.

Patient Maintenance: Care in biting hard objects to avoid fracturing. Fluoride treatments once yearly along with the use of fluoride toothpaste and flossing every day.

Results of Treatment: Porcelain inlays and onlays provide a conservative, natural looking restoration.

Average Range of Treatment Life Expectancy: Ten to fifteen years. Life expectancy is directly proportional to problems with tissue, fracture, and the danger of decay.

Cost: Approximately $1400 to $1800 per tooth.

Advantages:

Less tooth structure removed than with crowns
Most natural of all restorations
Longer life than composite resin
Offers latitude in improving tooth form
Takes less time than a crown
Feels most natural of all restorations

Disadvantages:

Can fracture
Requires anesthesia
Altered tooth form
Is irreversible
May trigger pulp irritation
May induce tooth sensitivity for a short time


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Invisalign Orthodontics


The Invisalign system is a revolutionary new alternative to traditional braces. Offering comfort, convenience and virtual invisibility during treatment the Invisalign system uses a series of clear, custom molded aligners to slowly move the teeth to their desired position.

The Invisalign system is used to successfully treat a wide variety of conditions including crowded teeth, widely spaced teeth, overbites, underbites and cross bites. Since the aligners are practically invisible the embarrassment that comes with metal braces is eliminated. And because they are removable, you can take them out to eat and to brush and floss thereby allowing you to maintain your oral health much easier. Although treatment time varies considerably depending upon how much movement is necessary to achieve the desired results Invisalign aligners can often reposition teeth in about a year or less.

Treatment Time: Varies with the amount of tooth movement required. Typical treatment plan is 12-18 months. Requires follow-up visits every 6 weeks for a new aligner..

Patient Maintenance: Remove aligners for eating, brushing and flossing. Aligners are maintained by brushing thoroughly with normal toothbrush and toothpaste .

Results of Treatment: Straightened teeth Suited mainly for a vast majority of adults and for adolescents who have their permanent teeth..

Average Range of Treatment Life Expectancy: Permanent, may require the use of a night time retainer after treatment is concluded..

Cost: Varies, dependent upon amount of tooth movement required and number of aligners required.

Advantages:

Invisible, so no one can tell you are straightening your teeth.
Removable, so you can eat and drink what you want while in treatment.
More comfortable than traditional braces..
Less time in the office for adjustments.
Oral hygiene is improved.

Disadvantages:

Not appropriate for children.
Treatment is dependent upon you, the patient, wearing the aligners.
Designed for less complex orthodontic needs.
May temporarily affect your speech


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Dental Implants


A dental implant is an artificial tooth root that is placed into your jaw to hold a replacement tooth or bridge. Dental implants are an ideal option for people in good general oral health who have lost a tooth or teeth due to periodontal disease, an injury, or some other reason.
While high-tech in nature, dental implants are actually more tooth-saving than traditional bridgework, since implants do not rely on neighboring teeth for support.

Dental implants are so natural-looking and feeling, you may forget you ever lost a tooth. You know that your confidence about your teeth affects how you feel about yourself, both personally and professionally. Perhaps you hide your smile because of spaces from missing teeth. Maybe your dentures don't feel secure. Perhaps you have difficulty chewing. If you are missing one or more teeth and would like to smile, speak and eat again with comfort and confidence, there is good news! Dental implants are teeth that can look and feel just like your own!

Treatment Time: Usually two appointments of approximately one to three hours for each implant. Expect to spend more time as additional teeth or more extensive treatment is included.

Patient Maintenance: Care in biting hard objects to avoid fracturing the crowns. A good oral hygiene program including daily flossing is required.

Results of Treatment: Dental implants can achieve the ultimate results in esthetics and comfort in replacing missing teeth.

Average Range of Treatment Life Expectancy: The life of the implant is indefinite however the crown placed on the implant typically needs replacement every ten to twenty years.

Cost: Approximately $2,000 to $6,000.

Advantages:

Dental implants look and feel like your own teeth.
Implants eliminate the discomfort of removable dentures.

Dental implants function like your own teeth, allowing you to eat your favorite foods with confidence and without pain.

Dental implants don't require reducing other teeth, as a tooth-supported bridge does. Because nearby teeth are not altered to support the implant, more of your own teeth are left intact, improving your long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.

Disadvantages:

A surgical procedure is required although this can often be done under local anesthetic

Cost! – implants can be expensive.

Bone grafting may sometimes be necessary.
In rare case, implants may fail to bond with the surrounding jawbone.


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Teeth Whitening


Some patients prefer the one hour in-office whitening procedure. We use the Sapphire system in our office. A gel is applied to the teeth and then a special light is placed over the teeth for one hour. The Sapphire light-activated whitening gel's active ingredient is Hydrogen Peroxide. As Hydrogen Peroxide is broken down, oxygen enters the enamel and dentin, bleaching any colored substance while keeping the structure of the tooth unchanged. The Sapphire light aids in activating the Hydrogen Peroxide and helps it penetrate the surface of the tooth.

Treatment Time: Allow one and an half hours. Actual Whitening time is one hour. Time is needed for determining shade and giving post operative instructions.

Patient Maintenance: Thorough brushing after meals is necessary to avoid plaque accumulation. Smoking, as well as stain-causing foods such as coffee and tea, should be avoided.

Results of Treatment: Deep yellow and brown stains can be dramatically lightened. Greyer teeth do not respond as well. Teeth can whiten to their original natural shade.

Average Range of Treatment Life Expectancy: Indefinite. Touch ups may be needed. Some patients use the at home gels in addition.

Cost: $750 - $850.

Advantages:

Safe procedure

Fastest way to whiten teeth

No messy trays

No tooth reduction

Disadvantages:

Poor patient expectations

Although rare, some people experience tooth sensitivity for a short while after treatment..

Can't eat or drink anything with color for 48 hours after procedure

Must purchase additional gel for home use with trays


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Suzanne Popp, DDS
Advanced Cosmetic Dentistry

Office Address:

1010 8th Street
Coronado, CA 92118
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