With the use of an in-house CAD/CAM milling machine, it is now possible for cosmetic dental procedures to be done during one visit including getting dental bridges, implants and porcelain veneers, saving patients time and energy.
If someone wants to change the appearance of their smile and their teeth, can a dentist provide a consultation to see what options are available to them, and at what cost?
Dr. Darren McKeever: Well, that’s really a broad question. It doesn’t seem like it, but it really is. A dentist should definitely be able to provide a consultation on how to improve somebody’s smile. The problem, more often than not, from what I see, is that patients really don’t know who to go to. I often quip in my office, “How do you get to become a cosmetic dentist in the state of New Jersey”? And the answer is you have to spell it right in the yellow pages. Which is kind of a problem.
Years ago, I went on a journey to try and advance my skills in aesthetic dentistry. I don’t always use the term cosmetic, because I don’t want people to recognize the work. I want it to look so natural that the work looks like, “Wow, you just were given beautiful teeth by God.” But dentists should be able to provide a lot of the answers to the patient, as long as you’re picking the right dentist, who has the training. It took me hundreds of hours to realize that the most subtle changes in materials, or just angulations in the final results of the teeth can have dramatic changes in the final product, and also whether or not the patient is pleased with it. Because cosmetic dentistry is completely optional. You don’t have to have a beautiful smile to be able to eat well and survive in the world. It’s different from restorative care.
So, usually when patients go for a consultation, the dentist should be able to provide ideas of what they are capable of, in order to get the patient where the patient would like to be. Sometimes, a dentist might feel out of their depth, in which case hopefully they would say, “I’m not the right person for this.” But usually cosmetics, aesthetics, when you’re talking full makeovers, they’re really not cheap, so patients need to make sure they’re in the right office, getting the right answer for them.
I often say that you’re literally going to be going to a very expensive art gallery, you’re going to be buying a piece of art that you’re going to hang on your wall, and you’re going to have it for many, many years and the wall that you’re hanging this on is your face. You better make sure you like the end result. You really should know what the end result is going to be before you even commit to the care.
Now, to achieve a brighter, more aesthetic smile, please describe the teeth whitening process that you feel works best for a smile makeover.
Dr. Darren McKeever: Well, there’s really a lot of different ways to whiten teeth. We even see it now in the mall sometimes where you can go in and you can have your teeth whitened in one visit. Over the years, I have shied away from the one-visit whitenings. Years ago, they were very risky. Even though they always worked, teeth always got lighter, you weren’t sure if there was going to be postoperative discomfort. People might have a cavity that wasn’t analyzed properly by a dentist and they would get whitening and then the next thing you know, they have pain for three days because of the whitening process.
In addition to that, the one-visit whitening processes, you really aren’t sure exactly where you’re going to wind up at the end of the process. It may be too light. It may not be light enough. In my office, when we consider cosmetic or aesthetic makeovers, I like to use the tray system where people wear little mouth trays, usually in their sleep. There’s a gel applied into the tray and then while they’re wearing the tray, usually overnight while they’re sleeping, which also helps if they clench their teeth, their teeth are whitening. And that way, we can sort of really tailor make the final result to what the patient wants. You’re not going to over-bleach and, of course, you’re not going to stop until you get the teeth lightened and whitened to the point where you want them.
So, I’m a little bit more of a fan of having more control over it rather than let’s roll the ball down the hill and see how fast and how far it’s going to go.
If someone has chipped teeth, can they all be fixed in one visit? And what is the process like?
Dr. Darren McKeever: Teeth can always be fixed in one visit using either bonding, or nowadays with the CAD/CAM milling machine, or our machine is called the CEREC machine. You can do porcelain. It takes a long time to do that, but porcelain lasts a lot longer than bonding. The issue though, with chipped teeth, is why did they chip? The biggest problem that I have found in aesthetic dentistry or cosmetic dentistry is anybody can provide a wonderful smile. Not every dentist can provide it for a long period of time. The bite is the most misunderstood part of aesthetic dentistry in the entire world, in my opinion.
People come in, they don’t like the way their teeth look. They’re chipped, they’re broken, or whatever, and then the dentist will go in there and restore it, but not diagnose why they broke. And that’s a problem. Because if you can break the God-given material, you’re going to break the man-made material. And that’s the biggest problem that I find. A lack of diagnosis.
In terms of doing things in one visit with proper planning, and maybe a couple of visits prior to that to analyze the bite and maybe even eradicate some bite problems, there’s no reason why some of these things can’t be done in one visit.
Can porcelain veneers change the color and shape of teeth, and can they be done in one visit?
Dr. Darren McKeever: Porcelain veneers are one of my favorite things to do, because the dramatic impact of the final result is like nothing else in dentistry. Veneers are incredibly strong. They can change the color of the teeth. They can change the shape of the teeth. They can even appear to make the teeth look like they’ve changed their position in the mouth. Can they be done in one visit? It really depends. A simple case could easily be done with the CAD/CAM milling machine, as long as the patient understands that the change in the shapes of the teeth will have some limitations.
If patients want a much, much, much more individualized result in the shapes of their teeth, the final shapes, then in my opinion, I favor having them done by a laboratory. And that cannot be done in one visit because the laboratory is going to need time to fabricate the veneers. Nowadays, though, we’re starting to see more, and more, and more, the databases in these CAD/CAM machines are so incredibly intuitive that people are very happy with the final result. I’m not saying we’re ever going to cut out the lab directly, but the veneering process done by the CAD/CAM milling machines are becoming more, and more, and more successful and sought after every year.
What are some other things that can be done in one day during a full aesthetic makeover?
Dr. Darren McKeever: Well, you can do bonding. You can change the shapes and colors of the teeth with bonding. You can even, nowadays, place an implant where you had a space and put a temporary crown on the implant. Not ideal, always, but it’s something that can be done literally in one visit to replace a tooth.
In my office, we’re actually even doing multiple unit bridges in one visit, thanks to the CAD/CAM milling machine, because the materials are so strong and aesthetic nowadays, that we don’t have to send it to the lab for a try-in for the metal and then send it back, and then you have to have the porcelain added. That’s still done, depending on certain parameters, but more, and more, and more we’re doing these aesthetic cases in one visit because everybody is busy and the materials have finally caught up to the desire of the population who wants to be done conveniently and quickly.
If you are interested in speaking with Dr. Darren McKeever, visit www.mckeeverdentalcare.com or call 973-839-8180 to schedule an appointment.