Esthetic dental implants have been a part of restorative and cosmetic dental procedures for over 35 years. Through the years, the dental profession has seen incredible progress in all aspects of implants, from placement techniques to implant materials to longevity and esthetic outcome. Originally invented in Sweden, dental implants are made of ultra-strong titanium alloy and look like a large screw.

Dental implants are used to replace a single tooth, several teeth or a whole arch of teeth. Implants not only stabilize the restoration that sits on it, but also stimulates bone growth around the implant. If a tooth is missing, the gums and bone it was attached to are no longer stimulated by the blood supply and activity of that tooth. Therefore, with the tooth gone, the surrounding bone and gums may resorb or melt away. Furthermore, the opposing tooth (on the opposite jaw) no longer has something to bite against, and may grow towards the missing tooth’s space.

Technology Makes it Easier to Get a Smile Makeover

For implant placement, the diagnostic information provided by the two-dimensional x-ray or radiograph used is limited. Critical questions which need to be answered prior to surgery include if there was enough bone level to place an implant, the location an implant could be placed, positions of the sinuses, location of nerves and other important aspects. More recently, the CT or computed tomography scan tremendously improves the diagnostic abilities of the implant dentist by providing more detailed information needed not only during the initial diagnostic phases, but also during the actual surgery.

CT scans assist in lowering risks of irreversible nerve damage and developing predictable success in attaining the best outcome for most situations. This is especially true if there is question if adequate bone is present in a site with a missing tooth or teeth.

Implants are placed during a surgical procedure, directly in the jawbone. The number of implants required depends on each person’s individual situation. The surgical site with the implants are then left (under the gums) to allow the bone to grow around the implant and “osseo-integrate”. Four to six months after the first surgery, the implant is uncovered from under the gums. An “abutment” or implant post is then connected to it, and the gums are given time to heal around this abutment. About a month later, a final tooth restoration is custom-made to fit onto the abutment. This final restoration could be a crown, bridge or denture. Thanks to advances in cosmetic dental technology in materials, the final restorations look more natural.

A second factor in natural-looking restorations has to do with periodontal (gum) esthetics. In the placement of a dental implant, the gums must first be prepared in achieving an optimal normal appearance. When the gums are not esthetically sculpted, it is difficult to attain a natural result. Gum sculpting is a cosmetic dental procedure that maximizes the natural appearance around a restored implant tooth.

Implants can ensure a healthy diet is maintained. Before implants, people with dentures (a full arch of false, removable teeth) or partials (several false, removable teeth) had no options when they were unable to get a firm, strong bite on food. Nutrition and overall health is highly dependent on a person’s ability to chew a variety of foods. A person may shy away from certain foods either because certain teeth are missing, their teeth don’t meet each other (occlude) properly, or there is not enough force due to slippage of a denture. For example, the inability to chew foods with a firmer consistency may lead a person to eat more unhealthy foods like french fries instead of fresh vegetables. It is challenging to eat a balanced diet of only softer foods.

Most Patients are Pain Free Once They’ve Healed From Cosmetic Surgery

There seems to be a common misconception that implants will continually hurt as long as they are in. The fact is that this is not the case if the implant is properly placed and heals correctly. Naturally, there is some discomfort immediately after surgery. However, advancements in medication for dentistry can address the pain. As the site quickly heals, post surgical pain subsides.

How long a implant can last is reliant on many factors. Although no restoration in dentistry is guaranteed to last forever, dental implants could last ten to fifteen years, or more, depending on how well the implant is cared for professionally and at home.

Dental implants may sound too good to be true, but unfortunately not everyone is a good candidate for implants. According to the Academy of General Dentistry, each patient must: (1) Have a comprehensive exam to determine if they are a candidate, (2) Be in good health, (3) Have healthy gums, (4) Have adequate bone structure, (5) Have excellent oral hygiene habits, such as brushing and flossing, (6) Maintain regular dental visits.

We live in such a great era of cosmetic dentistry where people are able to benefit incredibly from technology in implant dentistry. Combining cosmetic dental procedures with implant dentistry allow people to have implants in the most visible area of their smile and have it look natural. Implants offer bone and gum stimulation, and stability to restorations which lets people eat to their heart’s desire. Although there is no exact replacement to a healthy, natural tooth, dental implants that are assisted with the latest in CT scans allow dental professionals to give their patients one more reason to smile.

Dr. Wynn Okuda is an award winning international leader in cosmetic dentistry. He is one of only 280 dentists in the world to be accredited by the American Academy of Cosmetic Dentistry. Dr. Okuda turned the dental profession on it’s head nearly a decade ago , replacing pain, fear, & discomfort with the Dental Day Spa system. His offices for cosmetic, restorative and implant dentistry are located in Honolulu, Hawaii.

Dr. Okuda has been featured in the New York Times, Wall Street Journal, Reader’s Digest, American Spa, Shape Magazine, Better Homes & Garden, Health & Fitness Sports Magazine, New Woman, and dozens more!

Dr. Okuda is the founder of “Give Back a Smile”, a charitable foundation of the A.A.C.D. which helps survivors of domestic violence throughout the nation to restore their smiles and lives. He has assembled nearly 1,000 cosmetic dentists nationwide to help fight against domestic violence.

Whether we fully realize it or not, we are constantly communicating to others through our smiles or lack thereof. Non-verbal messages such as self-confidence, social acceptance, and friendliness are flashed in a second through a smile. Likewise, not smiling may be misinterpreted to mean self-uncertainty, social rejection and unfriendliness. But, what if a person felt they could not smile, as they were too embarrassed to reveal their broken smile? Whether damage to front teeth is caused by an intentional or accidental hit, advances in cosmetic dental materials and procedures can help you get your smile back.

Repair of Fractured Teeth Give Back Your Beautiful Smile

If a tooth is fractured, there are several possible ways to repair it. If it’s a relatively small section that’s missing, a composite resin material can be used. This starts as a moldable, liquid or putty consistency. The cosmetic dentist matches the resin shade to your tooth exactly, so no break can be detected. The material is then hand-sculpted to complement the existing tooth, then cured until hardened. When done correctly, a seamless, invisible appearance can be the result.

If a much larger section is fractured, it may be necessary to restore the tooth using a veneer or crown. A veneer is a thin shell of porcelain that covers the front and biting surface of a tooth. In spite of its thinness, its state-of-the-art fabrication and method of adherence in the end creates a strong, lifelike restoration. A benefit of the veneer is that only a very minimal amount of natural tooth needs to be removed before this porcelain restoration is fabricated and placed.

If even more of the natural tooth is fractured off, a crown may be required for repair. A crown is a restoration that fits over the natural tooth on all five surfaces. The strength of modern dental materials allows the placement of non-metal, all-porcelain crowns. These natural appearing restorations retain their esthetic and strength through time, and won’t reveal a black line at the gumline as crowns of years ago did.

For veneers, crowns and bridges, the cosmetic dentist and their lab technician need to develop an impeccable communication and work system in order to have optimal end results. The shape, coloring and texture of the veneer or crown are all dependent on the dentist’s ability to convey the subtle esthetic nuances needed for a natural result that blends to your adjacent teeth in your mouth.

If the fracture affects the tooth nerve or pulp, the tooth may need root canal therapy in order to save the tooth. Sometimes a tooth may not require root canal therapy immediately, but as a precaution your dentist will still require that it be periodically monitored.

Bring Back a Beautiful Smile by Replacing a Missing Tooth

If a tooth is completely knocked out, a bridge or implant is needed to close the gap. A bridge is a permanent, fixed restoration that uses adjacent teeth as anchors and replaces the missing tooth. Similar to a crown, non-metal all-porcelain materials are used to give the appearance of natural teeth, which retain their esthetic appearance through the years.

There is a possibility that a fully avulsed tooth (a tooth that is knocked out in its entirety) can be saved, but you must act quickly. First place the tooth in a moist environment. Research has shown that milk or the saliva in that individual’s mouth is the best to temporarily hold the fully removed tooth. Then contact your dentist at once. The best chance for successful reimplantation is if it’s done within an hour or less.

Domestic violence is a reality in every community. The “Give Back A Smile” Program is a national charitable service project of the American Academy of Cosmetic Dentistry (AACD). Since 1998, participating member dentists, laboratories, corporations and supporters have helped provide cosmetic dental care to survivors of domestic violence who have sustained injury of fractured, destroyed or missing front teeth due to a domestic violence attack.

I would like to thank dentists in Hawaii who participate in the “Give Back A Smile” Program: Dr. Ileana Carreno, Dr. Alvin Chung, Dr. Norman Cheung, Dr. Declan Devereax, Dr. Lia Dominici-Bly, Dr. Marcia Loo Eng, Dr. Clyde Ishida, Dr. Russell Kim, Dr. James Merrett, Dr. Dennis Nagata, Dr. Chester Naka, Dr. Melanie Vallejos, Dr. Ken Yasuhara, Dr. Randall Yoshida, and Dr. Donovan Young.

The work that these dentists provide through this program can very dramatically and drastically change the way survivors of domestic violence view themselves and their world. If you know of a survivor of domestic violence who could benefit from these services, please contact the “Give Back A Smile” Program at (800) 773 -GBAS (4227), or visit the website at www.givebackasmile.com.

What cosmetic dentistry has done to help to restore the many lives of people is remarkable. Being able to “recreate nature” not only gives a smile back to my patients, it also puts a smile on my face as well. Individually, we can only accomplish so much. Together, we can reach our goals and help heal the world.

Dr. Wynn Okuda is an award winning international leader in cosmetic dentistry. He is one of only 280 dentists in the world to be accredited by the American Academy of Cosmetic Dentistry (AACD). Dr. Okuda turned the dental profession on its head nearly a decade ago , replacing pain, fear, & discomfort with the Dental Day Spa system. His offices for cosmetic, restorative and implant dentistry are located in Honolulu, Hawaii.

Dr. Okuda has been featured in the New York Times, Wall Street Journal, Reader’s Digest, American Spa, Shape Magazine, Better Homes & Garden, Health & Fitness Sports Magazine, New Woman, and dozens more!

Coming soon.It still surprises me that after almost 30 years of existence, dental “veneers” are not a commonly known procedure by your average person. Many people have heard of teeth bleaching to get their smile whiter. And even more know that crowns are like a cap that sits snugly on a tooth. However, veneers are not as well known, even though they are seen daily gracing the cover of fashion magazines and movie screens, as well as on the smiles of everyday people. Today I wanted to focus on veneers, as they play such a vital role in cosmetic dentistry. Smile makeover, yes. But they have as much function as they have form.

First Stop Manicurist, Second Stop, Cosmetic Dentist

For those familiar with fingernail manicures, veneers most closely resembles an acrylic nail, where the nail is first lightly “roughened” to better accept the material placed on it. Then for nails, the acrylic is placed and shaped. For teeth, a thin layer of either laboratory-created porcelain or hand-shaped composite material is placed on the tooth, then adhered or cured with an ultra-violet light.

But that’s about where the similarities end. Of course there is a tremendous difference in the strength of the tooth compared with the nail. People who have had acrylic nails tell me although the acrylic adds thickness to the overall nail, they need to treat their nails gingerly. For example, they are told by the manicurist to press elevator buttons with their knuckles, dial phones with the eraser side of a pencil, and not to drum their fingernails on the counter! If they are careful with their nails, they can minimize “lifting” of the nail. On the other hand, patients with dental veneers are still able to bite into apples, corn-on-the-cob, or anything they were able to eat before. One study verified that the porcelain adhered to your natural teeth actually strengthened the natural tooth. Unlike acrylic nails which may tend to “lift” and needs maintenance every two to three weeks, the tooth veneer is completely sealed up against the natural tooth and lasts for years and years. So go ahead. Take that BIG bite!

Problem Solver AND Beautiful Smile

Whereas bleaching may have limitations, veneers have the ability to solve a wider spectrum of problems. Teeth bleaching can be effective for people with relatively straight teeth, with no fillings or crowns in the front, with staining or yellowing generally due to dark beverages, and with no contra-indicating factors such as gum disease. Bleaching is limited to lightening teeth, and can do nothing to change the shape, size, or position of teeth. Veneers, on the other hand, are the next level of advanced treatment by permanently whitening teeth that can’t be successfully bleached. Although each person’s smile must be evaluated individually, overall veneers can correct unsightly gaps or “straighten” crooked teeth, lengthen too short or square teeth, or modify too large or disproportioned teeth. Veneers let you to have a smile that’s brighter and proportionate to your face shape and lips.

Veneers do more than just make your teeth look pretty. They may allow better biting “function”, which means your teeth bite together or “occlude” in a more effective way. Poor function means not only an inability to bite or chew, but also may lead to discomfort and pain with the jaw joint muscle or temporo-mandibular joint disorder. In addition, when veneers fill the gaps between teeth or straighten overlapping teeth, this makes it easier to floss. Moreover, for those situations where it’s possible, veneers help to accomplish the goal of straightened teeth in only a few appointments compared to wearing braces for three years or more. This is a well-received benefit for many patients who feel they need to have a more professional, confident smile right now.

Finally, veneers allow you to keep most of your natural tooth. Often you may here the word “conservative” to describe a veneer. This does not refer to its political slant, but rather to the advantage that a considerably less amount of natural tooth needs to be removed for a veneer. Years ago, dentists would place crowns only instead of veneers to achieve the same result. However, the crown requires the natural tooth needs to be whittled down to a little “nub” or “stump”. It is always ideal to preserve as much of the natural tooth a possible. The custom fit veneer is able to cover just the front and biting surface of the tooth, leaving the back surfaces untouched. The crown preparation requires all five surfaces of the tooth to be carved down. Although the applications of veneers are quite remarkable, there are instances where a dentist must choose a crown or other procedure over a veneer. For example, if the tooth has extensive decay or breakdown and needs additional reinforcement or build-up, then a veneer may not be able to be placed.

You Need to Keep Your Teeth Healthy if You Want Veneers

A quick reminder for those people who do have veneer restorations, other restorations, as well as everyone else: it’s important remember that the status of your natural teeth, restorations and oral health is directly related to the daily home care you provide and timely professional care you receive.
As dental technology advances, cosmetic dentists are able to continue to introduce new materials and procedures to patients that encourage minimal natural tooth removal and extend the longevity of the restoration. Veneers are an ideal example of the blending of health, function and beauty from a conservative restoration.

Dr. Wynn Okuda is an award winning international leader in cosmetic dentistry. He is one of only 280 dentists in the world to be accredited by the American Academy of Cosmetic Dentistry. Dr. Okuda turned the dental profession on it’s head nearly a decade ago , replacing pain, fear, & discomfort with the Dental Day Spa system. His offices for cosmetic, restorative and implant dentistry are located in Honolulu, Hawaii.

Dr. Okuda has been featured in the New York Times, Wall Street Journal, Reader’s Digest, American Spa, Shape Magazine, Better Homes & Garden, Health & Fitness Sports Magazine, New Woman, and dozens more!

Dr. Okuda is the founder of “Give Back a Smile”, a charitable foundation of the A.A.C.D. which helps survivors of domestic violence throughout the nation to restore their smiles and lives. He has assembled nearly 1,000 cosmetic dentists nationwide to help fight against domestic violence.

With the ever growing popularity of teeth bleaching, I find that discolored, yellowed or darkened smiles still are one of the more prevalent smile complaints. There are many reasons for teeth not be a natural bright hue. Today’s cosmetic dentists have a variety of procedures to turn back the clock to a more youthful smile. This article continues a series featuring various types of problem situations and how these can be addressed. This month’s focus is the Makeover for the Darkened Smile.

Tooth Whitening Becomes Necessary Because……

Whether it is one discolored tooth or a uniformly yellowed or darkened smile, its easy to pick out when teeth are not as bright as they should be. The reasons why teeth become discolored are numerous. The first of the reasons are situations that someone is born with or develop in childhood. These include drug- or mineral-induced stains, genetic abnormalities or other congenital problems.

The second set of reasons are environmental causes. Realize that your 28 pearly whites have been bombarded for decades by everything you’ve eaten or drank almost all of your life. The guilty attackers include colas, teas, coffees, red wines, tobacco products and other stain-producing foods. Even with routine professional teeth cleanings, these stainers have a cumulative effect on your teeth’s overall whiteness.

A third reason is age-related. The older a tooth becomes the more it darkens or yellows. Yes, this is the unfortunate side of nature. A fourth reason is situational for specific teeth. Here are some examples: A tooth whose pulp is dead due to trauma, may become gray or blackened over time. Another example is teeth associated with old silver fillings or metal-containing restorations. Over time these restorations may irreversibly stain teeth internally or around the gumline.

The Solution? A Smile Makeover

In combating many of these common cosmetic dental problems, cosmetic dentists have various solutions at their command that can address all of the above. The types of treatments selected will vary, depending on each individual person’s problems and needs. Routinely, some discoloration may be due to just plaque or tartar build-up. Plaque and calculus can cause a yellowing stain on teeth, and if left untreated decay may result leaving a darker discoloration. Professional cleanings can assist in minimizing the stain build-up from the food stains mentioned above, such as red wines and tobacco.

Professional cleanings, however, are not the answer to every type of darkened smile. In-office or home bleaching may address other mild types of discolored smiles. In particular bleaching tends to be more effective on staining caused by food, drink and tobacco and the yellowing of aging teeth. In-office bleaching allows you to “jump-start” the whitening process with a quicker end result. A gentle bleaching gel is placed on your teeth and a light source is applied. Depending on the degree of darkness and the lightening you want to attain, this procedure may achieve your desired lighter shade in one visit. Sometimes one appointment may not be enough, and follow-up appointments may be needed.

“Home bleaching” takes place outside of the dental office, either while you sleep or at your leisure. A custom-fitted, clear plastic tray is made in the dental office. A gentle bleaching gel is placed in the tray, and the tray is fitted snugly over your upper or lower teeth. Optimal results are usually achieved in about 14 days. Home bleaching procedures allow more flexibility and control over the whiteness achieved.

You’ll find numerous other whitening kits at the neighborhood drug store or on infomercials. However my best advice would be to consult your dental professionals for what will work best for you. Unwanted side effects of these over-the-counter kits may include accelerated tooth-related and/or gum-related problems or having teeth of mismatched colors. Don’t fall victim to using the product that merely is most convenient and cheapest to obtain. Asking your dentist if you are a candidate for bleaching may save you from wasting money, time and heartache.

If the staining or discoloration is too dark or deep within the tooth for bleaching, then the next option would be veneers or non-metallic, tooth-colored restorations. Veneers are thin, yet durable shells of porcelain that are custom-made to fit over the front and biting surfaces of teeth, to permanently mask the discoloration. Non-metallic crowns would be used if there is extensive decay or breakdown of the tooth structure.

Great Progress Made in Recreating the Beautiful Smile

The great news is that certain darkened smile concerns that could not be addressed fully 10 or even 5 years ago can now be solved. One example of such a dental problem is drug-induced stains, such as tetracycline. This shows as a heavy discoloration of the teeth (gray or black) with or without stripes. Esthetically correcting such a strikingly noticeable smile has perplexed dental professionals for decades. Fortunately with advancements in dental materials and techniques along with infusing dental artistry, this dilemma can be addressed with consistency and beautifully natural results. A technique article I wrote that was published in the Journal of the American Dental Association discussed this complex problem, and uncovered a conservative solution that concludes in such a natural end result.

Q&A

Questions & Answers: Q: I have tried to bleach my teeth several times to whiten my dark teeth but within several weeks the darkness returned. I realize I now need porcelain veneers. How do I determine who is qualified to help me achieve the best natural results?

A: Great question! Undergoing any advanced cosmetic dentistry such as porcelain veneers is quite an investment. However, if done correctly the results can be fantastic. Recreating a natural-appearing smile takes artistry in developing the right color, contour, length and size of the veneers. This takes expertise on behalf of the cosmetic dentist as well as the dental laboratory being used. Not all dentists and labs are equal. Seek out a reputable cosmetic dentist professional and ask them to show you before and after photo examples of similar cases they have corrected.

Dr. Wynn Okuda is an award winning international leader in cosmetic dentistry. He is one of only 280 dentists in the world to be accredited by the American Academy of Cosmetic Dentistry. Dr. Okuda turned the dental profession on it’s head nearly a decade ago , replacing pain, fear, & discomfort with the Dental Day Spa system. His offices for cosmetic, restorative and implant dentistry are located in Honolulu, Hawaii.

Dr. Okuda has been featured in the New York Times, Wall Street Journal, Reader’s Digest, American Spa, Shape Magazine, Better Homes & Garden, Health & Fitness Sports Magazine, New Woman, and dozens more!

Dr. Okuda is the founder of “Give Back a Smile”, a charitable foundation of the A.A.C.D. which helps survivors of domestic violence throughout the nation to restore their smiles and lives. He has assembled nearly 1,000 cosmetic dentists nationwide to help fight against domestic violence.