Cosmetic Dentistry

Porcelain Veneers

Veneers are very thin pieces of durable, tooth shaped porcelain that are custom made (for shape and color) by a professional dental laboratory. They are bonded onto the front of tooth to create a beautiful and attractive smile.

Veneers can completely reshape your teeth and smile. They can often be alternatives to crowns and the ideal solution in treating many dental conditions.

As with most dental restorations, veneers are not permanent and will someday have to be replaced. They are very durable and will last many years, giving you a beautiful long lasting smile.

Porcelain veneers are recommended for:

Cosmetically; to create a uniform, white, beautiful smile

  • Crooked teeth
  • Misshapen teeth
  • Severely discolored or stained teeth
  • Teeth that are too small or large
  • Unwanted or uneven spaces
  • Worn or chipped teeth

Steps to make porcelain veneers

Porcelain veneers usually require two visits to complete the process, with local anesthesia required during the procedure. The teeth are prepared by lightly buffing and shaping the surface to allow for the thickness of the veneer. A mold or impression of the teeth is taken and a shade (color) will then be chosen by you and the dentist.

On the second visit the teeth will be cleansed with special liquids to achieve a durable bond. Bonding cement is then placed between the tooth and veneer and a special light beam is used to harden and set the bond.

You will receive care instructions for veneers. Proper brushing, flossing and regular dental visits will aid in the life of your new veneers.

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Porcelain Veneers

A crown (or cap) is a covering that encases the entire tooth surface restoring it to its original shape and size. A crown protects and strengthens tooth structure that cannot be restored with fillings or other types of restorations.

Although there are several types of crowns, porcelain (tooth colored crown) are the most popular, because they resemble your natural teeth. They are highly durable and will last many years, but like most dental restorations, they will eventually need to be replaced. Porcelain crowns are made to match the shape, size, and color or your teeth giving you a natural, long-lasting beautiful smile.

Crowns are recommended for:

  • Broken or Fractured Teeth
  • Cosmetic Enhancement
  • Decayed Teeth
  • Fractured Fillings
  • Large Fillings
  • Tooth with a Root Canal

Steps to make a Crown

A crown procedure usually requires two appointments. Your first appointment will include taking several highly accurate molds (or impressions) that will be used to create your custom crown. A mold will also be used to create a temporary crown which will stay on your tooth for approximately two weeks until your new crown is fabricated by a dental laboratory.

While the tooth is numb, the dentist will prepare the tooth by removing any decay and shaping the surface to properly fit the crown. Once these details are accomplished, your temporary crown will be placed with temporary cement and your bite will be checked to ensure you are biting properly.

At your second appointment, your temporary crown will be removed, the tooth will be cleaned, and your new crown will be carefully placed to ensure the spacing and bite is accurate.

You will be given care instructions and are encouraged to have regular dental visits to check your new crown.

Porcelain Inlay and Onlay

To repair damage to the tooth’s biting surface, rather than using a simple filling, or a crown, Dr. Alvarez will often use a porcelain inlay or onlay, This is now becoming the material of choice because of its strength and potential to match the natural color of your tooth.An inlay is similar to a filling and lies inside the cusp tips of the tooth. They are custom-made to fit the prepared cavity and are then bonded into place. An onlay is a more extensive reconstruction that covers one or more cusps of a tooth. Onlays are indicated in situations where a substantial reconstruction is required. However, more of the tooth structure can be conserved compared to placement of a crown.

Composite Fillings (fancy name for a Plastic Filling)

Typical posterior PLASTIC (Bonding/Composite)

Composite fillings are a mixture of glass or quartz filler in a resin or PLASTIC medium that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins. Composite fillings provide fair durability and resistance to fractures in small restorations that need to withstand moderate chewing pressure.

Originally designed for cosmetic anterior teeth restorations, it is broadly abused in dentistry as a “universal” filling material for the restoration of posterior teeth, especially in HMO driven  dental offices. Far better materials such as amalgam  are not  options  due to poor  insurance reimbursement  or low established fees.

In Dr. Alvarez's opinion, composite fillings are creating an enormous amount of dental problems on patients.

The following are some of the problems that Dr. Alvarez commonly finds related to composite fillings:

Cerec (Computerized Ceramic Onlay)

  1. Recurrent decay: Due to shrinkage during curing (placement), contraction and expansion from thermal changes and flexibility from biting forces, bacteria can leak under these restorations faster and more frequently then with other filling materials such as ceramics or amalgams.
  2. Sensitivity: To thermal changes (cold/hot), air, biting forces that could lead to irreversible nerve damage and the need of root canal treatment.
  3. Excessive wear: Due to poor properties of this “plastic“ material, Dr. Alvarez frequently finds this problem, especially on the biting (occlusal) surface of posterior teeth creating a distortion of the relationship between opposing (upper and lower) teeth, and in many cases requiring extensive reconstruction to correct the damages.
  4. Defective interproximal contact: Lack of posterior teeth interproximal ”strong/tight“ contact of this filling materials can lead to food impactation, gum inflammation, pain, discomfort, bone lose, localized gum disease and root sensitivity, along with other complications among other things.

All of these problems related to composite fillings can lead to frequent filling replacement, root canal treatment, crowns, tooth loss, and much more.

“I do not recommend the use of mid to large size composite (bonding) restorations for molars (posterior teeth) because of the poor properties of the material that lead to the list of problems mentioned above", says Dr. Alvarez.


Teeth Whitening

Teeth whitening (or bleaching) is a simple, non-invasive dental procedure used to change the color of natural tooth enamel and is an ideal way to enhance the beauty of your smile.Because having whiter teeth has now become the number one aesthetic concern of most patients, we now provide a number of ways to whiten teeth. The one hour (in office) whitening combine with the home teeth whitening system has given us the best results. Since teeth whitening only works on natural tooth enamel, it is important to evaluate replacement of any old fillings, crowns, etc. Replacement of any restorations will be done after bleaching so they will match the newly whitened teeth.

Teeth whitening is not permanent. A touch-up maybe needed every several years, and more often if you smoke, drink coffee, tea, or wine.

Teeth whitening is recommended for:

  • Fluorosis (excessive fluoridation during tooth development)
  • Normal wear of outer tooth layer
  • Stained teeth due to medications (tetracycline, etc.)
  • Yellow, brown stained teeth