Cosmetic Dental Therapy

A gummy smile or a smile where excessive exposure of the gums is there above the upper teeth when the patient smiles is a common problem. This can really hamper a patient's confidence and makes them feel very conscious.

There are various reasons for a gummy smile:

• A hyperactive muscle which controls the upper lip movement when smiling and causes excessive gingival exposure.

• Abnormal eruption of teeth, in case of teeth which are covered by gum tissue they look short even though they are of normal length.

• Abnormal or excessive bulging of the upper jaw can also result in obvious gumminess of the smile.

• High frenal attachment which pulls the upper lip up when a patient smiles.

There are various treatment options available to correct this gumminess which can bring a significant difference in the smile.

• Reshaping and trimming of the gum tissue over the teeth surfaces reduces the gingival exposure and makes the teeth look uniform and even. There are two methods of doing this one is a surgical technique and the other painless and bloodless method is to use lasers.

• Lowering the lip technique in cases of high frenal attachment.

• Orthodontic correction or repositioning of the teeth.

Black or discolored gums are another common complaint with many patients. This can drastically affect the smile and makes patients very conscious. There are various reasons for dark discolored gums like smoking also known as Smokers Melanosis which causes blackish brown discoloration on the gums, tongue and palate. Certain drugs like Minocycline or antidepressants also cause pigmentation. also, tobacco chewing or drugs containing nicotine is a common cause.

This condition can be corrected with gingivectomy or gingivoplasty. In other words reshaping or resurfacing of the gums using the above methods can give excellent results. A technique commonly used for this is known as gum bleaching in which soft tissue lasers are used to lighten the gums. This is a relatively painless and bloodless technique as compared to the surgical approach.

Orthodontic treatment or braces have advanced immensely over the years. We have a lot of young adults and elderly patients who want to correct or align their teeth. Also, patients working in the aviation industry or media want a highly aesthetic option to correct their malalignment. Orthodontic correction of teeth is not only for aesthetic reasons but also for therapeutic and functional disorders.

For these patients there are two options

1. Lingual braces: in this the brackets are fixed on the lingual or tongue side of the teeth. This corrects the position of the teeth without anything being seen on the outside. This is a highly aesthetic option for patients who do not want anyone to know they are undergoing orthodontic treatment.

2. Invisalign: The other highly aesthetic option which is also very comfortable are clear or transparent braces. In this a set of clear aligners or trays are used which are changed every two weeks. This is very comfortable for the patient and extremely easy to use. We are an Invisalign certified clinic which are the best clear aligners in the world with the highest quality control. This option is usually recommended for adult patients as high patient compliance is necessary for the success of the treatment.

In today's day and age both these treatment modalities give very good results which provides an easy aesthetic option for adult patients or those looking to correct their alignment. This treatment is highly patient friendly and is always started with an intramural scan. This thoroughly scans all the teeth with the adjoining soft tissues and jawbone. After the scan our Invisalign certifies orthodontist along with the rest of the team do the treatment planning for every case.

So even before the treatment starts the patient gets a clear idea of the expected teeth movement and result. The treatment plan is customized for each patient depending on the type of malalignment and other concerns of the patient.

In teeth where laminates and veneers cannot suffice like in cases with very dark dental stains which cannot be covered with a veneer. In extensively proclined or retruded teeth where the amount of tooth movement required is more. in such cases a more extensive treatment in the form of full coverage cast crowns are required.

A well-made crown with accurate margins and perfect shade matching can greatly alter and enhance a smile. In adult patients who want to alter their teeth alignment or position without fixed orthodontic treatment or braces, anterior aesthetic crowns are a good option for smile correction.

There are very good quality ceramic and zirconia crowns available, which have high strength and resistance to fracture. These crowns can easily be used in the posterior teeth or molars for chewing.

With the advent of high-quality materials and precise shade matching with natural teeth. It is possible to give very natural looking and highly aesthetic crowns. A highly polished and lustrous surface can be given to the crowns which provide a very good finish.

Also, every root canal treated tooth should be crowned or capped to provide strength and resistance to fracture. As after an RCT the tooth is saved but it becomes brittle in nature so to avoid a fracture it is imperative to cap the tooth.

These are thin sheets or layer of tooth colored material which can be cemented on natural tooth surfaces. There are made of very high quality ceramic which is processed in a dental lab by a ceramist. Laminates and veneers are ideal for defective or stained anterior or front teeth. In cases when the stains are intrinsic or within the enamel surface whitening or bleaching does not work.

Other conditions where laminates are indicated are pitted or defective enamel surfaces which causes enamel disfiguration. Various genetic conditions which cause defective enamel formations like whitish patches, soft crumbly enamel surfaces, brownish black discoloration, gnarly pitted surfaces can be corrected with this treatment.

Also, in adult patients who want to correct their teeth alignment but do not want to go for fixed orthodontic therapy. Veneers work very well in retruded front teeth or class III profile to bring the teeth forward. Similarly, proclined or forward placed teeth with open bite can also be corrected.

The procedure involves minimal reduction of the tooth surface only involving the enamel followed by an accurate chair side impression. This is than sent to the laboratory for processing the veneer.

One of the biggest advantages of this technique is minimal loss of tooth structure as compared to a full cast crown. This preserves the tooth structure and reduces chances of sensitivity and pain due to dentinal exposure. This is a much less invasive technique and can give fabulous results in adult patients looking for a smile makeover or correction. This is a highly technique sensitive procedure which should always be carried out by a dental professional with prior experience.

In patients with intrinsic or internal stains like incases of fluorosis it is very important to not do bleaching or whitening as this can worsen the defect. The white discolored patches can become worse or further stand out with bleaching. Also, in cases with tetracycline of other medicinal stains which occur due to exposure to drugs when the teeth are in a formative stage do not respond to any kind of whitening treatment.

In such cases composite or tooth-colored fillings are a very good chairside option. These are simple highly aesthetic fillings which can be completed in one sitting.

This is a cosmetic treatment in which a chemical bleaching agent is used to whiten or lighten the teeth surfaces. this is a very widely done treatment for discolored or stained teeth. Various cases in which this is indicated are nicotine stains in smokers and tobacco users, caffeine (tea or coffee) stains, discoloration due to medication. Also, other cases like discoloration of the enamel due to aging responds very well to bleaching.

There are two main types of whitening:

Office bleach - In this the procedure is carried out by a dentist in a professional dental setup. This is completely monitored and completed in a single sitting. The medication is applied on the teeth surfaces after proper soft tissue isolation, and the process is catalyzed using a bleaching light to enhance and speed up the treatment. If done properly this can give exceptional result which can last for a long time.

Home bleach - In this technique customized trays are fabricated which the patient has to wear overnight with the medication to bleach the teeth. in this technique patient compliance and cooperation is very essential to achieve satisfactory results. This can also be utilized in some patients as a maintenance therapy after the office bleach.

If the bleaching technique is followed accurately with all the adequate precautions it can significantly whiten or lighten the teeth. This greatly enhances the smile and confidence of the patient. However, it is very essential to follow the doctor's instructions post- bleaching. This includes avoiding any colored drinks like coke, Pepsi, red wine, black coffee etc. Also, any food containing color should be avoided like Indian curries containing turmeric.