What Is Aesthetic Dentistry?
Aesthetics, phonetics, and function form the fundamental building blocks of dentistry. Aesthetic Dentistry is a precise combination of scientific principles and artistic ability.
With the rising aesthetic expectations of today, principles related to smile design have gained importance. The concept of smile design refers to creating a beautiful smile by bringing together numerous scientific and artistic principles. The purpose of revisions made for an aesthetic smile is to develop a harmonious and stable masticatory system that encompasses the teeth, gums, lips, muscles, skeletal structure, and joints.
Smile design is planned by combining an individual’s personal aesthetic expectations with health and naturalness. Aesthetic judgments are not entirely objective criteria; while designing a natural smile, the dentist must also take into account the patient’s subjective characteristics and lifestyle. When the dentist and team create a smile, they must consider these criteria and combine them with their own artistic abilities and subjective perspectives.
- Hollywood Smile
- Digital Smile Design
- Dental Crowns and Veneers: Laminate Veneers, Prepless Veneers, E-max Crowns, Zirconia Crowns and Bridges
- Bonding Method
- Aesthetic Dental Fillings
- Inlay and Onlay Restorations
- Teeth Whitening
- Pink Aesthetics / Gum Aesthetics
Hollywood Smile
The Hollywood Smile is an aesthetic dentistry application developed inspired by the smiles of Hollywood stars, with certain standards, and trending worldwide. At the initial examination, it is very important that the dentist correctly understands the patient’s expectations.
The design process begins after the examination with taking the necessary X-rays, photographs from different angles, and impressions of the existing dental arch. Every design is unique to the individual, and the goal is to create a perfect smile. While achieving a perfect result may sometimes be possible with a single treatment method, for some patients it may be necessary to apply several treatment methods in sequence.
The standards that a Hollywood Smile should possess can be listed as follows:
The individual should have a deep smile line; when smiling, all upper teeth up to the upper molars should be visible, along with a slight visibility of the lower teeth. The teeth should be evenly aligned along the dental arch. The upper incisors should be more prominent than the other teeth, and the smile line following the incisal edges should curve upward toward the posterior teeth and be harmonious with the lips. While the teeth should be white, their color should also be compatible with the individual’s skin tone and gum color. During smiling, the gums should be visible up to approximately 2 mm in the upper jaw. The midline of the teeth should be aligned with the midline of the face. The gingival zenith points should be at an ideal level. The lips should be symmetrical.
The result created by the team making all these adjustments — through their experience, knowledge, and artistic skill — must integrate with the physical and emotional characteristics of the person wearing the design.
Digital Smile Design
What Is Digital Smile Design? How Is It Applied?
The foundation of creating a more impressive smile lies in the correct understanding between the dentist and the patient. Digital Smile Design makes our work easier precisely at this point.
At the patient’s first appointment: a digital impression of the teeth is taken with a 3D intraoral scanner; photographs of the teeth and face are taken from different angles; the smile design is custom-created in a digital environment and the expected outcome at the end of treatment is presented to the patient.
At the second appointment: the design prepared with digital technology, called a mockup, is applied in the patient’s mouth, offering the opportunity to see the smile design live. Evaluations of the design are made mutually. The necessary preparations are performed on the teeth, and a digital impression is taken again. The prepared mockups are temporarily bonded onto the teeth.
At the final appointment: the custom-fabricated restorations are tried in, and if the result is as desired, the porcelains are bonded to the teeth.
How Long Does It Take to Prepare a Digital Smile Design?
A digital smile design is prepared within 3 to 5 days. The data recorded at the first appointment is evaluated by the dentist and technical team, and the anticipated appearance is designed. When designing the smile, parameters such as the individual’s facial features, skin tone, physical characteristics, and personal traits are taken into consideration.
Is It Possible to Make Changes to the Digital Smile Design?
In digital smile design, we see the targeted smile digitally and then try the mockups prepared according to the design in the patient’s mouth. This trial provides us with the convenience of making the necessary adjustments in the most accurate way. Changes can be made during the trial stage, and the final state of the smile is decided upon.
Will I Have the Same Smile Shown in the Digital Design and Trials at the End of Treatment?
The materials used for the trial are obtained quickly from different materials; however, your actual teeth produced for the treatment will be far more aesthetic than what you saw during the trial.
Dental Crowns and Veneers
Dental crowns are divided into two categories: metal-supported and metal-free. For a more aesthetic smile, metal-free crowns are applied. Metal-free crowns are further divided into zirconia-substructure porcelains and full-ceramic crowns (E-max). E-max crowns are aesthetically superior to zirconia. However, zirconia has greater durability in long-span bridges. When the dentist examines the patient, they will identify the needs and plan what type of restoration is appropriate for each area. Let us briefly explain the types of crowns and materials used:
Porcelain Laminate Veneers
What Are Porcelain Laminate Veneers?
Porcelain laminate veneers involve the permanent treatment of structures that negatively affect aesthetics — such as color and shape irregularities in teeth — using custom-made, leaf-shaped porcelain veneers with a thickness of 0.3 to 0.7 mm. Laminate veneers are bonded to the front surface of the teeth. One of their greatest advantages is that instead of cutting the entire tooth, only the front surfaces are thinned by millimeters. Due to their light-transmitting structure, compatibility with the gums, and individual application to each tooth, their appearance is flawless and natural. Porcelain laminates are stain-resistant, do not yellow, and thanks to advanced adhesive systems, they do not fall off. Their resistance to fracture is quite high.
In Which Cases Are Porcelain Laminate Veneers Applied?
Correction of form and shape irregularities in teeth; closing gaps between spaced teeth; restoration of broken or worn teeth; restoration of severely discolored teeth where teeth whitening has not achieved the desired result; simple crowding conditions (orthodontic treatment should be considered in advanced crowding cases); frequent consumption of staining products such as cigarettes, tea, and coffee; and cases where tooth dimensions are small.
In Which Cases Cannot Porcelain Laminate Veneers Be Applied?
Jaw disorders requiring orthodontic treatment; cases with advanced gum recession; cases with an edentulous gap due to missing teeth in the anterior region; patients with harmful habits such as severe bruxism (teeth clenching), nail biting, or pen chewing; and pediatric patients whose growth and development are still ongoing.
What Are the Stages of Porcelain Laminate Veneer Fabrication? How Long Does Treatment Take?
The fabrication of porcelain laminates takes approximately one week and requires meticulous work, technical skill, and experience. E-max materials are most commonly used in the fabrication of laminates.
For a patient suitable for laminate veneers, the process begins with taking pre-treatment photographs and initial impressions. The smile design is created on data transferred to a digital environment, and models called mockups are prepared according to the design. At the second session, the mockups are applied in the patient’s mouth so that the final appearance can be seen live, and necessary adjustments are discussed at this session. Also at this session, minimal preparation is performed on the teeth where needed, and impressions are taken again with a scanner or conventional methods. The impressions are transferred digitally to the laboratory. After the previously taken photographs, photographs taken during the mockup trial, and the desired tooth shade are also sent to the laboratory, the actual design process begins. The laminate veneers are ready within approximately five days. At the third session, the porcelain laminates are tried in the patient’s mouth. If necessary adjustments are needed, they can be made at this session, and following the polishing process, the laminates are bonded to the teeth one by one with a meticulous technique.
Do Porcelain Laminate Veneers Fall Off?
Thanks to advancing technology, the bonding values of adhesive materials to both teeth and porcelain laminates are quite high. You can use porcelain laminates that are meticulously bonded following the necessary technical steps just like your own teeth.
How Long Do Porcelain Laminate Veneers Last?
Laminates that are successfully fabricated and bonded to the teeth with appropriate adhesives have a very long lifespan. With good and proper oral care and by maintaining your gum health, you can use your porcelain laminate veneers trouble-free for many years. They are resistant to staining and wear. Thanks to this, they maintain their original appearance even after years.
Prepless Laminate Veneers
Prepless Laminates stand out as a conservative application that provides excellent aesthetics in suitable patient groups. They are a type of laminate veneer that can be applied without mechanical reduction of the tooth surface. They can be applied in cases where there is no crowding of the teeth. (If there is crowding, some reduction may be necessary.)
This is a suitable aesthetic treatment method for individuals who want a whiter appearance for their teeth, who have issues such as wear or fractures on their teeth, or who have small, spaced teeth. Laminate treatment can be applied to individuals who have completed their dental and jaw development. In patients with negative behaviors such as teeth clenching and nail biting, these conditions must be treated first.
E-max Crowns
What Is E-max?
E-max is a type of lithium disilicate ceramic. It is prepared under special laboratory conditions by pressing glass ceramics. It is one of the best materials used as a dental crown material. Laminate veneers, full crowns, inlays, and onlays can all be designed very aesthetically with E-max. It has a semi-translucent appearance and can be fabricated very thinly. Thanks to its light translucency, it is difficult to distinguish from natural teeth. It is long-lasting.
What Are the Advantages of E-max Crowns?
When fabricating E-max, there is no need for a metal or zirconia substructure. For this reason, they can be prepared very thinly, and only minimal reduction of healthy tooth structure is required. The need for minimal reduction from natural teeth is one of the greatest advantages of E-max. The fabrication of E-max crowns requires meticulous work and technical experience. They are most commonly used in the restoration of aesthetic teeth in the anterior region. Their aesthetic properties are superior to zirconia as well.
How Are E-max Crowns Applied?
Depending on the type of restoration to be made, minimal preparation is performed on the natural teeth, and a digital impression is taken with a scanner or impressions are taken with conventional methods. A model is obtained from the impression, and temporary teeth are prepared on this model. The temporary teeth are placed in the patient’s mouth at this session. After the impressions transferred to the laboratory are designed on a computer, production begins. Photographs and short video recordings taken of the patient are also shared with the laboratory. The custom-fabricated E-max crowns are tried in the patient’s mouth. Aesthetic, function, phonation, and shade evaluations are made together with the patient during the trial. After the necessary adjustments, the E-max crowns are polished and bonded to the teeth.
How Long Does It Take to Fabricate E-max Crowns?
The preparation of E-max crowns takes approximately 5 to 7 days.
How Long Do E-max Crowns Last?
E-max crowns are durable and long-lasting aesthetic materials. When you pay attention to oral hygiene and maintain your gum health, you can use your E-max crowns healthily for many years.
Zirconia Crowns and Bridges
What Is Zirconia?
Zirconia is a white-colored, hard metallic element. In dentistry, it is used in the form of zirconia (zirconium dioxide). Thanks to its light translucency, it is aesthetically superior to metal-supported crowns. It is also a biocompatible material suitable for patients who have allergies to metallic elements such as chromium-nickel. In metal-supported porcelains, the metal used beneath the porcelain is gray in color and can cause gray discoloration at the gum line. Zirconia substructures, however, are natural tooth-colored and do not cause gray reflections.
In Which Treatments Are Zirconia Crowns Used?
Due to their light translucency, fracture resistance, and the ability to layer aesthetic porcelain materials on top, zirconia can be used in the fabrication of all restorations (crowns, bridges, inlays, and onlays) in both anterior and posterior regions. Zirconia, a material with superior aesthetic properties, high durability, and tissue compatibility, has a very broad range of applications.
How Are Zirconia Crowns Applied?
When fabricating zirconia crowns, treatment begins by performing preparations on the existing teeth depending on the type of restoration and the condition of the tooth in the mouth. Impressions of the teeth are taken with a 3D digital scanner or conventional methods. A digital model of the tooth to be restored is created on a computer, and the crowns are produced in zirconia milling devices. The fabrication takes approximately 5 days. During this period, to ensure patient comfort, temporary teeth are placed in the patient’s mouth at the same session as the impression-taking.
Is There Pain During the Zirconia Crown Procedure?
The patient does not feel any pain during dental procedures performed under local anesthesia. After the tooth preparation is completed, temporary teeth prepared according to the impressions taken are placed in the patient’s mouth on the same day, ensuring patient comfort during the period until the permanent teeth are fabricated.
How Long Do Zirconia Crowns Last?
A well-made zirconia crown that is compatible with the oral tissues can be used trouble-free for many years, provided the patient also pays attention to oral hygiene.
Do Zirconia Crowns Break?
Zirconia crowns and bridges that are well-adapted, do not interfere with chewing movements, do not cause any elevation, are compatible with the occlusion (chewing plane), and are fabricated in accordance with mechanical rules will not break. In posterior regions where chewing force is intense, zirconia blocks with high strength are preferred, while in the anterior teeth, zirconia blocks that provide better aesthetics are preferred.
Does Color Change Occur in Zirconia Crowns Over Time?
Zirconia crowns are resistant to wear and staining. They are easy to clean and maintain their original appearance.
Bonding Method
What Is the Bonding Method?
The bonding method is the process of correcting aesthetically bothersome issues in the teeth by the dentist in a short time and in a single session, using composite resins.
The experience and aesthetic perception of the practicing dentist is a very important factor in the success of the bonding method.
In Which Cases Is the Bonding Method Applied?
If there are gaps between the teeth; if the teeth are short in size; if there is a fracture due to trauma on the front teeth; if there is discoloration on the teeth; or if there are old composite fillings with poor aesthetics on the front teeth — all of these elements that negatively affect the smile can be easily treated in a single session using the bonding method.
How Is the Bonding Method Applied?
The application takes approximately half an hour per tooth. The bonding method can be applied without any reduction to the teeth. This characteristic makes the bonding method stand out, and thanks to this feature, it is safely used to address the aesthetic concerns of very young patients. Very tiny flaws on the teeth can negatively affect aesthetics, and simply correcting that small imperfection can make a significant difference in the smile.
The bonding method has advantages such as ease of application, no need for anesthesia during the procedure, no tooth reduction required, the ability to complete treatment in a single session, and costs that are much lower compared to porcelain laminates. For patients with significant crowding, advanced tooth discoloration, or those requiring a full smile design, treatment with porcelain laminates is a more suitable option. Composite laminates have lower resistance to fracture and staining compared to porcelain laminates. However, repair is possible and easy.
If you have minor flaws on your teeth, the bonding method is a suitable treatment option.
Aesthetic Dental Fillings
Aesthetic dental filling is the restoration of teeth after the decay has been cleaned, using light-cured composite filling materials that match the tooth color. The fillings made should match the natural tooth form in shape and color, the filling margins should not be visible, and the filled tooth should be indistinguishable from the other teeth. The polishing and buffing procedures performed after the filling process will extend the life of the filling and increase patient comfort. The prejudice that aesthetic fillings are not durable has begun to break with the increase in successful practitioners and the advancement of aesthetic filling materials. Aesthetic fillings made with the correct technique and the right material are quite durable and long-lasting. Aesthetic fillings chemically bond to the teeth; when technical procedures are correctly followed, separation of the filling from the tooth or recurrent decay beneath the filling does not occur. Even in teeth with very large tissue loss, composite fillings can be applied successfully. Composite fillings can be applied directly in a single session, or for teeth with very extensive tissue loss, they can be applied using the indirect method — taking an impression, preparing the filling on a model, and bonding it into the patient’s mouth in a short time. The advantage of the indirect method is that the filling can be shaped more beautifully on the model and the working time in the patient’s mouth is shorter.
Inlay and Onlay Restorations
Inlay and onlay restorations are a type of filling applied using the indirect method. After the decayed portion of the tooth is cleaned, an impression is taken of the remaining healthy tooth structure. The filling shaped on the model is bonded to the tooth in the patient’s mouth, completing the procedure. We prefer inlay and onlay restorations in cases where there is significant substance loss in the tooth. Before this technology was developed, teeth with large fillings needed to be crowned in order to better ensure aesthetics, chewing function, and contact relationships with neighboring teeth. To create space for the crown, some reduction of healthy tooth structure was also necessary. With inlay and onlay restorations, however, healthy tissue is preserved while aesthetics, function, and durability are maximized. The difference between an inlay and an onlay relates to the size of the restoration and the area it covers. We can say that inlays are smaller restorations covering less surface area, while onlays are larger restorations covering a wider area.
Different materials with varying properties can be preferred when fabricating inlay and onlay restorations. For example, composite resins, E-max, and zirconia can all be used in inlay and onlay fabrication. This application, which has high aesthetic value and durability, can also be counted among aesthetic dentistry applications.
Teeth Whitening
White teeth hold an important place as part of an aesthetic appearance. Over time, discolorations can occur in the teeth due to physiological reasons or internal and external causes such as antibiotic use and tea or coffee consumption. Teeth whitening is the process of removing the discoloration that has formed in the porous enamel and dentin structure on the tooth surface using teeth whitening gels. Teeth whitening methods are divided into two groups based on the technique applied: at-home teeth whitening and in-office teeth whitening.
At-Home Teeth Whitening
In the at-home teeth whitening method, custom whitening trays are prepared by taking an impression from inside the mouth. A specified amount of teeth whitening gel is applied inside the prepared tray, and the patient is asked to wear the tray. The trays should be worn for 4 to 8 hours per day without removal. The whitening period lasts approximately 10 to 15 days depending on the need. With this method, in which the tooth shade gradually lightens, the results are more long-lasting compared to in-office whitening.
In-Office Whitening
This method is also known as “laser teeth whitening.” It is performed by the dentist in the clinic. Before the application, the gums are covered with an appropriate barrier. The whitening gel applied to the teeth by the dentist is activated with the help of UV light or laser. The whitening procedure takes approximately one hour, and the gel application process can be repeated until the desired result is achieved.
The decision on which method to apply is made based on the extent of the discoloration and the targeted degree of whiteness. To achieve maximum whiteness and longer-lasting results, in-office whitening can be followed and supported by at-home whitening. In the subsequent period, by applying at-home whitening gel to the existing whitening tray at intervals of approximately 6 months, we can ensure long-lasting results.
Single Tooth Whitening (Internal Whitening — Endobleaching)
Internal whitening treatment is applied to teeth that have changed color following root canal treatment. The filling on the tooth is removed, whitening gel is applied into the resulting space, and the tooth is sealed with a temporary filling. Sessions can be repeated at two-day intervals until the desired whiteness is achieved. Once the desired result is obtained, a strengthening material is first applied to the tooth, followed by the permanent filling. Your dentist will decide which teeth whitening method is appropriate for you after an examination.
Whitening methods may cause some degree of sensitivity in the teeth. This is a normal and expected side effect. The sensitivity in the teeth is expected to resolve within a few days. During and for two days after the whitening process, staining liquids such as tea, coffee, wine, and cola, as well as tobacco products, should be avoided. Teeth whitening can be applied to all adults over the age of 18. It is not recommended for pregnant women.
Pink Aesthetics (Gum Aesthetics)
Having a beautiful smile requires more than just white and straight teeth. Healthy gums that are harmonious with the teeth are also necessary. Aesthetic adjustments made to the gums are called pink aesthetics (gum aesthetics). For gum aesthetics to be performed, the gums must be healthy. If gum diseases are present, they must be treated before gum aesthetics. Healthy gums are light pink in color and have a stippled appearance similar to an orange peel.
The ideal gum level is achieved when the imaginary line located at the zenith of the two central incisors at the front center of the jaw — the line that is thought to pass through the gums — slightly touches the lip during smiling. A smile in which the gums are excessively visible negatively affects aesthetics. When performing gum aesthetics, surgical techniques are used depending on the nature of the problem. In some cases, it may be necessary to adjust the gum appearance of all teeth within the smile line, while in other cases, intervening with the gum tissue around only a few teeth may be sufficient.