Cosmetic dentistry and aesthetics
ONCE damages have been allowed to occur to teeth, their repair or replacement treatments will require artificial materials to be used.
Not only are these materials never quite as good as the original, natural tooth structures, but the health of the repaired tooth and gums around them can never regain its previous state. There is no available method to date to regenerate tooth structures. Although ‘test-tube teeth’ aims promisingly towards this objective through stem cell research, it is still at its very early stages.
The materials used to restore teeth can affect your smile cosmetically. However, if they deteriorate in the mouth over time, they can deteriorate your smile at the same time. Some materials are more durable than others, and gold shines in this respect, but gold and silver coloured filling have declined in recent years because of their colour.
White fillings are either made of composite resin or porcelain. Now, when compared, composite resin fillings are never as strong as porcelains, and are best limited to small cavities. Composite resin fillings are, however, much cheaper than can be done directly in a single visit at the chair-side.
Porcelain, on the other hand, is far more expensive, and is made indirectly in the dental laboratory from a mold taken of your teeth. Whereas a composite resin filling tends to stain both on and around it over time, particularly around the edges, porcelain is, however, harder, far more durable, and more resistant to staining in the long-term.
A porcelain inlay is like a piece of jigsaw puzzle: Made of china ware, tailored to fit accurately into that one specific cavity in your tooth, and will not fit any other tooth cavity in your mouth nor any other’s in the whole world.
Composite resin, on the other hand, is fluid, blended into any cavity like a soft white piece of plastercine, shaped to an approximation by hand instruments, and hardened by a chemical reaction. This is triggered by exposure to a light source. During this hardening process, it also tends to shrink slightly, leaving the tiny micro-crevice around its perimeter which may eventually collect stains. However, the effect is less significant in the small cavity, but if you should need a white filling for the large cavity, a porcelain inlay is more appropriate. Notably, porcelain in rarely used in Guyana.
The art of cosmetic dentistry involves not only restoring your teeth to full health, but also retaining the appearance of your smile in its most natural form. A smile which displays the black margins of your crown and filling edges, gaps under your bridge, or metal clasps of your denture could never be aesthetic. Crown margins are best tucked just under the gum-line; porcelain bridges are adapted exactly to the gum ridges; and denture clasps are redesigned and positioned discreetly.
Whilst cosmetic dentistry is concerned with correct colours, which can serve to camouflage their existence, the fine quality of restorations in the mouth determines the long- term survival of the teeth they aim to preserve. They should all feel smooth and comfortable when they are in the mouth, and the precision of their fit is of the highest degree. Their shapes, forms, contours, and sizes should replicate the lost tissues in order to restore teeth back to their original anatomy, to maintain their original contacts with all neighbouring and opposing teeth. The more perfect they are, the more comfortable, durable and ‘invisible’ they get.
The reason why dental restorations which are indirectly fabricated from a model of your cavities in the dental laboratory often last longer is because the technician is able to contour them precisely. Fillings which are directly made at the chair-side and placed into cavities by hand may not give the dentist the luxury of time, and the 360 degree view provided by a model, and approximate shaping of them at the chair-side often results in oversized fillings, which often overflow outside of the cavities to form either overhanging ledges or undersized fillings which fail to fill the cavity completely, creating step-defects around their perimeters.  Such ill-fitting and poorly-constructed restorations not only look bad, but they invite food and dental plaque to settle around them to cause recurrent decay, drastically shortening the longevity of the tooth.
Blackness around fillings could ruin your smile. The ‘perfect filling’ with perfect fittings do still have fine margins at their edges where they meet the tooth, and can still invite the collection of dental plaque, but far less.
Once you need to have artificial materials in the mouth, it becomes inescapably important that they, and all their many perimeters, are swept clean at all times because their existence alone creates new stagnation areas for extra dental plaque to collect. This is why the gums around crowns tend to bleed more readily than around natural teeth, and fillings tend to have more recurrences of decay underneath them when compared with wholly intact and natural teeth without fillings (virgin teeth) in the same mouth.