When it comes to smile makeovers, there is a lot to consider, and it can be very confusing. What is critical is that you obtain a few different points of view before embarking on complex and sometimes irreversible dental work. What applies to your friends, influencers or relatives likely does not apply to your situation. There is only one you!
Let us look at some of the facts and myths around cosmetic and rehabilitative dentistry to help make the right decision for your circumstances. It is critical to get your advice from knowledgeable, experienced professionals, and getting second opinions is also encouraged.
A good starting point is – What is the LEAST you can do for you to reach your smile goals?
This can mean different things to different people.
Least time? Least invasive or destructive to the natural tooth? Least expensive? Least ongoing maintenance?
If you are happy with the position and shape of your teeth, but would like to change the colour, then whitening is the least invasive, and least expensive option. Apart from the risk of some temporary sensitivity and gum irritation, dentist-prescribed and monitored at home whitening is safe and reliable. This is especially true of take-home whitening in custom fitted trays. Whitening gels come in different strengths and it is important to understand what you are getting and how this influences the outcome.
Whitening will not change the colour of existing fillings or crowns, and it will need to be repeated periodically as the effect fades. It is also related to what you eat and drink (coffee tea, wine etc). You can expect nice results from whitening when used as prescribed, but not outrageous refrigerator white smiles!
Aligning your teeth
(braces, Invisalign or other clear aligners) If your teeth are rotated, out of alignment or crowded for space, then moving them into an ideal position is usually the best option. This is especially true if they are of a satisfactory shape, and you are after a more natural appearance. You can of course have them whitened as well. Aligning does take time and compliance, especially when it comes to using aligners. This can range from months to years, depending on how much movement is required. It is not an instant fix, but you also have not modified your teeth or placed anything on them that requires maintenance. Once your teeth have been straightened it is important to use retainers to keep them where they are for many years to come.
Can’t I just get my teeth veneered instead of aligning?
Where it becomes more complex is if you want or need your teeth to be reshaped or rebuilt AND they are crowded. In many cases, aligning your teeth into a better position before placing veneers can result in improved aesthetic outcomes, reduced thickness of the veneer and most importantly, less cutting back of the natural tooth. Getting veneers done just because you want an instant result is not a decision to be taken lightly and an ethical dentist will present all options to you for your consideration.
Porcelain Veneers are not always about glowing white giant Hollywood smiles. They are a way of restoring a worn tooth, making more significant changes to the shape of a tooth or blocking out discolouration. Porcelain veneers can also be customised to show very natural and life-like features. Only a small amount (or in some cases none) of your natural tooth is removed for a veneer to be placed over it. In most people who do not have excessive grinding or wear, a veneer is a very durable (10+ year) restoration which has excellent colour stability and lustre. Veneers are, however, expensive and will require replacing which needs to be factored in over your lifetime, which is why aligning, and whitening are particularly important to consider. It is also very difficult to have the veneer repaired if it does chip or is damaged, which means replacement is required in the event of an accident. Wearing a nightguard, also known as a splint, is often indicated to prevent damage to veneers in the future.
Composite Veneers are made of white filling material and are usually hand made by the dentist with little or no trimming of your natural tooth. In many ways, a well-done composite veneer can look comparable to a porcelain veneer, but they are more prone to chipping, breaking, and staining and require more frequent polishing, repair or replacement. They are of course less expensive but are also more easily repaired. In general, people are more satisfied with the long- term colour, shape and luster and durability of porcelain over composite.
Crowns are rarely indicated for aesthetic smile makeovers where the underlying teeth are fundamentally sound. If a tooth has an existing crown, has significant wear on the back surface and other surfaces, or already has multiple large fillings, then a crown can be the best choice for longevity. For teeth that are only worn on the tips or edges and are otherwise sound, a crown is not the ideal choice. The reason is that crowns require more natural tooth to be removed so they can be fitted over the top of them. Think of a veneer as a false fingernail and a crown as a helmet. Preserving your natural tooth is preferred by conservative dentists who wish to minimise invasive dental procedures that can have less desirable outcomes. Crowns can be especially useful in strengthening back teeth that are prone to breaking but not as much for only cosmetic purposes.
So what are the take-home messages?
Your specific situation, goals, budget, aesthetic expectations and expectations of longevity and maintenance will all play a part in the decision making.
The less invasive procedures generally carry less risk but may not meet your smile goals.
Aligning and whitening natural teeth with perhaps a small amount of composite filling or veneers is often the least invasive way to get great, more natural results. It just takes longer to get to the completion of treatment.
Porcelain veneers are a wonderful way to restore certain types of worn teeth or make more significant changes to their shape. Composite can achieve good outcomes for less money, but with less longevity and less long-term satisfaction. Crowns are used for aesthetic makeovers where certain conditions require them but are otherwise not the preferred choice.
In some cases, you might need none, some, or all the above options to achieve your ideal outcome.