Q. I am a 30 year old female, and for years, I have been unhappy with my smile. My teeth are slightly crooked and look yellow- brown and dirty when I smile. I also show too much gum when I smile as well. I am very embarrassed about this. I have tried to bleach my teeth with various tooth whitening options, but still, I am unhappy. My teeth are basically OK apart from this problem, and I have only a few fillings.Can anything be done, to give me the smile that I have always wanted?

A. Absolutely! You are not alone! Many people suffer the embarrassment of having a smile that they are not proud of. In many cases it detracts from an otherwise attractive and beautiful face, and unfortunately, the worst feature is always the outstanding feature that dominates the viewers assessment of facial aesthetics and beauty.As in most areas of the cosmetic and reconstructive dentistry, by far the most important factor is the consultation with the patient as to their needs and wants, and an appropriate and comprehensive examination and diagnosis. This then leads to an overall aesthetic prescription to deliver the treatment goals. With respect to your individual problem, we firstly need to investigate the reason for the gummy smile. Whilst this may be due to a short upper lip, and various other factors, most commonly it is due to an excess of soft tissue or gum covering the teeth. This excess tissue can be removed, exposing more of the underlying tooth and hence reducing the gummy smile affect. Today, the use of technologies such as all porcelain crowns or indeed porcelain veneers, provide the opportunity to achieve natural and lifelike aesthetics in the restoration of teeth.

Again, in your particular case, following the “gum-reduction” procedures, in- surgery tooth whitening can be undertaken to reduce most of the yellow-brown colour from the underlying teeth, and then with the use of porcelain veneers, we can then correct the crowding and shaping concerns, and achieve the final desired shading of your teeth. Chuck has done dial This combination of treatment procedures will then provide you with a beautiful and long lasting smile, that you can be proud of!

“Aesthetic dentistry is characterised primarily by the smile. The goal in the creation of aesthetic dental restorations is to simulate, or improve upon, the appearance of the natural dentition (teeth.) However, it is important to note that the smile is just one element of the face, which serves as the primary means of emotional expression. Therefore, successful aesthetic restorations must integrate harmoniously with the whole of the face, not just with the surrounding teeth. This requires a full understanding of each patient’s unique personality — the psychology of dental aesthetics.” What does all this mean? Well, too often, we see in practice, patients who have undergone “cosmetic treatment” which is totally in disharmony with both their personality and general facial expressions.

More importantly, these patients also recognize that something is “wrong” and that they do not like the result! Just as every patient’s smile is unique, so then must any dental aesthetic treatment be undertaken in consideration of the special and individual influences of facial form and emotional expression. Thus, when we need to make restorative and cosmetic changes to your present smile due to a variety of reasons, which may include for example; dark tooth colour, worn and unevenly shaped teeth, missing teeth, heavily filled teeth, gum issues etc, we need to firstly and most importantly, undertake, an aesthetic consultation.

Understanding YOU -the Aesthetic Consultation

This consultation includes a discussion with you, to understand your special and individual needs and wants with regard to your new smile expectations. An important part of this consultation will be to study and assess your unique facial form, colouration and the range of expressions, and assess how any restorative changes to your smile, needs to harmonise with your unique personality. As part of this consultation and examination, we will also include certain diagnostic records to assist in further planning. Most importantly, following these initial discussions and early planning, we need to then establish an aesthetic prescription. This is in effect is the “architects plan” for your news smile, including the colour, form and arrangement of teeth. From this aesthetic prescription, we can then translate this to a “mock-up” whereby, utilising special materials and techniques, we are able to show how this treatment will look in your mouth and fulfil your aesthetic expectations. Of course, at this stage, this aesthetic prescription can be altered or modified and “tested” so that both patients and practitioners alike are happy with the proposed treatment solution.

Your New Smile! Following the finalisation and acceptance of the aesthetic prescription and “mock -up, ” we are then ready to proceed to the definitive treatment solution. This is equally a very critical part of the treatment process and includes a team approach to create the very best and artistic result. Today, there are numerous, high-tech materials along with some exciting techniques which together, with appropriate experience an application, enablers to fulfil our patients high aesthetic expectations. When you are next contemplating cosmetic, implant or other reconstructive dental treatment, please remember that you are a unique individual and that the psychology of the smile is a crucial element in your treatment. The Macquarie Street Centre for cosmetic, implant and reconstructive dentistry, specialises in creating unique and beautiful smiles for our patients. We look forward to meeting with you soon, and discussing how we may create that special smile that projects your own unique and individual personality!

 Q. I’m getting married in six weeks time, and want everything to be just right for my big day. I am concerned that my teeth look yellowish and I would like to have a whiter and brighter smile, especially for my wedding photos. I have tried many “over-the-counter” tooth whitening products, I have brought from the chemist or supermarket, but none have had that much effect. I understand there are new tooth whitening systems available, that may be able to help me achieve a better smile? Can you advise me, what I can do to get a beautiful smile for my big day!

A. unfortunately, many of the over-the-counter tooth whitening products that can be purchased from the chemist or supermarket, have a very low percentage of active ingredients to achieve any sort of significant tooth whitening effect. Further, these products commonly lack appropriate application trays, so that even these small percentage of active ingredients are rapidly diluted with saliva etc. Tooth whitening procedures; often employ the use of special agents of either carbamide peroxide or hydrogen peroxide, in high concentrations, as their active ingredients. These medicaments are utilised in special gels to maximise the affective of the agents and also prevent tooth dehydration, which may lead to excessive tooth sensitivity. Often these agents may also be activated by UV, halogen light or even lasers.

Research has indicated that professionally applied tooth whitening procedures will achieve a more rapid tooth whitening effect, however, unfortunately, there is still considerable marketing hype associated with some of the new systems purporting improved affects that is unfounded. Essentially, you can achieve the same level of tooth whitening, utilising professional systems applied in special trays to be worn for a half an hour to an hour per day for 10 to 14 days, as you can achieve with the use of some of the accelerated tooth whitening professional systems, overtime.

However, for some people who find compliance in using the tray systems everyday for some two weeks, hard to achieve, then in- surgery tooth whitening systems are of great benefit, or alternatively, if you are wishing to achieve a rapid start to your tooth whitening process. Systems such as “Zoom”, “Laser Bright” or “Bright Smile” are all affective in achieving an additional and rapid tooth whitening effect. To achieve the most desired result, this effect can be further improved with some “at home” tooth whitening, utilising professional tray systems. Ideally to achieve your beautiful smile for your wedding day, I would recommend some in-surgery accelerated tooth whitening with some at home tooth whitening for a further 10 to 14 days for the best effect. I hope you have a wonderful day, and smile radiantly!

Most people appreciate the advantages of having a beautiful smile. A beautiful smile endows a person with confidence and attractiveness that far outstrips any impact that clothes, a new hairstyle or even a facelift can hope to offer. A beautiful smile implies youthfulness, vitality and happiness and is with us 24 hours a day, seven days a week, year after year! Smile ProblemsWhat then are some of the main ageing factors and cosmetic issues with most people smiles?

As we get older, our teeth become denser and hence appear more yellow-brown in colour. Furthermore, we are seeing clinical evidence of people clenching and grinding their teeth more and more. Most of this damage is done at night whilst asleep, and some patients are totally unaware of the damage that they are doing. This has a great impact on the attractiveness of a smile, as the upper and lower front teeth in particular become shortened, chipped and “sawn off” in appearance. This, combined with the yellow- brown colour of ageing teeth, result in a significant negative cosmetic impact on the attractiveness and youthfulness of the smile.

Tooth colour can also be dramatically affected by old restorations or dark fillings in teeth. These may not match perfectly with the natural tooth colour or alternatively teeth may have had poor or ill- fitting crowns that don’t match, or where teeth have had the nerves removed (root canal treatment) resulting in brown- grey looking teeth. The end result is a mish-mash of various shapes and colours leading a loss of harmony and symmetry of the smile.Crowding or irregular arrangement of teeth may also contribute to poor smile aesthetics. This may be the result of incompatible jaw sizes, too small or too large teeth for the available jaw space, or other tooth to jawbone discrepancies.

In some instances, these discrepancies can be corrected restoratively; i.e. using bonding of tooth colour materials, porcelain veneers or porcelain crowns etc, whilst in other cases, this will require the use of orthodontics or even orthognathic surgery, ( whereby we move the jawbones to more ideal relationships along with the teeth) to create the ideal symmetry and arrangement of the smile.Another factor in assessing an attractive smile is the display of the soft tissues or gum tissue around the teeth. Again symmetry plays an important role here, and we need to see healthy, pink gum tissue around the individual teeth with the appropriate symmetry. Some patients, due to diseases such as periodontal disease or toothbrush abrasion with recession of the gum tissue or even due to tooth loss, have a marked asymmetry of the gum tissues, again leading to poor smile aesthetics.

There may also be an excessive display of gum tissue which may be due to an alteration in the eruption or growth of the teeth through the gum tissue or even a short or highly active upper lip. Alternatively, due to a variety of reasons teeth may appear too long, and similarly, this will disturb the artistic proportion of the smile.These are but some of the many issues relating to the attractiveness or otherwise of a smile.The Solutions !The first and most important step is the assessment of the smile including the proportions of the face and how the smile relates to the face. This will take into account many issues such as facial features and symmetry, tooth colour, shape, tooth proportion, soft tissue or gum display and symmetry, arrangement of teeth, jaw relationships etc. Time needs to be spent with our patients discussing these various issues of their smile and importantly, their individual needs and aspirations as to what they want to achieve.Most often the “solutions” require a combination of treatments and may include tooth whitening, orthodontics to correct tooth arrangements or crowding, periodontal treatment to correct soft tissue or gum problems/asymmetries and restorative treatment that may involve tooth bonding, the use of porcelain veneers, implants to replace missing teeth or all porcelain crowns and/or bridges.It is critical that an artistic appreciation is made of the smile with a clear and concise vision of the changes that need to be made, utilising the appropriate options, to achieve these mutual and desired treatment outcome, of a functional, healthy and attractive smile.

At the Macquarie Street Centre we pride ourselves in spending time to understand each particular patient’s needs and wants and then to undertake a full and comprehensive examination and assessment. From these discussions and examinations we can then create an individual aesthetic prescription and treatment plan for our patients to fulfill their desires of a youthful and attractive smile and at the same time, one which is healthy and easily maintainable for many years into the future.

Cosmetic Surgery Article December 2005

Attractiveness!” Many people, unfortunately, are unhappy with the appearance of their smile. For some, it may be simply the colour of the teeth, whilst for others, it maybe due to missing teeth, crowded teeth or worn and misshapen teeth. Of course, often we see that it is a combination of several factors. The end result, however, is an often prematurely aged and unattractive smile and hence, a person who is reluctant to show their teeth and make expressive movements, such as smiling and laughing.

The smile, as many studies have shown, is the major factor contributing to overall facial attractiveness, and we know that an attractive face is the most important factor in body image. Hence the importance of an attractive smile can never be underestimated. Today, with new exciting techniques in cosmetic and reconstructive dentistry, a beautiful smile is achievable for most, if not everybody! Whether your teeth are discoloured, misshapen and worn, or even missing, the options are available to you today, to achieve a life-like, beautiful smile and at the same time achieve a long-term solution, with minimal maintenance needs.

With the latest in metal- free ceramic solutions, crowns or caps, need never look opaque and dead, with dark lines around their edges, and red and inflamed gum tissue !With these new technologies, we can achieve beautiful, lifelike and natural looking teeth, with pink, healthy soft tissues around them! Discoloured and worn teeth that are otherwise intact may be made beautiful again, often utilising a combination of tooth whitening procedures and ultra-thin customised ceramic veneers. Missing teeth, that have historically been replaced with dentures or fixed bridge work, can now be reinstated to health, function and attractiveness utilising the latest in dental implants.

Utilising cutting- edge computer aided surgery and design, whether it be a single tooth missing, several teeth or indeed all teeth missing, dental implants can provide very attractive, highly functional and most importantly fixed replacement, to missing teeth. Indeed in most cases today, we can utilise immediate placement and immediate loading of implants whereby we can remove a failing tooth or teeth, placed the implant/s and connect replacement teeth to the implant/s, all in the same visit! Age, is not a barrier to implant treatment, with our youngest patient aged 17 and with our eldest patient, 87! This treatment does not require hospitalisation and is generally done under local anaesthesia only, and in our own facility! Indeed, with our new computer designed and guided-surgery, a patient can attend wearing, for example, a full upper or lower denture, and, within approximately an hour, have all implants inserted and replacement teeth connected to the implants, without any stitches and with only minimal discomfort. Many of our implant patients have then, returned to work or gone on to have lunch or dinner that same day!

Indeed, it is a wonderful time to be contemplating cosmetic or reconstructive dental procedures. Never before have techniques and technology being better equipped to fulfil the aesthetic and functional needs of our patients. Further, with no-interest financing options, these procedures are now obtainable for everybody! We look forward to welcoming you to the Macquarie Street Centre for aesthetic, implant and reconstructive dentistry, and discussing with you, how you to, can achieve that beautiful smile you have always wanted!