The Most Challenging Cosmetic Problem in Dentistry


There are many challenges in cosmetic dentistry. One might think that getting  6 or 8 crowns or veneers would be challenging. But, the lab can make everything the same size and use the same shades of porcelain in each part of the tooth, and achieving this result, though it may require some time, is not that challenging.

A more difficult cosmetic problem is to match one of the central incisors with the one that is next to it.

Tooth discoloration

A common problem occurs when someone is hit in the face and one of the two teeth dies and needs a root canal. Very often, the way a patient realizes that a nerve has died is when the color of the tooth gets darker and there are changes on the x-ray the signify this condition. How is that corrected? One possibility is to place a bleach product internally into the chamber of the tooth, seal it up and let it sit for a few days. The dentist must carefully seal off the root of the tooth before placing the bleach, and then place a temporary in the back of the tooth. In my experience, this never works perfectly and there is some subsequent fade. Much of the success for this procedure is in the eyes of the patient. The big advantage is that no drilling is done on the front of the tooth, so the enamel retains its original surface texture, shape and size. If “just getting it to match a little more” is the final goal, the patient will be happy to that extent. If they need a perfect match, it’s very difficult to achieve.

I have tried having patients wear a bleaching tray where the discolored tooth is the only tooth receiving bleach. I have not seen great results with that, and the internal bleaching is better.

The next step is to try to make a crown or veneer to get it to match the natural tooth next to it. This is quite a task and requires a very skilled lab technician. Some patients opt to have the front 2,4,6 or 8 teeth to get to have veneers or crowns, thinking that they dislike more than just the one tooth. This is the time for many patients to make that decision. Since I am a bit more conservative, I recommend that patients bleach their teeth, and then decide what really bothers them , and then decide what they want. If they desire to have really white teeth, veneers or crowns are the most likely option for those people.

There is a purely cosmetic option for patients who want to change their smile. This is getting a “snap-on-smile” which is a removable appliance. It fits over all of the teeth and provides a pleasing appearance. The problems with this is that it’s removable, you can’t eat with it, and problem teeth are masked behind the removable teeth. Many dentists are not pleased with this option, but I mention it for those who need a quick, temporary, affordable fix.