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DENTISTRYTODAY.COM • JANUARY 2013

FOCUS ON: Aesthetics

Q: What is aesthetics in dentistry?

A:Aesthetics can be defined as a branch of philos-ophy dealing with the nature of art, beauty, and

taste, with the creation and appreciation of beauty. Formany years, aesthetics in dentistry dealt solely withthe shape and form of restorative ma ter ials, recreat-ing nature’s blueprint of the posterior occlusal sur-faces in dental restorations. The evolution of porce-lain bonded to metal substructures gave the dentista full-coverage restoration that could further thataesthetic value by mimicking the color of naturalteeth. Partial coverage restorations still revertedback to the “old metal standards.” This choreogra-phy of the cuspal ballet has been termed the aesthet-ics of occlusion by Dr. Harold M. Shavell. In the mid1980s, dental aesthetics took a quantum leap withthe development of light-cured, microfilled directcomposite restorative materials and adhesivechem istries that gave us the ability to bond tooth-colored restorative materials to enamel and dentin.Today, both direct and indirect aesthetic dentalmaterials have advanced to a degree that the dentistcan place beautiful dental tooth replacements thathave the aesthetic value of natural teeth.

Q: How has adhesive and materials technologieshelped advance the level of aesthetics in dentistry?

A:Predictable bonding of restorative materialsto tooth structure continues to improve andalso be a controversial subject. It is universallyagreed between researchers and clinicians that thebond to enamel is much stronger and more pre-dictable than the bond to dentin. How much bondstrength do we really need for clinical success? Doesthe bond itself degrade with time? Most cliniciansalso agree that steadfast attention to detail and tech-nique yield better results, regardless of the systemthat is used. As far as porcelain restorative materials,they have also evolved to a point where they canreplicate the natural opacities and translucencies ofnatural teeth in thicknesses as little as 0.3 to 0.5 mm.Lithium disilicate has comparable aesthetics tomany feldspathic materials at 4 times the strength.Full-contoured zirconia is beginning to replace goldin posterior teeth where strength is an isssue.

Q: How have advances in restorative materialsand technologies affected the quality of aes-thetics in dentistry?

A:Materials science and technology have defi-nitely increased the level and quality of aes-thetics that can be achieved in dental restoratives.However, some practitioners forget that ultimatelyaesthetics is in the eye of the beholder. Some clini-cians are openly critical of anything but the highestlevel aesthetic dentistry has to offer, but whom arewe really serving? The person who has to look in the

mirror every day! Does everyone need a Maseratiwhen they can’t appreciate the difference between aMaserati and a Chevy? The answer is no. We shouldcontinually strive to reach for the golden ring.

Q: How does today’s dental patient view dentalaesthetics?

A:Because of the advances in dental aesthetics,combined with the Internet that is availableto everyone, the average dental patient’s expecta-tions have surely risen. Tempering those expecta-tions to be realistic for every clinical aesthetic con-cern is now a major challenge for all dentists. Theme dia is more of an influence on patients’ view ofdental aesthetics than ever before. Digital photogra-phy and computer imaging has forced us all to stepup our game because patients no longer accept re -sults that 20 years ago were considered state of theart. Dental aesthetics is truly a double-edged sword.Some days I long for the past when the only colorchoices were silver and gold, because they alwaysmatched! On the other hand, when patients remark,“I can’t even tell which tooth was restored,” it’s agood day!

Q: What is the role of aesthetics in the otherdisciplines of dentistry?

A: It is important to realize that dental aestheticsis much more than just tooth color. The aes-thetics of the gingival tissues, ie, the height of the tis-

sue over the respective teeth, the position of the gin -gival zenith, overall symmetry, and balance of thepink and the white play an important role in the aes-thetics of the smile. Hence, an interdisciplinary ap -proach to dental aesthetics is very important to max-imize the total aesthetic result of a case. Peri odontalplastic surgery, dental implants, connective tissuegraf ting, orthodontics, and orthognathic surgery allare building blocks for total fa cial aesthetics. Botoxand dermal fillers are also tools for improvement offacial aesthetics that are starting to come under theprevue of the dentist. Today, we need to think aboutmore than just the teeth; the bigger picture is not justdental aesthetics, but facial aesthetics. As Dr. IrwinSmi gel, the father of modern dental aesthetics wouldask, who owns the face? The answer is, dentists do!

Q: What is the future of aesthetics in dentistry?

A:As our world becomes more digital, so haveour dental offices. Tech nologies such as digitalimpressions and CAD/CAM milling, both lab andchairside are changing the way we deliver aestheticdental restorations to our patients. High-level dentalaesthetics, in the opinion of many clinicians, stillrests in the hands of the ceramist. As the stock mate-rials for CAM/CAM improve in aesthetic quality,these technologies will become more mainstream. Afew of us realize that one totally undiscovered aes-thetic dental medium is indirect composite. In thehands of an artistic lab technician, the aesthetics ofthese restorations can and do rival their ceramiccounterparts. Since the material is 100% convertedmonomer to polymer chains (the best direct com-posites convert only up to approximately 70%!),indirect composites are more dense, stronger, andmaintain a surface luster much better than theirdirect composite counterparts. Some of the clinicaladvantages are that they are easier to place, with lessadjustment. This is because porcelain shrinks whenbaked and ceramic restorations must be overbuilt tocompensate for this. Indirect composites have mini-mal shrinkage when light-cured and do not shrinkfurther when processed under heat and pressure.This makes delivery in many cases much easier thanwith ceramics. With the economy the way it hasbeen the past few years, indirect composite can be aless costly alternative to ceramic for some patients,yet still yields a beautifully aesthetic result.

Dr. Lowe graduated magna cum laude from Loyola Uni versitySchool of Dentistry in 1982. Since January of 2000, he hasbeen in private practice in Charlotte, NC. He lectures interna-tionally, publishes on aesthetic and restorative dentistry, andis a clinical evaluator of materials and products. He re ceivedFellowships in the AGD, ICD, ADI, and ACD, and re ceived the2004 Gordon Christensen Outstanding Lecturers’ Award. In2005, he was awarded Diplomate status on the Amer icanBoard of Aesthetic Dentistry. He can be reached at (704) 364-4711 or at boblowedds@aol.com.

Robert Lowe, DDS, discusses recent trends in aesthetics.

Robert Lowe, DDS

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