Our case of the month for September 2021 was a simply stunning one using ultra minimally invasive E max veneers. Our client disliked her front teeth composite bonding which had discoloured, worn and chipped over time. Although teeth bonding is a superb treatment, there are disadvantages compared to porcelain such as those mentioned above. Porcelain will not stain or change colour and it is far more durable than composite. However, in the past, porcelain needed considerable preparation to create space for the material which was a huge disadvantage. Today, material technology and modern techniques allow us to create beautiful veneers without having to cut teeth.

Our case highlights this, just take a look:
 

Our case of the month for August 2021 was a straight forward one but effective. In many cases, we get asked to correct one or two teeth which really bothers our patient. Most of the time, this is perfectly feasible using modern day cosmetic dental techniques such as lingual braces and cosmetic bonding. 

For our case, one tooth had slipped behind the others and was in cross bite with the lower teeth. This is where the upper tooth actually sits on the inside surface of the lower tooth when closed. This is not desirable aesthetically nor functionally. One tooth in cross bite will often wear at a greater rate and can interfere with the bite. 

To keep things really simple, we used a Social 6 lingual brace to correct the tooth and place it back to the normal position. As mentioned above, due to wear, it was much shorter than the adjacent teeth. However, with some snazzy cosmetic bonding using our own techniques and polishing methods, we had a life like tooth back again which looked as good as new.
 

Over the years, Invisalign has transformed drastically to embrace digital technology and improve their product which is by far and away the best on the market (our opinion having used all of the copycats!). There are now several Invisalign products available to dentists which brings us to Invisalign Lite. The Lite version is specifically for mild to moderate crowding with treatment time frames of around 6-8 months. Within the package, there are 14 initial aligners to correct the main crowding issues. After this first set, we have the opportunity to fine tune any crowding using refinement aligners. As of October 2021, Invisalign Lite allows 2 sets of refinements of 14 aligners within each package. This provides us with ample scope for adjustments and minor corrections.
 

Our case of the month for July 2021 is quite a complex one involving multiple ceramic crowns after an accident during the first lockdown. Our patient, Xavier, had a cycling accident where he cracked 3 of his front teeth. Now with any trauma case, there is a certain way to handle the situation and it is important not to rush into a specific treatment. The reason being is that once the teeth and gums have been damaged, the consequences may not be apparent for several weeks or months. Hence the use of provisional materials such as composite and temporary crowns are vital during this healing phase.

Periodontal or gum health is paramount also and we needed to spend some time stabilising the gum health with conventional and laser treatments. Beata Kynsak did a wonderful job using Waterlase i Plus and the Epic 10 diode laser with a complete transformation from inflamed , swollen gums to a pink, firm attached gum line. Laser dentistry, although not new, is still a rarity across our profession but we are firm believers in the technology and have many years of experience highlighting great results. 

Once the gums were stable, provisional crowns were made using a diagnostic wax up. This is where our laboratory, Ceramic Studios, re create the teeth using digital means to provide us with a prototype of the final teeth. We can use this guide to define our preparations of the teeth, make the temporary teeth and allow our patients to see what the final crowns can look like. Our temporary crown material of choice is Luxatemp; the gold standard. 

After some time in the temporary crowns, we were ready to proceed with the final crowns which were E Max all ceramic crowns, again the gold standard when it comes to aesthetics. There is no better. Ceramic Studios did a great job and just take a look at the before and after results:
 

Our case of the month for May 2021 was a simple one involving ICON to treat a white spot and then cosmetic bonding to repair a small chip. Initially. we used Invisalign Express to treat some mild mis alignment. Putting teeth in the correct position will mean that that any future treatment will always look better especially bonding. 

The treatment in our case is completely non invasive. There is no need for any drilling, no needles of any sort and no pain! Furthermore, the cost is affordable compared to traditional veneers or crowns. A no brainer! 

ICON white spot treatment works by changing the light refractions of the white spot using resin infiltration. This way the white spot is camouflaged and blends in the surrounding tooth. The process is super simple and takes only a few minutes. 

Cosmetic bonding can further enhance the appearance of the tooth by using highly aesthetic composite resin to layer over an defects such as chips, uneven edges, gaps, sharp edges and even discolouration. 

Here are the before and after photographs:
 

Our case of the month for June 2021 was one where spaces were closed using composite bonding or teeth bonding. Often there are spaces between teeth which are either natural, developmental, after orthodontic treatment or following a trauma. One of the simplest ways to close the spaces is via bonding.
 

Our case of the month for April was one involving E Max crowns by Ivoclar, which is our opinion, give the best aesthetic results. In the past, tooth coloured dental crowns had a layer of metal underneath for strength with the ceramic bonded on the outside. Now these could look perfectly acceptable but there were issues. Having two layers means that more of the underlying tooth has to be cut down to accommodate the material. For any of you that has read any of our posts knows that we believe in minimally invasive dentistry, cutting away more tooth than necessary just does not sit right with us. Another issue with metal ceramic crowns is that the metal layer may become visible over time as the gums recede which gives that classic grey line around the tooth. Not very desirable. One of the main advantages of ceramic crowns is that there is no metal underneath and this grey line will never be an issue. 

The aesthetic qualities of E max crowns are second to none. Our case shows that the crowns can be fully customised with translucency at the edges, varying shades, light reflection and opaque areas to name a few. The skill of the dental technician plays a huge role here and we work with some excellent laboratories know for excellence. 

For our case, Ceramic Studios in Kensington made the wonderful E max crowns fully which were fully customised.
 

Our case of the month for March is a simple but great one- we love it so much! It features composite bonding which is a favourite treatment of ours. People often ask what is cosmetic or composite bonding. Well the answer is simple. For many years, dentists have been using adhesive technology to bond fillings inside of teeth. The same technology can be applied to the outside of teeth to make them look pretty! In essence, if a tooth is worn down, fractured, uneven or discoloured then composite bonding can be used to enhance the tooth without having to cut the tooth down or destroy healthy tooth enamel. After all, dental enamel is the hardest tissue in the body for a good reason. It is there to protect teeth- why on earth would we cut it all away? The old days of Extreme Makeover (remember that show) are over. 

Often cosmetic bonding can be used for very subtle treatments such as our case. In this example, we treated the front teeth using Social 6 lingual braces to straighten the teeth first and then use composite bonding to enhance the smile line to even the edges, make pointed teeth look natural and camouflage the canine teeth which were quite pointed. There was absolutely no drilling of the underlying teeth, no needles were required, an entirely pain free process. Take a look at the difference:
 

At the end of orthodontic treatment, retainers must be worn otherwise you run the risk of undoing all of the hard work straightening your teeth. This is called relapse. We advise a combination approach of a fixed wire retainer placed behind the front teeth as well using a removable retainer at night.