Aesthetic dentistry

Aesthetic dentistry is a field of dentistry that focuses on the appearance of teeth and gums. The goal is to achieve a beautiful and harmonious smile that looks natural and healthy.

Aesthetic dentistry, also called cosmetic dentistry, combines various methods to restore a patient’s perfect smile.

Through a variety of techniques, a healthy and radiant smile can be recreated, although the actual situation in the mouth does not reflect true health.

This article aims to explain important points about the potential, but also the limitations of aesthetic dentistry.

Teeth and gums – An inseparable unit

Imagine a person with the most beautiful teeth, but the gums look unhealthy and have receded. This does not look very aesthetic.

The teeth and gums form an inseparable unit also known as red-white aesthetics. Both components must be healthy and harmonious in order to be considered attractive.

There are several things that can harm the teeth and gums. These points are very important and should be considered.

Gums – Gingiva

The gums are the red aesthetics. It should be a healthy pink color and firmly attached to the tooth and bone. The gum form a garland shape around each tooth and completely fills the interdental spaces. Aesthetic dentistry places great importance on a healthy and harmonious gingiva.

Healthy gums form a stable connection to the teeth. This dento-gingival connection is very important for overall health. It prevents external bacteria or toxins from entering the bone, i.e. the inside of the body. If the gums are damaged, aesthetics are not ideal and overall health is constantly affected.

What can cause gum disease

Unhealthy bacterial flora

If the oral bacterial flora contains bacteria that can destroy the gums, a pathological change of the gums occurs. The firm connection to the tooth is lost and deep gingival pockets form. Through these pockets, large amounts of bacteria, metabolites and toxins enter the blood and cause a burden on the body.

The gums appear softened, reddened and tend to bleed much faster.

A bacterial coating is often seen on the gumline.

The picture shows healthy gums that completely fill the spaces between the teeth. Bacterial plaque can be seen on the gumline, which can lead to health problems.

Anatomically defective inlays and crowns

Broken teeth can be restored with fillings, inlays or crowns. It is very important to replicate the correct anatomy during reconstruction, otherwise problems with the gums may occur, among others.

Incorrect cleaning technique

A toothbrush that is too hard combined with too much pressure can permanently traumatize the gums and lead to gum recession.

Electric toothbrushes can also cause permanent recession of the gums, especially if the bristles are too hard.

Therefore, we recommend using super soft manual toothbrushes.

Interdental brushes, small pieces of wood and dental floss put pressure onto the delicate dental papilla. All tissue reacts to pressure by breaking down gradually. It is the same with dental gingiva. As a result, there is a gradual loss of the gingival papilla, which appears as “black triangles“.

When using dental floss, dental brushes or anything in the interdental spaces, one should be very careful. After the loss of dental papilla, small areas form in which plaque can build up and food can easily get stuck. Aesthetic reconstruction of “black triangles” is possible, but costly.

In our experience, patients who have optimal bacterial flora in the oral cavity and whose correct dental anatomy has been restored, no longer need dental floss or dental brushes.

Materials that are problematic from a health point of view

Smoking and gums

Teeth and gums come into direct contact with smoke and are therefore highly affected. Patients who smoke often usually have problems with their gums. There is increased recession of the gums with the formation of “black triangles” and often long-looking teeth.

In addition, smokers usually have chronic inflammation and deep gum pockets.

Teeth – The white aesthetics

Teeth are the hardest tissue in the human body and have the function of grinding food. These are individual organs, which are supplied with blood vessels, nerves and lymphatic capillaries.

The specific shape of each individual tooth comes from the function of chewing food, and differs only slightly between people.

Healthy and anatomically correct teeth harmonize with the appearance and facial features. People with broader faces often have bigger teeth than slender, petite individuals. It is essential to consider this when providing dental restorations.

An aesthetically pleasing set of teeth shows an anatomically correct dental arch, which supports the lips, cheeks and jaw joints and gives a youthful appearance.

A healthy tooth should be preserved by the dentist at all costs. Diseased teeth, on the other hand, should be replaced, preferably with ceramic implants. Tooth gaps can lower the bite and make the face look sunken.

With any dental restoration (fillings, inlays, crowns, ceramic implants), the correct anatomy of the teeth should always be restored. This can ensure that both aesthetics and function are ideal.

An extreme example of an incorrect function due to the bite anatomy is a TMJ disorder. The incorrect bite forces the temporomandibular joints into a non-physiological position, resulting in tissue remodeling and various TMJ symptoms. As long as the dentition is not corrected, the disorder remains and can massively affect the quality of life.

What can damage teeth

High amount of caries and periodontitis bacteria

This is one of the main reasons why teeth decay over time.

The caries bacteria produce acids from sugar and etch holes in the teeth. Little by little, dentist have to place more and more fillings. The fillings become larger with time until the tooth has to be crowned or even extracted.

Periodontal bacteria destroy tissue around the tooth so that it loosens and eventually has to be extracted.

It is therefore very important to start to optimize the bacterial flora in the mouth right away. This can greatly reduce destruction of teeth, gums and tissue.

Incorrect tooth brushing technique

Brushing with toothbrushes that are too hard and with a lot of pressure can rub away the surface cell layer, making the teeth look thinner and aesthetically unattractive.

Using very soft toothbrushes can protect the teeth and gums. It is best to use a manual toothbrush. Electric toothbrushes should be used rarely or not at all.

Grinding and clenching

Grinding and clenching is a common problem among many people these days. The masticatory system is used as an outlet to process stress and let out built-up energy/emotions. This results in enormous forces on the teeth and jaw joints.

People who grind gradually wear away the enamel of their teeth, causing aesthetic and functional problems.

Aesthetics descrease as the natural tooth shape is lost and the teeth appear short. There is also a loss of support of the lower jaw – in other words, the lower jaw becomes closer to the upper jaw, causing the facial profile to lose its youthfulness.

The proper function is disrupted as the temporomandibular joints experience unnatural forces and must adjust. This adaptation leads to an influence on all skeletal, muscular and fascial structures of the body, which can lead to an imbalance. This imbalance is noticeable in the form of TMJ symptoms.

Learn more about TMD.

Smoking and caries

Smoking harms not only the gums, but also the teeth. The smoke reduces saliva production and the oxygen content in saliva decreases.

In addition, smokers have an increased oxidative stress in saliva.

This leads to people who smoke having a higher risk of tooth decay.

Aesthetics and function

An aesthetic appearance is important. However, the patient will not be satisfied if the function of the masticatory (chewing) system suffers because of the aesthetics. The patient wants to be able to bite and chew correctly without disruptive tooth contacts.

Consequently, the proper function must be considered in any dental treatment and goes hand in hand with aesthetics.

Restoring the correct function of the masticatory system is always based on achieving the ideal anatomy, tooth position, tooth shape and bite height.

These optimal anatomical conditions always lead to the correct function.

In these cases, function and aesthetics is particularly important and complex to implement:

• In patients with TMD, temporomandibular joints and surrounding tissue must be regenerated and the anatomically correct bite has to be restored.
• For edentulous patients who require a fixed restoration with dental implants. In this case, the correct bite height, the anatomically correct dental arches and the tooth shapes with the exact tooth contacts must be reconstructed in such a way that aesthetics are achieved in the best possible way.
• In patients with pronounced bone loss, due to an accident or bone inflammation.

Cooperation between different specialists

In aesthetic dentistry, it is of great importance that dentists with different specialties work closely together to achieve the ideal aesthetic and functional result. This way, challenging, complex cases can be treated with an ideal, aesthetic and functional result.

Periodontology

A dentist who specialises in periodontology treats the gums and tissue surrounding the teeth (red aesthetics). The basis of having healthy gums and tissue is an ideal oral flora.

Oral surgery

Dentists who specialise in oral surgery treat patients by removing broken and diseased teeth and place ceramic implants in the most ideal, aesthetic position possible. Periodontal surgical optimization of the bone and gums can also be performed. If jaw bone is missing in height and width, it can be built up with autologous bone by oral surgery. Oral surgery is an important part of aesthetic dentistry.

Prosthetics

Implants and anatomically defective teeth are provided with prosthetics like ceramic onlays or crowns. During this process, the correct anatomy each individual tooth must be ensured. In order to optimise the function of the masticatory (chewing system) as well as the appearance of the face, the position of the teeth and contact points (occlusial points) should be correct and the position of the teeth in the dental arch should be ideal.

Orthodontics

In complex situations, an orthodontist can harmonize the position of the teeth before implants are placed and dental prosthesis are made. This way, an excellent result can be achieved even with complex dental restorations.

Dental Technology

For a perfect aesthetic result, a dental technician with a lot of experience and artistic talent is needed. Since ceramic is the material of choice, a high level of expertise with this material is a prerequisite for maximum aesthetics.

Methods and techniques of aesthetic dentistry

Bleaching / Teeth whitening

Teeth become darker with age, despite regular dental hygiene and cleaning. Therefore, a light-colored set of teeth tends to be associated with health and youthfulness. Bleaching is a way to lighten the natural tooth structure and improve aesthetics.

In our dental office we offer a mild bleaching with plasma and ozone. This method is non-invasive and not painful. It is gentle on the gums and does not cause sensitive teeth.

Veneers and Lumineers / Non-Prep Veneers

Veneers are ceramic shells that are permanently bonded to the front teeth to make their shape, color and tooth structure more appealing. Conventional veneers are approx. 0.7 to 1 mm thick, which is why teeth must be ground down and prepared.

Lumineers are also called non-prep veneers. These are very thin ceramic shells that are just 0.3mm thick. In many cases, it is not necessary to grind down the tooth beforehand.

In the case of veneers, it is very important to avoid overloading and pressure on the ceramic shells. Therefore, an exact check-up of the masticatory system should be carried out in advance.

Aesthetic dentistry and ceramic implants

Ceramic implants are made of zirconium oxide. They not only have health advantages over common titanium implants, but also improve aesthetics significantly

• The gum and bone attach firmly to zirconia ceramics. Since a pocket does not form, gingivitis is less likely to occur and the red esthetics look natural and healthy.
• Fewer bacterial biofilms adhere to zirconium ceramics compared to titanium or natural teeth. As a result, there is less tendency to inflammation, which is an important for the natural pink aesthetics of the gums and surrounding tissue.
• The white, tooth-like color of the ceramic implant does not appear disturbing and is not associated with disease. Even if a part of the ceramic implant is visible, it does not have a negative implact on aesthetics. Titanium implants, on the other hand, have a metallic grayish color. They can shimmer through the gingiva. If the upper portion is uncovered, it quickly becomes noticeable and looks unaesthetic.

Ceramic crowns and bridges

Ceramic crowns and bridges show the best aesthetics and should be preferred over metal. In terms of gum attachment, zirconia ceramics in particular show optimal results and can prevent gum pockets from forming and bacteria from getting into the bone.

Even with simple crowns and bridges, all points including aesthetics, biocompatibility, anatomy and function must be considered.

With our in-house dental laboratory, patients can receive zirconia ceramic crowns and bridges within one treatment. Patients who travel from far away do not need to travel back to the practice a second time.

Ceramic inlays and aesthetics

Ceramic inlays are superior to classic composite fillings in terms of health and aesthetics. Inlays are also made of zirconia ceramics and show the best biological results, as gums adhere well to this material.

We can also produce and place laboratory-made inlays made of zirconia ceramics in just one session. This allows patients to receive laboratory-produced zirconia restorations without having to travel multiple times.

Amalgam removal

Amalgam is a material that has many disadvantages in terms of biocompatibility and aesthetics. Therefore, removal of amalgam under effective protective measures is highly recommended and very important for overall health. After the removal of the amalgam, teeth can be restored with laboratory-made ceramic inlays in one treatment.

Orthodontics – Transparent dental splint

The purpose of orthodontics is to align the teeth into a harmonious and anatomically correct dental arch, thereby aesthetically improving the smile and facial profile. Orthodontics should also improve, not worsen, the function of the entire masticatory system.

Many cases can be treated with transparent dental splints (e.g. Invisalign®) so that patients do not have to wear other dental appliances.

Unfortunately, we often find that incorrectly planned and performed orthodontic treatments can result in functional problems for patients. Patients can develop different TMD symptoms throughout their lives and require a proper treatment of their masticatory (chewing) system and jaw joints.

Highly experienced dental technician

A dental technician restores a part of a defect tooth in the dental laboratory and has an important role in the treatment process. The manufactured dental restoration such as in inlay, crown or bridge should integrate perfectly with the patient’s dentition in terms of color, structure and shape.

All functional properties, such as chewing contacts, form to the neighboring teeth and surface texture, should be considered and adapted accordingly.

The dentists and dental technician should coordinate and work together closely, knowing exactly what needs to be taken into account so that mistakes happen during the treatment and manufacturing process.

Each case should be planned carefully by both dentists and dental technicians. Through close cooperation and short distances, errors in planning and processing can be minimized. Thus, it is a significant advantage if the dental technician works directly in the dental practice and can focus only on the patients of the practice.

FAQ about Aesthetic Dentistry

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