The Conservative Case for Cosmetic Dentistry
Adamo E. Notarantonio, DDS, FICOI, FAACD
Huntington, NY
Cosmetic dentistry can do wonders to improve the esthetics of our patients’ smiles, and social media platforms are a great way to showcase these life-changing transformations. Unfortunately, a lot of what we see on these platforms are cases involving 20-plus teeth with aggressive preparations and little to no orthodontics or other procedures. Should this be the norm for every patient who walks in our door? One can easily see how a young dentist can get caught up in the glamour of social media without the education and knowledge to base treatment on risk assessment and conservative dentistry.
My philosophy on cosmetic dentistry is simple and conservative. Ideally, I prefer simple orthodontics and bleaching, a noninvasive and effective way to correct functional and esthetic issues. A second choice would be periodontal plastic surgery and composite resin. If none of these are effective, porcelain veneers would be my final choice. As much as porcelain veneers are an extreme esthetic makeover, some seem to forget that this treatment is a full-mouth rehabilitation where the function is just as important as the esthetics.
I’ve come to be a big proponent of direct composite resin as a great, conservative solution for many patients. The composite resins available today do a great job of combining strength and esthetics. It used to be that a strong composite didn’t polish well or appeared dull and opaque—or, a material was really translucent and esthetic, but the strength was lacking. Now, individual chemistries incorporate different particles that strengthen the composite while allowing it to keep its natural luster and shine for a long time. Today's composite can be as nice as, if not nicer than, porcelain. And based on the wealth of products on the market right now, there’s a flavor out there for every clinician.
My hope is that the younger generation coming out of dental school doesn’t just say, “I’m going to put my head down and drill deep and make as much money as I can.” We all need money to survive, but if we become educated and skilled enough, we can charge whatever we want and do the right thing at the same time. The amazing innovation we are seeing right now in direct restorative materials is definitely helping us achieve that.