The two images to the left above are an example of "direct" dental bonding done at our office. These restorations are known as veneers. In order to accomplish this form of "instant orthodontics", tooth colored composite filling material was "bonded" to the front surfaces of the natural teeth and then carved using a handpiece (high speed drill), and slow speed polishing instruments to sculpt more esthetic (pleasant appearing) teeth in a better position.
Direct veneers are very thin coats of filling material placed on teeth, which are sometimes altered (prepared) beforehand, and sometimes not. The above teeth were not prepared, and the veneers were placed without giving shots. The image on the right is the completed case finished with a "Flipper" which is the least expensive way to replace missing teeth. If the patient had chosen a more expensive flexible partial denture instead, the clasp would not have been so visible. This is a fairly inexpensive way to take a bad situation and turn it around.
Below are before and after images of 2 less complex cases of "instant orthodontics" through direct bonding. In these cases composite filling material was applied to three teeth (the two central incisors and the lateral incisor to the right in both cases). The top case was done about eight years ago and looks essentially the same today as when the veneers were first applied. The bottom case was done in the summer of 2001. The lower case demonstrates the difficulty in placing wide veneers on short teeth since the finished result shows teeth which are a bit wide and somewhat blocky. In spite of this, the patient was pleased to be rid of her spaces.
The term "bonding" is a misnomer. It applies to a process, and not the product. Bonding is the process of applying a dilute acid to the enamel of a tooth to produce a frosted surface which looks microscopically like a series of mountains and valleys. This microscopic roughness is then filled with a liquid plastic which, when hardened, mechanically adheres onto the surface of the tooth and allows the further bonding of a glass filled composite filling material. (See my page on dental materials for more than you probably want to know about the technical aspects of bonding fillings to teeth.)
This composite can be shaped into the form of a tooth, as I have done in the example above. Direct bonding is an artistic endeavor on the part of the dentist. No laboratory is involved in the production of the final product. The two images to the right show the replacement of old composite fillings with new ones. Even though this type of work is bonded, they still are billed as simple fillings and are paid for by most dental insurance companies while the bonded veneers shown above are considered cosmetic and are generally not covered by insurance.
The image at the right shows a patient with crooked canine teeth (eye teeth) which are twisted, making them look like fangs. The left central tooth has had a root canal and has darkened. This patient seldom smiled because of the appearance of his teeth.
The image to the left shows the patient's smile one hour later. Composite was bonded to the inside of the canine teeth to close the space between the canines and the lateral teeth. This gives the "fangs" the appearance of being straight. The darkened central incisor was shaved back slightly and composite was bonded over the front to hide the dark color. This entire procedure was done without getting the patient numb.
Composite filling materials are actually quite complex, and there are quite a few different kinds. For a better understanding of the chemical and physical makeup of composites, as well as a technical explanation of the different types, please click on the dental material button below:
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