Aesthetic Dentistry

At this point, understanding why a person dislikes their smile becomes crucial. Considering the patient's concerns and wishes, a personalized treatment plan is developed based on digital analysis, radiographic examination, and intraoral examination. This treatment plan evaluates criteria such as tooth position, tooth size, gum levels, tooth color, lip position, lip-tooth harmony, and smile line. Treatment is carried out systematically to achieve ideal results.

Aesthetic dentistry is a significant branch of dentistry that deals with the redesign of the oral and dental area from a health and aesthetic perspective. Its main focus is designing a healthy smile. Smile design aims to renew the ideal smile for each individual with health and naturalness. The important thing is to create an aesthetically pleasing smile that suits you, within the framework of medical principles. Besides their primary functions (chewing, speaking, etc.), our teeth significantly affect our self-confidence in society from an aesthetic point of view. Our smile is a very important factor in our communication with people. Discoloration and shape irregularities in teeth can cause problems ranging from psychological distress to other issues. Studies have shown that individuals who are confident in their smile are much happier and more successful in their social, professional, and daily lives compared to others. Our teeth reflect our smile, and our smile reflects our energy. A beautiful smile means self-confidence. The branch of dentistry that deals with this is called ' aesthetic dentistry '.

A cosmetic dentist must first get to know their patient and understand their expectations. It's crucial to remember that each individual requires different treatment. Many factors, such as the patient's personal preferences, socioeconomic status, and professional background, must be considered. Then, physical factors come into play. The cosmetic dentist should design a smile that the patient will perceive as pleasing and attractive, correcting any imperfections. Their goal is to create a dental alignment that is aesthetically acceptable and biologically compatible for the patient. For this, the initial examination should be lengthy if necessary, diagnostic models and photographs of the patient should be taken, and the expected result should be clearly and fully explained. Cosmetic dentistry is a very delicate scientific endeavor. Health should not be compromised in order to achieve the ideal appearance. Cosmetic surgeons and cosmetic dentists conduct their work within specific medical guidelines. Below, we will outline the factors that influence aesthetic correction.

There are certain angles and proportions present in the mouth, face, and head region. When treatment is performed according to these rules, achieving an aesthetically pleasing result is almost guaranteed. However, it should be noted that aesthetics are a relative concept, and everyone's aesthetic preferences may not match. For example, while I find person 'A' very beautiful, someone else may not find them beautiful at all. Therefore, understanding the patient's expectations is the most important criterion in aesthetic dentistry.

Ultimately, the dentist will decide on the technique and materials to be used. Before starting treatment, the quality of the material and its suitability for the patient must be determined. A sound decision-making ability, a desire to improve technical skills, and a continuous effort to stay informed about new products should be combined with a natural aesthetic sense and vision—the most important qualities your dentist should possess.

FACTORS THAT INFLUENCE SMILING

1. Age
2. Gender
3. facial features
4. Lips
5. The color, shape, and alignment of teeth.
6. Gums

AGE

Our faces undergo certain changes as we age. 

For example, the distance between the hairline and the eyebrows, the distance between the eyebrows and the tip of the nose, and the distance between the tip of the nose and the tip of the chin are equal in youth, but as we age, the tip of the nose and the tip of the chin get closer together. In other words, the lower third of the face shortens. This is due to gravity causing sagging in some areas, wear and tear on teeth over time, and bone resorption resulting in a decrease in the vertical dimension. For example, when we smile in our youth, more of our upper teeth are visible, while as we age, more of our lower teeth are visible. In such a case, the most effective treatment method is porcelain onlays that cover the chewing surfaces of the teeth and porcelain laminate veneers in the front area. This provides both ideal aesthetics and corrects the loss of space caused by the shortening of the teeth.

Another cause of age-related discoloration is physiological staining. Years of consumption of tea, coffee, cigarettes, alcohol, etc., and sometimes the erosion of the enamel layer, cause discoloration of the teeth. In such cases, polishing (whitening the teeth) and bleaching (teeth whitening) can solve the problem. The important point is that these procedures should look as natural as possible.

GENDER

There are significant differences in smiles and teeth between women and men. Women's teeth are more rounded, with softer corners. Men's teeth are straighter and more angular. In women, the two central front teeth are larger and longer, while the lateral teeth next to them are smaller. In men, there is no significant size difference between the four front teeth. In women, the smile line curves and follows the lower lip; in men, the smile line is straighter.

FACIAL FEATURES

There is a harmony between natural teeth and facial shape. For example, if you have an oval face, the shape of your teeth will be oval or close to oval. Square teeth will look more pleasing on square faces, and round teeth on round faces. Sometimes we struggle to achieve this harmony and resort to certain illusions. For instance, long teeth can be added to a person who is overweight and does not have a long face, making the face appear thinner and longer.

COLOR, SHAPE, AND ARRANGEMENT OF TEETH

If there is a discoloration problem in the teeth, polishing should be done first, followed by teeth whitening. If the applied treatment is not effective (in some cases it is difficult to achieve the desired result with teeth whitening), covering the tooth surfaces with porcelain laminate veneers or composite filling material will be the appropriate treatment. In some cases, both can be applied.

If there are deformities in the teeth, porcelain laminate veneers can provide an effective solution. In this case, for example, a very small lateral tooth can be aesthetically improved with porcelain laminate veneers bonded to it after minimal abrasion of only the front surface of the tooth. If there are gaps between the teeth (diastema), porcelain laminate veneer applications or composite applications are the closest treatment options. With these techniques, the gaps between the teeth can be easily closed. If there is wear and breakage at the edges of the front teeth, you can easily achieve an aesthetically pleasing smile with the same methods. If there are old fillings in the front teeth, these fillings should first be renewed and aesthetically evaluated. However, as we said at the beginning, this depends on the dentist's planning. For example, in an individual who consumes a lot of tea, coffee, and cigarettes, the edges of the fillings will discolor again in a short time. In this case, porcelain laminate veneers will again be the most suitable solution. The reason is that laminates absorb color.

Another factor to consider when dealing with tooth discoloration is the individual's skin tone. Skin tone significantly influences the color of the treatment. Very light-colored teeth will look unnatural on individuals with dark skin, while they will appear much more natural and aesthetically pleasing on individuals with light skin.

If teeth are misaligned, orthodontic treatment (braces) should be recommended first. This way, the most protective method will ensure both healthy teeth and ideal aesthetics. Proper tooth alignment is just as important in aesthetic consultation as it is in effective chewing and clear speech.

GUMS

Healthy gums are the most important criterion in oral and dental health. However, sometimes even healthy gums can detract from your appearance, making even the most beautiful teeth less appealing. Healthy gums are pink and have a "orange peel" appearance. Gums that are swollen, red, and shiny due to periodontal disease must be treated.

LAMINATE VENEER

Veneers are porcelain sheets bonded to the front surfaces of teeth. They are one of the most conservative (protective) treatments possible. This is because very little tooth tissue needs to be removed for veneers to be made; on average, removing 0.3-0.7 mm of tooth tissue is sufficient. The veneers are then prepared in the desired color and shape and bonded. Due to their thinness and lack of metal content, they are aesthetically very successful. Laminate veneers have a unique ability to allow light to pass through, making the teeth they are applied to look completely natural. Because of this feature, they appear like real teeth even under flash and disco lights. (Under these lights, veneers containing metal appear as black spots, as if they weren't even there). The light transmittance of laminates varies depending on the porcelain used and the manufacturing technique.

The treatment process is short. During the initial examination, an impression is taken of the patient before the teeth are even prepared. A mock-up (trial run) is then created in the laboratory using a special material based on this model. The doctor and patient have the opportunity to reach a consensus on this 3D model. This allows you to see how your teeth will look in 3D before they are actually prepared.

Next, the teeth are prepared in a short and painless procedure, and impressions are taken. Temporary plastic veneers, made in the shape and length agreed upon by you and your dentist, are then bonded. These are important for protecting your teeth until the porcelain veneers arrive. They also serve as a second 3D model for necessary corrections. The harmony of the teeth with the face is checked, and the ideal smile is determined through necessary adjustments and refinements. Porcelain veneers are then prepared and bonded in the laboratory according to this model.

Porcelain veneers, despite being very thin, are highly resistant to breakage once bonded. The bonding process is carried out using a special method (bonding resin), and once bonded, it is impossible to separate the laminate veneer from the tooth. However, they can be removed by abrasion, just like a natural tooth.

Veneers require minimal preparation, are not stained by agents such as cigarette smoke, tea, and coffee, and are indistinguishable from natural teeth due to their light-transmitting properties. Therefore, they have become the most ideal aesthetic treatment method used today.

WHO CAN BENEFIT FROM LAMINATE VENEERS?

• In those with broken front teeth
• To correct differences in level and color between teeth. Beans-front gap (if the patient does not want orthodontic treatment)
• In those whose tooth surfaces are worn down
• In people with large fillings and dark-colored teeth in their front teeth
• In those who are dissatisfied with the color of their teeth (tetracycline discoloration, etc.)
• In cases of crooked teeth, if the patient does not want orthodontic treatment
• In those with spaced teeth
• People who are dissatisfied with the shape of their teeth (long, short, small, etc.)
• In creating a wide, U-shaped smile line, thereby providing energetic and natural beauty.

Laminate veneers can be applied to anyone who wants to achieve a beautiful smile without damaging their teeth.

WHAT ARE THE ADVANTAGES OF LAMINATE VENEERS?

• This is one of the most conservative (protective) treatments possible. This is because very little tissue needs to be removed from the tooth to make the veneers. Only an average of 0.3-0.7 mm of material is removed from the front surface of the tooth. Thus, there is no need to cut (reduce) any tooth.
• Treatment is quick. You'll have a brand new smile in 2 or 3 appointments.
• With a custom-made model, you can see in 3D how your teeth will look in your own mouth before any preparation.
• With the right indication, the right technique, and a good smile design, the teeth are so integrated into the person's face that they are not immediately noticeable to others.
• Because of their light-transmitting properties, they are indistinguishable from natural teeth. The more light-transmitting a laminate veneer is, the more natural the result will be.
• The highly polished porcelain surface minimizes tartar formation.
• It does not change color due to external factors such as coffee, tea, or cigarettes.
• The material itself is quite brittle. However, when fully bonded to the enamel, its resistance to tensile and compressive forces increases significantly. For example, it is impossible to remove a bonded veneer from a tooth in its entirety. It can only be removed by abrading it from the tooth surface with diamond burs.
• It has high resistance to wear and tear.

WHAT ARE THE DISADVANTAGES OF LAMINATE VENEERS?

• It is more expensive compared to other treatment alternatives.
• It's a delicate technique.
• It requires thorough clinical and laboratory work.
• The dentist and dental technician must have complete technical knowledge and artistic skill in this area.

METAL-FREE FULL PORCELAIN AESTHETIC CROWNS

The most fundamental rule of aesthetic dental work is that the resulting tooth  should look as close to natural as possible  . In other words, we can say this:

Let's create a tooth that, despite its perfection, looks natural and doesn't look artificial at all.

Porcelain teeth have long been a preferred material in dentistry due to their natural appearance and durability.

However, when comparing natural teeth with metal-supported porcelain crowns, disadvantages such as light transmission, color rendering, dullness in appearance, and discoloration of the gums have been observed over many years of application, and solutions to these problems have been sought. The metal substructure under the ceramic superstructure has been identified as the cause of these disadvantages, and new alternatives that are equally strong but more aesthetic have been produced.

Metal-free ceramics began to be used as a result of this quest.

While many factors influence the appearance of crowns, the most important is their response to light. Natural teeth transmit light, resulting in greater depth and vibrancy. Metal-free porcelain crowns, due to their light-transmitting properties, offer greater depth and vibrancy, thus achieving visual results closest to natural teeth.

ADVANTAGES OF METAL-FREE FULL METAL CROWNS

• Full porcelain crowns create an aesthetic appearance because their light transmittance is identical to that of natural teeth, whereas metal-supported porcelain crowns, even if very well made, have a dullness and artificiality. For this reason, full porcelain crowns are preferred, especially for front teeth.
• Metal-supported porcelain crowns are mechanically bonded to the tooth. Full porcelain crowns, on the other hand, are bonded to the tooth both mechanically and chemically. Therefore, their retention is much higher than that of metal-supported crowns.
• In metal-free crowns, since there is no metal in the substructure, a dark line does not form at the crown-gingiva line. A more aesthetic appearance is achieved at the cervical junctions.
• Metal-supported porcelain crowns appear excessively white under certain lighting conditions (ultraviolet light, flashlights, spotlights, etc.), while the existing natural teeth create a dark, almost invisible gap in the mouth. This difference is not clearly noticeable with full porcelain crowns.
• In metal-free porcelain prostheses, due to the properties of tooth preparation, the prostheses do not put pressure on the gums, and gum diseases and gum recession are less common.
• When gums recede, full porcelain crowns maintain their aesthetic appearance, while metal-supported porcelain crowns create an unsightly appearance where they join the tooth.
• The risk of allergies to some metals used in the substructure (such as nickel) is absent in full porcelain veneers.
• Zirconium oxide is a biocompatible material and does not cause allergies.
• Studies have shown that it is perfectly compatible with the gums.
• It has the feature of being temporarily applied and tested.

IPS – EMPRESS II CROWNS

Reinforced porcelain is produced by compressing it in special machines and firing it at high temperatures. It is preferred, especially in front teeth, due to its excellent light transmittance. It is not sufficiently resistant to chewing forces, especially in the back area. However, its high aesthetic advantages are the reasons for its preference in front areas.

ZIRCONIUM-BASED BRIDGES

In this system, zirconium, a white alloy, is used as the substructure instead of metal. This state-of-the-art substructure is the only material that can offer both aesthetics and durability. The system's greatest advantage is that its very high durability allows for a completely aesthetic appearance even in the bridges in the posterior region.

WHAT IS ZIRCONIUM?

For many years, a metal substructure was used under porcelain teeth to ensure durability. Since this metal substructure was known to have drawbacks in terms of gums, bad breath, general health, and most importantly, aesthetics, the search for an alternative material to metal in porcelain substructures had been ongoing for years. The application of zirconium, previously used successfully in other fields of medicine, to replace metal in porcelain dentistry marked a new era.

Because these new zirconium-based porcelain veneers do not cause gum problems or allergies, and their light-transmitting properties allow us to achieve aesthetics and function close to natural teeth.

Crowns and bridges made by placing porcelain on zirconium are known by the short name CERCON, which is a combination of the words Ceramic and Zirconium. With a resistance of 900 Mpa-1200 Mpa, this system, in addition to its highest physical values, offers excellent light transmission, tissue compatibility, and covers many different indications, initiating a brand new era in dentistry.

The material's success has been proven in both medical and industrial fields. Following research that began in 1988, clinical applications have been implemented worldwide since the beginning of 2002. This new application completely eliminates aesthetic concerns associated with metal-ceramic and all-ceramic restorations in patients.

WHERE CAN IT BE USED?

• Single tooth crown restorations
• Various bridges
• Implant-supported crown and bridge work.

HIGH TECHNOLOGY FOR EXCELLENT RESULTS

Until now, zirconium oxide was not used in dental applications due to its high production cost. Thanks to a project developed by the Zurich Federal Institute of Technology, zirconium oxide has become economically available for use in dentistry. Zirconium has also been used in medicine since the 1960s. Long-term studies have proven the material's reliability.

Zirconium has been used for various purposes in different parts of the body, primarily in hip joint replacements, and to date, no side effects, harm, or allergies have been detected.

Zirconium is a lightweight element that is resistant to high temperatures and impacts, and it does not conduct heat or electricity, but it is translucent.

It is also a healthy material that does not cause taste disturbances, gum problems, or bad breath.

A wax model of your teeth is prepared based on an impression taken of your teeth. A computer-aided design (CAD/CAM) then uses the information from this model to mill a zirconium oxide block, preparing the substructure of your teeth. The milled block is colored using a special dye and technique that penetrates the structure according to your chosen color. The colored substructures are then filled with ceramic tiles of the appropriate color to give the tooth its shape, and the process is completed with a polishing procedure.

Now, thanks to advanced zirconium oxide technology, strong and aesthetically pleasing metal-free prostheses can be successfully produced.

COMPLETELY COMPATIBLE WITH THE BODY AND TEETH.

Cercon applications also offer some important advantages for users. Cercon ceramic, placed on a zirconium oxide substructure, reduces the rate at which food particles and microorganisms adhere to the tooth surface. This ensures good oral hygiene. Zirconium oxide does not conduct heat, so you will not experience sensitivity when consuming hot or cold foods.

One of the most important properties of zirconium is its antibacterial nature. Bacteria cannot settle or multiply within the zirconium structure. Therefore, it is extremely advantageous for protecting teeth and preventing bad breath during prosthetic applications.

In conclusion, it can be said that Cercon is the highest quality product achieved to date in terms of aesthetics, durability, tissue compatibility, and naturalness, which are the fundamental requirements of modern dentistry.