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Cosmetic Dentistry

In the past decade there has been a dramatic interest in cosmetic dentistry.  We all realize that having a healthy, bright, beautiful smile enhances our appearance and allows us to smile with confidence.  Thanks to the advances in modern cosmetic dentistry, we are able to improve our teeth and smiles with quick, painless and surprisingly affordable treatments.

Cosmetic dentistry creates attractive smiles that function in a state of health.  As cosmetic dentists, we can help determine how to improve your smile, thereby looking better and feeling better about your appearance.  If your teeth are chipped, spaced or discolored, if their shape is somehow unattractive or if you simply want to have an eye-cathing smile, we can give you the smile you once had or the one you always wished for.

At Artesa Dental we realize that every face is unique and therefore can't prescribe a generic set of teeth to every smile.  Facial features have to be carefully evaluated to determine what works best for the individual.. Cosmetic dentistry can be a life changing event which often times paves the way for career advancements and a greater zest for life.


Cosmetic Problems & Concerns
Black Hole Disease
Congenitally Missing Teeth
Enamel Defects
Gapped Teeth
Rotated and Crowded Teeth
Severe Discoloration from Tetracycline
Small Teeth
Triangular Shaped Teeth
Gummy Smile/Uneven Teeth

Black Hole Diseases
This problem appears in your gum tissue as a black hole or as if a poppy seed is stuck between your teeth. The black space can appear larger with time. Sometimes we see this problem after orthodontic treatment. The teeth are aligned nicely but due to the anatomy of the teeth being triangular or bulbous a space exists above where the teeth contact leaving a black hole instead of healthy pink gums. Or, after orthodontics the teeth are aligned properly but the roots aren’t which helps create a lower bone level and resultant black hole where the healthy pink gum tissue should be.  Moving the position of the teeth with Invisalign and or reshaping of the sides of the teeth can quickly, comfortably and effectively treat this problem in less than 6 months.

Another cause of this problem is active gum disease or from treatment during gum therapy. Now when you smile, there are spaces and air goes through them. Sometimes this can affect speech. This can be quite unsightly if it has progressed far. With the correct type of porcelain laminate preparation for this situation, this condition can easily be corrected in two visits and the results are quite stunning and confidence building.

black hole disease before photo black hole disease after photo
black hole disease before picture


Congenitally Missing Teeth
A very common problem that we see is clients who never had their lateral teeth form. Those are the teeth right next to the two upper front teeth. What happens is that now the arch is bigger than the number of teeth occupying that space. The eye teeth (which are the sharp teeth at the corners of the mouth) begin to drift into the missing tooth space. Sometimes braces are done as a child for a client missing these teeth. They either had the space closed or almost closed to bring the eye teeth into the position of the lateral. Now you have sharp teeth in front of the smile rather than to the side and often spaces remain. Another way it is sometimes treated as a child is to maintain the space for a lateral and some type of restoration is placed there to retain the spacing. Many times there is an associated “gummy look”. If the spaces are closed or almost closed the best way to correct this is with porcelain veneers. This requires very skillful knowledge of the problem and artistic capabilities to give the illusion that the smile never had any problems. If the space has been maintained with a removable tooth or with a bonded metal based fixed tooth (Maryland bridge), there are different ways to esthetically place a non-removable tooth with no metal. These would include a couple of types of all-porcelain bridges or implants.

ongenitally Missing Teeth before photo ongenitally Missing Teeth after photo
ongenitally Missing Teeth before picture ongenitally Missing Teeth after picture


Enamel Defects
1) Bulimia and Acid Reflux- These are very destructive to the enamel. Slowly they erode the enamel away from the teeth at the gumline and sometimes at the back of the teeth where it is not visible. Teeth will slowly get thinner and thinner and chip away very easily. This not only causes esthetic problems- it causes severe functional problems as well. If this destructive process is not corrected the bite can collapse and cause severe jaw problems. If corrected soon enough, bonding can be done to cover exposed areas of teeth. If more than 25% of the tooth has eroded, porcelain veneers need to be designed to protect the underlying dentin and correct the bite problems that may have occurred. Ultimately, the acid level in the mouth has to be regulated by a gastroenterologist.

2) Swimmers-
Swimming in overly chlorinated pools can wear away the enamel in people who swim quite frequently (i.e. daily). We have seen severe cases of this. We recommend that you have your teeth checked frequently and letting your dentist know that you swim in a chlorinated pool. Fluoride treatments can be given to help keep the teeth strong and swimming with a well adapted and custom fitted mouth guard can minimize exposure of teeth to chlorine.

3) Enamel/Dentin Hypoplasia- Localized enamel hypoplasia refers to individual teeth that have hypoplastic, hypocalcified or hypomineralized areas on a tooth resulting from infection or trauma. It can vary from a mild to a severe form in which pitting and irregularity may be extensive in the crown. Developmental (amelogenesis imperfecta), systemic disturbances and nutritional deficiencies during infancy or metabolic disturbances during prenatal or neonatal life can cause hypoplasia. Tetracycline exposure, excessive ingestion of fluoride and high body temperature (fever) has also been implicated in enamel defects. Treatment options include crowns and veneers (if enough enamel remains) to protect the teeth from chipping and breaking as well as to improve overall esthetics, reduce sensitivity and restore function.

4) Soda/Citrus Drink Overuse- One of the ingredients in soda drinks (diet Coke, Pepsi, Mountain Dew, etc) is phosphoric acid. Phosphoric acid is caustic to enamel. Citrus drinks have citric acid in them which is also caustic to enamel. Bathing the mouth in orange juice or soda, especially when sipping it slowly and allowing it to stay in the mouth too long can cause the enamel to slowly wear. Sucking on lemon wedges is also a way to breakdown the enamel on your teeth. If too much breakdown of enamel occurs, we have to consider treatment options to rebuild the lost tooth surface and the resultant sensitivity, loss of function and loss of esthetics.

Enamel Defects before photo Enamel Defects after photo
Enamel Defects before picture Enamel Defects after picture

Gapped Teeth
If the shape of the individual teeth are correct and they are symmetric to their identical counterpart in the arch, with Invisalign they can be brought close together and easily retained so they won’t relapse. However, if the spacing is too severe or if the teeth are not beautiful to begin with, porcelain veneers are necessary to correct this defect.

Gapped Teeth before photo Gapped Teeth after photo
Gapped Teeth before picture Gapped Teeth after picture

Rotated and Crowded Smile
As long as the shapes of the individual teeth are beautiful they can be de-rotated with Invisalign within a few months. However, if the teeth are misshapen individually, uncrowding them will only place them in the correct position in your arch and they still need to be improved with porcelain veneers. If the crowding and rotation is severe we recommend a combination of Invisalign and veneers. If the crowding is minor we may consider either Invisalign or veneers.

Rotated Teeth before photo Rotated Teeth after photo
Rotated Teeth before picture Rotated Teeth after picture


Severe Discoloration from Tetracycline
Tetracycline is an antibiotic used to treat numerous infections. One of the unfortunate side effects of this important medicine is that when it is given to growing children it will drastically discolor their teeth. Unfortunately this type of discoloration does not respond to bleaching well and it may require numerous applications of laser bleaching to achieve a noticeable result. The treatment of choice in such severe discolorations is porcelain veneers.

Tertacycline Discoloration before photo Tertacycline Discoloration after photo
Tertacycline Discoloration before picture Tertacycline Discoloration after picture


Small Teeth
Often times teeth are small because of extreme wear from grinding or combination of grinding and acid erosion. If the teeth have worn away severely i.e. 20% or more of the original volume, then the only solution is rebuilding them with porcelain reconstruction. However, there are times that teeth are just hiding underneath the gums and all one needs to do is lift the curtain up with a cosmetic laser gum lift. Another situation that might give the illusion of small teeth is limited upper lip movement when smiling. If the upper lip does not move, the solution might be plastic surgery and or lengthening of teeth with porcelain veneers.

Small Teeth before photo
Small Teeth before picture Small Teeth after picture

Triangular Shaped Teeth
This can happen as a result of aggressive tooth brushing or from teeth that are positioned too much in front of the arch. It is quite a common problem these days, especially with people who have the most meticulous oral hygiene routines and unwittingly abuse their gums from brushing too much or too forcefully. It also can occur after braces where teeth are moved far out of the arch to alleviate one problem has created another-exposure of the root surface. As long as the recession is not too severe requiring a gum graft, the shape of the teeth can be altered with porcelain veneers. Sometimes both may be required.

Trisangular Shaped Teeth before photo Trisangular Shaped Teeth after photo
Trisangular Shaped Teeth before picture Trisangular Shaped Teeth after picture


Gummy Smile / Uneven Teeth
Often times teeth may appear uneven and asymmetric due to the uneven level of gums. One tooth may appear shorter than its matching tooth on the opposite side mainly because the gum levels are different. This can easily be corrected with laser gum lift to reveal the hiding tooth and create symmetry. However, if the teeth are still misshapen, porcelain veneers are necessary to bring brilliance and luster and just an overall pleasing smile.

Gummy Smile before photo Gummy Smile after photo
Gummy Smile before picture Gummy Smile after picture