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

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

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?

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!

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

Closing gaps between teeth

I thought it worth jotting a few words down about this one – it’s such a common problem for people, and frankly so easily fixed (without breaking the bank)!

Here at Winning Smiles we’ve been closing gaps between teeth for years, using our Italian composite-filling system (the same white filling system we use for tooth decay) – see our best white fillings blog article.

The beauty of using ‘Cosmetic bonding’ with a top class tooth-coloured filling system (like Enamel Plus) is that:

  • the teeth don’t need to be cut or ground down;
  • it’s over and done with in one visit (no waiting for crowns or veneers to come back from the lab);
  • it’s painless, really, I don’t even use anaesthetic for this technique!

So what are the drawbacks?

Nothing too serious really, I recommend having them polished once or twice a year to maintain their ‘lustre’ and I usually do the polishing during routine 6 month examination appointments (at no extra charge).

They can get chipped/broken, but so can veneers, the difference is that these bonded build-ups can be repaired seamlessly (chipped veneers have to be replaced completely).

And all for around £400. Something worth talking about?  In fact, it’s such a popular treatment I don’t know why I haven’t mentioned it before!

Here’s an example of the before and after pictures:

Immediate Veneers to Close Gap between upper front teeth Immediate Veneers to Close Gap between upper front teeth

 

Perfect smile not required

Someone came to the surgery the other day, and this happens a fair bit, they apologised for their teeth.

It reminded me that I should put ‘something on the website’ about this, as we’re really not here to judge anyone and people should not feel the need to be embarrassed (even if it is human nature).

You see, its only when people really need us that we get to make the most difference.

And if its not too selfish of us, we’d be delighted to see you.

Dentist reviews on our website

So with this (newish) website we wanted to enable people to leave their own reviews on our dental practice – both good and bad on this reviews webpage

We didn’t exactly push this facility, it felt a bit like fishing for compliments – but someone just pointed out that people might actually want to have the opportunity. So, for any of our existing patients please find the facility in the reviews section in the above drop down menu, and click the link. You can enter feedback directly into the form.

Our latest colleague at Winning Smiles, had some positive feedback recently, and because it is directly about his dental sedation – which addresses a lot of people’s desire for ‘painless dentistry’ – we thought we’d produce an excerpt here.

I came in for 4 hours sedation with your FANTASTIC sedationist Doctor Damian. It was recommended as I needed 10 upper crowns and surgery to even up my gum lines. This involved a very lengthy treatment, which thankfully I was not aware of. Amazingly I was told to eat and drink before treatment. The drug process to put me to sleep was not in the least bit traumatic. It only involved a tiny needle, with just one drop at a time of the drug. When I came round, I did not feel unwell in the least (just not quite with it). It was a totally stress free experience, and I recommend it to anyone undergoing lengthy/complex work.

Ruth is extremely generous in terms of her comments, but also the time taken to feed back on this site.

We’re just a bit worried now that it looks like we’re paying her instead of the other way round!

Smile transformation creates emotional journeys

The stress and worry during a complex dental case isn’t only felt by the patient – as all sorts of pressures, not least that of expectation, can fall directly on your friendly dentist’s shoulders.

But its worth it!

As a cosmetic and implant dentist, the greatest feeling in the world is when a mouth has been transformed and a person smiles for the first time with their new teeth.

The first reaction is revealed in the eyes – as bright as the north star, sometimes with tears, sometimes laughter and occasionally a stunned silence. But always there is a sincere joy at the lifting of that invisible veil of self-consciousness.

These are the jewels in my working life.

Nothing compares.

Aesthetic Dentistry Conference:What about Botox?

Time to read: approx 2 minutes

I’ve just returned from the Aesthetic Dentistry conference at the NEC Birmingham (www.aesthetic-dentist.co.uk). It’s my first time at this particular event as I am more often found at the British Academy of Aesthetic Dentistry conference (www.BAAD.org.co.uk) or related events.

Those of you who have read past posts of mine or been on the website will know that I am a keen member of BAAD and actively involved in providing high end ‘aesthetic’ dentistry in my day to day private practice in Essex.

This ‘Aesthetic Dentistry’ conference was organised by a number of the cosmetic/aesthetic dental companies headed by Dr Bob Khanna. ‘Dr Bob’ as he is affectionately known in our little community is a dentist who has branched out somewhat from Aesthetic Dentistry to get involved (heavily) in non-surgical cosmetic enhancement ie Botox, Dermal Fillers etc.

I have to say that I have been a fence dweller on this subject for some years now -not least because it seems a bit crazy to be injecting people’s faces with Botulinum Toxin- a well known poison- simply to make a few crows’ feet recede for 3 0r 4 months. ‘Take poison, feel better’ is a contradiction in terms, surely?

More seriously, I have also been waiting to see if repeat doses of this stuff are going to cause any permanent damage….and I have to admit that considering how much of it has been administered over the years both here and in the US, there is no evidence of any ill-health effects providing the practitioner is properly trained. And Dr Bob showed some compelling before and after photos of his work that demonstrated what a difference these treatments can make. There is no doubt that in the right pair of hands and with an eye for the aesthetic/artistic, significant improvements can be made.

Should dentists be using this stuff?

Well the ‘it’s not proper dentistry’ thing is now out the window, with only very conservative types considering any cosmetic dental enhancement as ‘not proper dentistry’.

We have definitely reached a point where it is ‘okay’ to want to improve one’s self and one’s appearance and this now extends well into dentistry. So it’s hardly a quantam leap to go from providing cosmetic/aesthetic dentistry to including non-surgical facial aesthetic treatments as part of the modern cosmetic dental surgery services.

The other argument ‘in favour’ is that dentists have a specialist knowledge of the face, not just the teeth, including muscles, nerves and blood vessels, where they are and what they do. Add to this is the infamous familiarity we have for -dare I say it- needles, and I am beginning to believe my own rhetoric!

Watch this space….