Cosmetic Fillings: Why the Italians have got it White

I am often asked why my white fillings are significantly more expensive than Dr.A.N.Other’s just around the corner. They’re white, right? What more is there to ask?

So I thought that I’d tell a little story about how I ended up spending a considerable number of long weekends hanging out with arguably the best cosmetic filling dentist in the world. He calls them ‘aesthetic composite restorations’ and his name is Dr Lorenzo Vanini (google him and you’ll see). Now Lorenzo, apart from being the best cosmetic dentist in the world is also a fine pianist and jazz-composer, a black belt in karate, and lives on the shores of Lake Como not far from George Clooney.

I went to find Lorenzo because my experience of white fillings was that:

  1. They didn’t last very long (less than 5 years)
  2. They didn’t look like tooth, they often looked like murray-mints surrounded by a dark brown leakage-line
  3. They often had decay underneath them (so if anything, they looked worse underneath than they did on top)
  4. They were weak and prone to fracture
    a n other dentist white filling
    a n other dentist white filling

    In short – mercury fillings were better in every way except they looked a bit black!

White fillings

2 teeth with italian fillings, the one in the middle not done yet

Lorenzo opened my eyes and proved beyond a doubt that:

  • Quality white, cosmetic fillings can last 20 years!
  • Quality white, cosmetic fillings are indistinguishable from natural tooth tissue
  • They won’t decay underneath (providing a strict placement protocol is adhered to as prescribed by Lorenzo)
  • They are strong and not prone to fracture
  • They are so much better (for the tooth and patient) than mercury fillings – and they look good to!

Lorenzo opened my ears too, because being a keen musician myself, we inevitably found ourselves jamming after a long hard day’s teaching/learning (and some decent italian wine of course).

Lorenzo also taught me to use his material to produce free-hand immediate veneers which have become a very popular cosmetic treatment here at Winning Smiles over the years.
Anyway here is my recipe for making the best white fillings in the world (and our ‘routine’ procedure here at Winning Smiles)

  1. Purchase the best white filling material in the world (‘Enamel Plus’ from Italy, produced by Mycerium, designed by Lorenzo and his chemists)
  2. Ensure that the tooth is properly numb (using ‘The Wand’ our painless injection system from the US)
  3. Apply ‘rubber dam’ to the tooth so that it is isolated from the saliva in the mouth (saliva + white filling = disaster, also we use the rubber dam to prevent bits of mercury filling being ingested!)
  4. Remove old filling/decay etc, the cavity has to be prepared precisely as prescribed by Lorenzo (margins polished, etc etc)
  5. Chemically clean cavity (Lorenzo technique)
  6. Apply bonding agent (Lorenzo technique, the bonding agent is also one of the best in the world – cheap bonding agent = leakage and brown lines around the filling)
  7. Apply different shades of Enamel Plus filling material, laminating/layering technique as per Lorenzo
  8. Finish with specific tungsten-carbide tipped drills and specific polishing brushes and pastes (as per Lorenzo’s technique)
  9. Voila! A white filling that can be (easily) guaranteed for 5 years, will last much much longer, and actually looks like a tooth – even after years of use!

 

Italian Filling by Winning Smiles

Italian Filling by Winning Smiles

Using the best materials and the best technique and ensuring the best environment for the alchemy to take place takes time, and those materials cost double what the cheap stuff does….but is it worth it?? Of course it is. Anybody for a cheap white filling now?

Fit & Forget Dental Implants – Part 2

So here’s the follow up to my last blog about fit and forget implants:

If you think that you might benefit from dental implants..

here’s a few questions to put to the dentist before you choose to go ahead:

Q. What guarantees do you offer on your dental implants?

Q. Will you replace an implant if it doesn’t take – free of charge?

Q. And in the long term – how will you ensure that I still have my implants in 10 years?

Q. What are the ongoing maintenance requirements for dental implants, and how much does that maintenance cost?

Q. Can I see some before and after photos of your work?

Q. Can I speak to any of your patients who have had implants placed by you? (Ask for testimonials)

Q. How long have you been placing dental implants?

Q. How many implants have you placed?

Q. How many of those implants have failed?

Q. Talk to me about peri-implantitis!

Q. I’m a smoker – am I still suitable for dental implants?

Q. I have had gum disease, this is how I lost my teeth (they got wobbly and fell out), will the same thing happen to my dental implants?

Its important to know everything before you choose, and of course, we’ll answer all these questions for you in the Free Consultation.  

Fit and Forget Dental Implants?

Dental Implant

I love talking my patients. They are my lifeline to the real world out there – you know the one where most people don’t spend all day every day think
This lady is one of my long standing dental implant patients – a few years ago we completely rebuilt her upper and lower jaws using custom porcelain bridges supported on titanium implants.ing about teeth (just ask my wife, it drives her potty!)

The thing is, they look as good today as the day we fitted them all that time ago. But this is no accident. Gill follows Laura’s (one of our lovely hygienists – yes they’re out there, honest!) advice to the letter. She cleans the bridges and implants twice a day, and visits us every 6 months for her Healthy Mouth Review to allow us to monitor the health of her mouth and implants, to clean those areas even she can’t get to, and to carry out our Oral Cancer Check.

This is routine at Winning Smiles.

Implants need as much – possibly more – upkeep than natural teeth…they are a great copy of the real thing (better than a chinese rolex) but even I don’t claim to have beaten mother nature at her own game!

So when Gill told me yesterday that she is coming across more and more people who are benefiting from this sort of dental treatment – but most of them can’t understand why she has to keep coming back to see us for what they see as ‘unnecessary maintenance’, I had to press her for further clarification! ‘Why.’ I said? And Gill went onto explain that these patients are popping into dental practices (yes,in the UK) and having implants placed ‘as if they are just expensive fillings’!

This is a worrying trend. Problems with dental implants rarely cause pain, so for a patient who has been advised in this way the first time they realise there is a problem with their dental implants might be the day they fall out! The fact that this may take 5-10 years is what is protecting both these dentists (and their patients – ignorance is bliss) for the time-being. But it’s a ticking time-bomb. These cheap ‘quick-fit’ (and forget) implants have been placed in the last couple of years as more and more of the profession learn about them – in response to greater and greater demand from patients….alas it is only a matter of time before the chickens come home to roost. And when they do, the only winners (as usual) will be the lawyers.

Leaving the cost issue aside, once implants fail it is not nearly as easy to do them a 2nd time. The bone around them disappears – which is why they fall out – so if they fall out, by definition there is often no bone left to put another one in….and this puts us right back to the 1970s: dentures for all.

Happy Easter. Lay off the eggs ;-)

"Your Complete Guide to Smiling, Chewing and Eating again with Confidence"

 

The Times Raconteur Supplement Monday 20th Feb

Minmally Invasive, Oral Health conscious, High Tech Cosmetic Dentistry

New Cosmetic Dentistry As seen in ‘The Times Raconteur Supplement‘ Monday 20th Feb

I’m excited.

For years I’ve been banging on, extolling the virtues of a philosophical approach that puts Cosmetic Dentistry and Healthy Dentistry in bed together – often in the face of a seemingly increasingly agressive approach being driven by our Atlantic cousins.

I’ll explain.

If you were to have followed my musings over the years you will know that I am inclined to be kind to both patients and their teeth. Our emphasis at Winning Smiles is pain free dentistry (eg use of the wand) and tending to try and enhance the natural tooth (eg Alignment, Bleaching and Bonding or ‘ABB’ rather than wall to wall enamel destruction and shed-loads of porcelain veneers).

These treatments are not only better for the teeth, they are better for the patient experience, better for their pocket! More ‘Gentle’ in every way!

So for me to read in the National Press that they have dedicated a whole supplement to Gentle, Healthy Cosmetic dentistry, well it’s music to my ears [grist to your mill? - ed].

As the title page of ‘Raconteur’ (linked above) says: previously ‘Cosmetic Dentistry’ was all about grinding miles of enamel off teeth to make room for great big ultra-white porcelain veneers – and this aggressive approach continues today. But clearly the New Wave is on the ascendent and the old way of doing things is being replaced by a more health conscious, gentle approach.

Sadly there are still well known clinics in well known parts of London encouraging patients to spend ‘A grand a tooth’ on that ‘Perfect Smile’:

A 2nd Opinion

Only last week a young lady of 20 came to me for a 2nd opinion. She smiled broadly at me to reveal a perfect set of straight teeth albeit for one upper central incisor which was grey…’I've been told I need 10 veneers’ she confided. On further investigation it was revealed that she had had an ‘E-consult’with a West London Clinic who had advised her that to get a perfect smile she needed 10 veneers at a grand each.

Needless to say, she is coming to us to have a single EMAX crown fitted to the grey front tooth after we have internally bleached it. The colour matching will take a while and will probably involve re-shading that crown a couple of times to get it to blend seamlessly with the natural teeth.

Matching a single front tooth to its natural neighbours is one of the hardest things to do.

I wonder how many times people have been recommended to fit 6, 8 or 10 veneers because the dentist finds it easier than the alternative. At best, a lazy approach, and it does all make you wonder sometimes.

But veeners will always match each other, won’t they?! (it’s hard to do sarcasm written down)

Shaping and restoring teeth to their former glory:

  • Better for teeth – tick
  • Better for patient – tick
  • Less expensive – tick
  • More challenging (and therefore more rewarding) for the dentist – tick

That’s our kind of dentistry!

Invisalign Offers, Jan and Feb

Book Free Consultations now for January or February

We’re expanding our Orthodontic Clinic in the new year, and have created some special offers to get started with.

The offers are outlined over here

The Invisalign and Inman Aligners have been extremely popular, for good reason as they do seem to tick all the boxes for people looking to improve their smile.

Please feel free to book and in with us and see which might be the best treatment for you, and in the mean time we wish you a great Christmas and a Happy New Year

Instant Veneers – as seen on Jeremy Kyle

I never thought I’d say it, but the Jeremy Kyle show had quite an impact one day last month on our dental practice.

Thanks to a recent programme featuring new cosmetic dentistry techniques and ‘instant’ veneers, our phone rang off the hook all day. Who’d have thought the show would have that much influence!

You’ve probably heard of porcelain veneers, they’ve been around for quite some time.  They’re the reason so many celebrities have perfect teeth and bright, white smiles.  Simon Cowell, Miley Cyrus, 50 Cent, Katie Price and Hilary Duff are all rumoured to have got themselves a set of veneers – and at a celebrity price.  A full set of porcelain veneers can cost thousands, and yes, we do still fit these when the occasion demands it.

However, ‘instant’ or ‘composite’ veneers, at a fraction of the cost, put a fantastic smile within the reach of the rest of us, which I guess is why Jeremy Kyle’s show provoked such as response.  But then, a dazzling smile, a more confident and youthful look – it’s a service that was always going to be popular, if only people knew it existed!

Immediate veneers before and after picture

The flexibility of this new material does mean that Instant, or Immediate Veneers are the modern answer to crooked teeth, staining or gaps between teeth.  They are fitted quickly and easily over your existing teeth in just one visit to the surgery, and there’s no need for your own teeth to be filed down (as with porcelain veneers) so it’s pain-free too.  Yes, really.

If you think that sounds too good to be true – we thought that too, but there really isn’t a downside to this. Instant veneers do look great, they are long lasting, and easily repaired if chipped. The cost is just £350 per tooth, which is about half the price of the porcelain method.

When choosing instant veneers our main piece of advice is to find an experienced composite dentist. I know, we would say that, but not all dentists follow the same career path.

It is different, because whereas porcelain veneers are made in a lab by a technician, instant veneers are shaped by the dentist in the surgery so your dentist needs to have a good eye and a little artistic flair!

“Keep smiling – it makes people wonder what you’ve been up to.” Author unknown.

How do you find a busy dentist?

We have just posted a description of the kind (of) dentist that we are seeking to join us at the Winning Smiles dental practice. More detail over here…

The dentist vacancy has been created by a steady increase in patient numbers over the last couple of years. And the only way we can continue being able to serve more people whilst still giving patients the time they deserve, is to find some help. We’re nothing if not logical around here.

So if anyone reading this knows someone special in the field of dentistry, if you would be kind enough to point this job out to them, then we would be very grateful. We feel we should ask because we know that special people are always busy and aren’t always looking for a new role at exactly the time the perfect opportunity comes up!

We’ll update you on our search when we have some news.

The Winning Smiles Team.

The top three reasons why I like Damon System braces, by Almarie Odendaal

Almarie Odendaal is the new orthodontist at Winning Smiles and is an expert in fitting braces using the new Damon System.

Almarie Odendaal, new Winning Smiles Orthodontist

Almarie Odendaal, new Winning Smiles Orthodontist

Here are the top three reasons why Almarie thinks Damon braces are a great treatment to choose if you need a full brace:

1. Damon braces typically provide excellent results in a shorter treatment time than conventional braces, and patients have to make less appointments.

2. Using the Damon System means that it’s very rare that a patient will need to have any teeth extracted, and they won’t have to wear any headgear during treatment.

3. Patients are a lot more comfortable during treatment.

Damon braces use a new passive slide mechanism to maintain the shape of the archwires within the bracket.
This allows the wires to move freely and reduces friction and binding, so your teeth can move quickly and comfortably. Other types of braces use elastic ties or active clips that bind archwires in place, this results in friction, making treatment slower and less comfortable. Elastics ties also attract a lot of plaque and so Damon System braces are also a lot easier to keep clean.

Almarie Odendaal, joined our team in June. Almarie qualified as a dentist from the University of Pretoria in South Africa in 1993. She is a member of the British Orthodontic Society, the Faculty of General Dental Practice and the British Dental Association.

You can book a consultation with her by dropping us a note via the form on the web site, or call us on 08000 90 10 60.  Consultations are currently FREE!

Alignment, bleaching and bonding vs teeth veneers

Or the story of how three techniques (alignment, bleaching and bonding), when skilfully combined, can save you money and give you better results than just one (wall to wall teeth veneers)…

Before alignment, bleaching and bonding

Before alignment, bleaching and bonding

After alignment, bleaching and bonding

After alignment, bleaching and bonding


Alignment Bleaching and Bonding vs Wall to wall teeth veneers

Here in Essex, Cosmetic dentistry is evolving. A decade ago when decent porcelain veneers came along cosmetic dentists were very keen on placing lots of veneers – in 2010 there are still a lot of veneers being placed by cosmetic dentists, but here at Winning Smile we believe that the Age of the Veneer is on the wane.

A colleague of mine Dr Tif Qureshi (www.dentalelegance.co.uk) recently addressed the profession with his ‘evolved’ concept of Cosmetic Dentistry – updated to reflect the progress in dental knowledge and treatments within the profession and changing attitudes among our patients. Tif brought the Inman Aligner to the UK from the States and combines this brilliant little brace with 2 other treatments to produce significant dental transformation without the need to grind away good teeth as is the case with veneers.

Tif’s concept is called ABB: ‘Alignment, Bleaching and Bonding’

Alignment

Using the inman aligner the front teeth can be lined up orthodontically in as little as 10 weeks

Bleaching

The cosmetic dentist’s best friend – professional teeth whitening to noticeably ‘lift’ the colour of all the teeth

Bonding

The addition of cosmetic filling material (like our Italian HFO system) where necessary to add the finishing touches.

Here at Winning Smiles we have been using the bleaching and bonding techniques for years and Michael Fennell one of our orthodontists has been doing the straightening. We are no strangers to these ideas. But Tif has put a label on it for us, and we think people will be hearing of this costmetic dental technique a lot more.

As always my regular readers will notice that I like to bullet point the pros and cons

ABB Advantages over Teeth Veneers

  • No grinding off of the front surfaces of the teeth
  • No porcelain veneers that can fracture easily and begin to lose their looks after a few years – ABB simply enhances your own teeth
  • Cost – ABB costs around £2000 at Winning Smiles, 6-8 veneers cost £3600-£4800!
  • ABB is one hit: veneers usually need to be replaced every 10 years or so (think of the cost implication of that)
  • ABB is kind to the teeth – occasionally a veneered tooth will need a root filling because the nerve reacts badly to the grinding process

Disadvantages of ABB vs Veneers

  • Very badly discoloured teeth or teeth with lots of visible fillings may be better treated with crowns or veneers
  • Teeth that have always been the wrong shape (eg too small, or misshaped) usually benefit from veneers/crowns despite the drawback
  • ABB will take on average 12 weeks – veneers can be done in 2-4 weeks
    Jodie Marsh lookalikes need porcelain veneers for that level of whiteness

Are false teeth now history?

How old, dodgy dentures have given way to beautiful, permanent replacement teeth

Truly transformational: the full arch titanium/acrylic fixed implant bridge:

before treatmentafter treatment
Times (they are) a changing.  I’m actually not listening to Bob Dylan as I write this, but times are definitely changing in the world of UK dentistry, and where dentures are concerned, the change is accelerating.

20 years ago if you had lost all your teeth, false teeth or ‘falsies’ were your only option. Cheap and cheerful, available free on the NHS…and utterly hopeless as a functioning pair of teeth. Some of them looked ok and even stayed in when you were talking, sometimes!

20 years ago dental implants were in their infancy, only a few brave dentists with hugely rich patients ventured into such unchartered territory..

Fast forward 10 years and things had changed dramatically:

10 years ago if you had lost all your teeth (or a complete top or bottom set)  then it was possible to find a few dentists with the ability to replace a whole set of top or bottom teeth - but the costs, although vaguely affordable for those with serious property equity, were still somewhat eye-watering. A full set of porcelain teeth needed 10 implants to support them and each tooth was lovingly crafted – the dental technician would spend days or even weeks making them.

Some dentists realised that there must be ‘another way’ and started to use fewer implants to fix dentures in place: the implant-denture was born. The beauty of the implant denture is that instead of needing 10 implants to hold a complex custom made porcelain bridge in place, with the extra support that the implant denture gained from resting on the gums, the implant dentists could use fewer implants to hold these teeth in place:

Result! Dentures that stay put and can be used for eating most food without any fear of them falling out when discussing the latest episode of the Simpsons [Grandpa should have implant-retained dentures by now surely? -ed]

The only problem with implant retained dentures is that in patients’ eyes they are still dentures! They need to be removed for cleaning purposes every night….and no matter how well they stay in with their super-duper implant-connectors, they still have the ‘false teeth’ label.

2010

Enter the new era of ‘full arch’ implant dentistry [full arch: aka a top set, bottom set or complete set of implant-teeth].

Combining the ease of construction of implant-dentures with the satisfaction of having a set of fixed teeth that really feel like your own, without resorting to using 10 implants at a time and without the days and weeks of painstaking construction time at the dental lab…..it has become possible to completely replace a top set, bottom set or both for a rather less eyewatering fee than those huge ceramic bridges….

How?

This has been made possible by using digital scanning/CNC technology to produce titanium ‘backbones’ with micro-tolerances that are screwed into place on as little as 4 implants for a full set.

Top quality acrylic teeth are then firmly attached to the titanium backbone and the full arch titanium/acrylic fixed implant bridge is complete.

How do they look? The photographs speak for themselves.