The goal of any treatment is to be as conservative as possible while establishing the most predictable long term result. When deciding between implants and conventional bridgework, the first question to ask is whether the adjacent teeth need to be restored. If the answer is no, then grinding down healthy teeth to be used as anchor teeth is very aggressive treatment which will permanently compromise those teeth long term.

The next question to ask is in the event that the adjacent need to be restored is this reason enough to opt for conventional bridgework or should implants still be considered? The biggest obstacle to implant dentistry is the need for surgery. However, once this procedure is complete the rest of the treatment can usually proceed much simpler than conventional dentistry and usually without anesthetic. Furthermore an implant does not rely on the adjacent for support therefore each tooth will continue to carry its own weight. This takes less pressure on the remaining teeth.

Finally there is no risk of future decay or pulpal problems with implant restorations compared to conventional restorations. It should be noted that these two problems account for 80% of the failures associated with conventional bridgework. Thus even though there is a surgical component, the use of implant dentistry to replace missing or failing teeth may turn out to be the most conservative treatment long term and the most predictable.

This question has no absolute right or wrong answer since each case is different. What is important is that a thorough discussion involves the benefits and risks of either treatment. Any treatment should be based on longevity and ease of maintenance. Thus it is important to know that any dentistry no matter how well completed will NOT last forever. Therefore if the smile makeover can be completed without restorative procedures (say orthodontics and bleaching) then the long term results will be much more predictable. If on the other hand the teeth involved in the smile makeover require restorations for structural reasons, then restorations only if possible and no orthodontics would be the most practical. Most cases may require both.

Should we use veneers or crowns and what about black lines and black triangles?

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It may be interesting to note that veneers under the proper circumstances will be every bit as strong as full crowns. The critical factor is the length the veneer will extend beyond the natural part of the tooth being restored. When this is minimal (less than 2mm) the choice is a veneer and not a full crown, provided the remaining tooth structure is sound.

This procedure can be performed in a number ways. It can be done by the patient using over the counter products or with special trays made in the dental office with a bleaching gel provided by the dentist. It is important to monitor the color change or the benefit may be difficult to measure. A starting shade is a simple of monitoring the results. Bleaching can also carried out in the dental office by the dentist or the hygienist to produce quick results. This may be supplemented with take home kits to continue the process.

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The next question to follow is, “…assuming that not all the plaque has been removed from all the surfaces of all my teeth with my home brushing and flossing, how long can this plaque sit on my teeth before I have to worry about aggravating my gum problems?” The scientific literature tells us that it takes approximately three months for calculus to reform under the gum once it has been meticulously removed. The source of mineral for tarter under the gums (subgingival tarter, as compared to tarter above the gums, supragingival tarter, which is the saliva) comes from the blood supply in the gum tissue around each tooth. Therefore the more blood supply around a tooth (i.e. the more inflammation) the more likely the calculus is to reform underneath the gum and therefore the more potential there is for further breakdown in the support tissues surrounding the tooth. Thus if you have a gum condition evidenced by bleeding or deep pocket readings (greater than 3mm) it’s more likely your dentist is to recommend 3-4 month cleanings to try to manage the gum problems. Reference an article.

What about insurance?