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Permanent Teeth Whitening - Cosmetic Dentistry Methods Beyond Bleaching

Jul 14, 2013
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Whiter teeth make us look younger, more confident and more attractive. History shows that people wanted healthy, whiter teeth 3000 years ago. And today? There are hundreds of teeth whitening products in stores or online, in addition to professional tray whitening, light-activated or chairside teeth whitening procedures your dentist may perform.

All these techniques, however, have something in common - they're temporary. Sooner or later, you'll need to re-whiten. The foods we eat, the natural effects of aging, genetics, and the likelihood of dental conditions combine to make teeth whitening necessary from time to time.

The least invasive method to maintaining a white smile is through teeth bleaching and proper dental hygiene. Because it is the least least invasive method, we recommend teeth bleaching over any other cosmetic procedure for maintaining white teeth. However, there are instances where teeth bleaching may not be effective in whitening to the patient's desired level. Those suffering from tetracycline stained teeth or other dental conditions might need a more invasive cosmetic dentistry procedure to obtain a whiter smile. There are also those who may want to achieve a whiteness level that is greater than what is achievable through traditional teeth bleaching. Or, perhaps you may have other smile aesthetic concerns you'd like to address.

The field of cosmetic dentistry encompasses professional teeth whitening - but there are many other options available to you for achieving a permanent white smile, from a full smile makeover to veneers and other types of restorations.

Which brings us to an important point; cosmetic dentistry is serious dentistry. Make sure you speak with your dentist about ALL options available to you; and look for the least invasive way to achieve your goals. Everyone wants a great smile - but there's only one healthy way to reach your goal; working with the best dental cosmetic professionals and setting clear and reasonable expectations. A word of caution though. Before you even consider a more invasive cosmetic dentistry procedure to achieve a whiter smile, please ensure you've considered the following options first.

  • Check with your dentist about other professional teeth whitening methods first. For instance, if you've only tried over-the-counter teeth whitening methods, definately visit a cosmetic dentist to discuss professional-grade teeth whitening. The results can be night and day to an over-the-counter procedure! If you were using an over-the-counter teeth bleaching product, there are many reasons why it may not have worked: Was it an expired product? Was the hydrogen peroxide percentage too low? Was it purchased from a reputable brand? Does it even have carbamide/hydrogen peroxide in the bleaching gel?

  • There are more aggressive teeth bleaching methods now available through cosmetic dentists. For instance, there are techniques to intrinsically bleach a discolored root-canaled tooth.

  • Even if you suffer from tetracyclined stained teeth or other genetic conditions, there are some newer professional bleaching methods available on the market which can be very effective.

If a whiter smile is simply your goal, we recommend that you consider the below options ONLY if you have exhausted all teeth bleaching options.

This article, like several other new features, includes comments from noted Master Ceramist, Vincent Devaud. As an in-demand professional behind the creation of veneers, restorations and more for celebrities, he's one of the top authorities on smile aesthetics.

Cosmetic Dentistry: Permanent Whitening Techniques and Procedures

So, you've decided you'd like to whiten your teeth permanently? The field of Cosmetic Dentistry offers a variety of procedures and techniques that can augment, reduce or reshape existing dental or oral structures for a more pleasing appearance - and create a permanent white smile.

Working with your dentist, you'll discuss what you'd like to have done, what can be done - and then what combination of dental procedures can be combined to accomplish your goal. Remember to look for the least invasive procedure - which in many circumstances may be veneers. But regardless of the approach you take, be sure to follow these basic steps before committing to permanent teeth whitening through cosmetic dentistry..

  • Find a qualified provider, schedule a consultation, review their work and background.

  • Ask for a detailed treatment scenario, cost estimate and follow-up plan.

  • Secure financial arrangements - many insurance companies DO NOT COVER purely cosmetic dental enhancements.

Cosmetic Dentistry: The Basics

There are five basic kinds of dental modifications that can help to create a permanent white smile:

ADDITION: These techniques add or apply dental material to teeth or gums to change their appearance- examples: porcelain veneers/laminates, bonding/shaping, crowns, caps, bridges, gum grafts. Some of these techniques are used with teeth whitening - and do not affect the teeth themselves.

REDUCTION: Reduction means taking away either tooth or gum tissue or the removal of tooth structure or gums - examples: enameloplasty, gingivectomy

COSMETIC: neither adding nor removing dental materials, tooth structure, or gums - examples: chairside teeth whitening with lights, lasers or without.

ORTHODONTIC: straightening of teeth accompanied by improvement in appearance of face.

WHOLE FACE RECONSTRUCTION or FULL SMILE MAKEOVER: combinations of any of the above procedures

For the purposes of our article, we'll assume you already know the top resource for detailed information on regular teeth whitening, Also, since orthodontia is a full specialty in its own right, we'll only refer to it in conjunction with Whole Mouth Reconstruction or a Full Smile Makeover.

The Addition Techniques

Addition techniques and procedures add material to existing dental structures to improve shapes, correct defects and improve overall aesthetics - including a permanent white smile. They include: dental veneers, indirect fillings, inlays and onlays, bonding, and more (commonly referred to as restorations, caps, crowns, bridges, fillings et al.). Addition techniques might allow you to achieve a "whiteness" that is brighter than your natural tooth color by either reducing transparency or adding a brighter pigment. We recommend you aim for natural "white" that does not look unrealistic in hue. As a rule of thumb, you shouldn't go whiter than the whites in your eyes.

Dental Veneers for Whiter Teeth

They are ultra-thin, tooth-shaped sculptures that are bonded to the surface of a tooth. In addition to permanent teeth whitening, they can cover chips, gaps and cracks or, working side-by-side, change the appearance of the upper or lower arch of your smile. Additionally, they're an option for closing gaps or disguising discolored teeth that don't respond well to temporary whitening procedures. Veneers are also considered the least invasive permanent white smile techniques; little natural tooth structure is harmed.

Dental Veneers Consultation and Preparation: If you're considering veneers, you'll first need to consult with your dentist.

After making an appointment, you'll discuss your expectations, budget and time-frame with your dentist and he or she will respond with some ideas and suggestions, and, hopefully, photographs of some of their successful procedures. Then, your dentist and his team will take measurements and pictures of your face from many angles, conduct an examination and take a set of X-rays. you'll discuss your whitening choices - how white do you want your teeth to be - and also - what coloration would best suit your face.

Your dentist will also make a mold of your mouth, documenting the shape of each individual tooth, your bite and your arch dimension. "If you are looking for a serious aesthetic change and your dentist fails to take pictures of your face or a cast of your mouth, ask why. These are important steps in creating a smile that looks like you," says Vincent Devaud.

Because creating permanent white teeth involves surgery in many instances, your dental professional needs a complete workup of your gums, teeth, bone and surrounding facial structure. Make sure you ask questions throughout the consultation - and find out who will be working with you if other professionals are necessary, i.e., specialists like a periodontist, or oral surgeon, a dental lab, or in some select instances, a Master Ceramist.

Dental Veneers Process: It takes a minimum of 6 weeks to receive veneers, including the initial consultation, fitting, a preparation appointment where your teeth are ground to accept the new overlays and a final session.

DENTAL CERAMIST'S TIP: "Make sure you ask your dentist about the possibility of using feldspathic porcelain veneers, these generally give a more natural look than pressed porcelain veneers"

After you have your "fitting," your new veneers will be created at the laboratory. Depending on the nature of your makeover, your veneers may be made of porcelain, or a standard composite, or, if you are using a high-end lab, a material may be custom-blended to meet your specifications for shade, translucency and luminosity*; coloration is created at this stage as well.

In the past, tooth restorations were made of gold, amalgam and other metals-some of which were veneered with porcelain. Now, dental work can be made entirely of porcelain or composite materials that more closely mimic the appearance of natural tooth structure. These tooth-colored materials are bonded to your teeth with resin adhesives. Cosmetic dentistry has evolved to cover many new procedures and new dental materials are constantly introduced.

"Good veneers do not look like "candy" - light passes through them and bounces off them, like naturally beautiful teeth," says Vincent Devaud.

When your veneers are ready at the laboratory, they will be applied at your dentist's office, after first, shaping your natural teeth to accept the veneers. You will likely be given a standard dental anesthesia. Under some circumstances, your dentist may offer you "temporaries" before your regular veneers are applied. This is rare.

Dental Veneers Maintenance: On a day-to-day basis, you will take care of your permanent white teeth the same way you would take of your original teeth. But because you won't need to bleach, your dentist may occasionally need to polish your veneers with a special material designed for use on porcelain.

Dental Veneers Cost: Composite veneers cost per tooth ranges between $250 and $1,500. Porcelain veneers (recommended) cost per tooth ranges between $925 and $2,500.

Aesthetic Crowns and Bridges

These techniques are typically used for restoring a tooth to its unblemished state, either from decay, wear and tear or accidental damage. Typically, the "replacement" teeth or fillings (as in inlays) are crafted in a laboratory - where it is possible to create a whiter tooth. If the damaged teeth are visually prominent, a Master Ceramist may be called in to sculpt the tooth's surface. Restorations, inlays and onlays are fitted and placed in the dentist's office. If the goal is a permanently whiter smile, restorations will typically be made in conjunction with teeth whitening from your dentist. You won't have a permanent white smile, but you will have a foundation of whiter teeth. Crowns, caps and bridges are so precise, in fact, that you may choose to whiten a single tooth (if it's damaged, dead or discolored) to match the rest of your teeth.

Consultation and Preparation for Crowns & Bridges: If you require some kind of new tooth structure, need to stablize a decaying tooth, or have enough visible damage to an existing tooth or set of teeth, it's usually obvious that you'll have to see a dentist. But sometimes, these typical dental issues have aesthetic repercussions - especially when part of a larger smile enhancement process.
At your consultation, you may discuss treatment options, or, if the solution is obvious, your dentist may choose to take measurements, x-rays, pictures and casts at that first meeting. Make sure you're informed about the scope of the project, the cost of the project and the mainteinance and care of your teeth following completion. If an augmentation technique is being used as part of a larger smile makeover plan, make sure you understand it's place and importance in the process.

Process for Crowns & Bridges: It can take from 1 to 6 weeks to complete crown or bridge, depending on it's complexity. Anesthetic is usually required. The process for dental restorations is the same for each technique:

  • 1. Take measurements, match colors

  • 2. Create the restoration in a lab (or in some cases a mock-up of the restoration)

  • 3. Fit the restoration to the patient. Remove and refine if necessary. If necessary, you may receive a temporary restoration until the permanent one is completed.
    Fit the finished restoration and secure it.

"The key to making restorations part of a permanent whiten smile is to make sure you whiten your non-restored teeth 3 weeks prior to your procedure. That way, the teeth can be matched to a whiter shade. After whitening, you need 3 weeks for teeth to stabilize - dehydration can make teeth seem darker." Vincent Devaud.

What's What In Dental Restorations?

Onlays: Onlays are like fillings, they serve to fill a cavity in the tooth, except they come up to the top of the tooth and cover the edges, to further secure it in place - this is used when a tooth needs additional structural integrity to stand on its own. They are color-matched to surrounding teeth.

Crowns: Crowns are like onlays or veneers except they cover the entire tooth. They're used when there is less structural integrity left to the tooth, but it is still alive and functioning at the root level.

Bridges: Bridges are clusters of crowns that are used to replace two or more damaged teeth.
Each or all of these techniques can be part of cosmetic dentistry, depending on how they are used, how visible they are and how they work with a variety of other cosmetic techniques.

Maintenance: You'll maintain restored teeth just as you would normal teeth. If there are special circumstances, or the need for more frequent dental visits, your dentist will inform you as part of a follow-up plan. You'll also probably need to see your dentist for periodic cleaning and polishing. The hygienist will use a special polish designed specifically for porcelain - helping to restore it's lustre and bring out its whiter color.

Costs: It's impossible to give you a meaningful snapshot of the costs related to various dental restorations; check in your local area, on Yelp and with friends. Some common sense here comes in handy; single-tooth inlays will cost less than multi-tooth solutions. Board-certified and peer-group accredited specialists are likely to be more expensive than the mini-mall dentist. Do your homework before you let anyone in your mouth.

Bonding and Shaping Techniques for Whiter Teeth

Once, bonding was considered merely a way of securing one dental surface to another, but with the invention of new bonding materials that are stronger, more flexible and longer-lasting, its usefulness has exploded. The technique of working with a bonding liquid/material can now be used to correct discolorations in a smile to ensure even whiteness as well as close gaps between teeth, lengthen teeth and re-contour the entire mouth rather than using crowns. Composite can work great for those with chipped, broken, or discolored teeth.

Dental Bonding Consultation and Preparation: Most bonding procedures take place in a single session; many corrections do not require an anesthetic. Your dentist may wish a preliminary consultation to have time to identify the proper bonding product to match your teeth and solve your problem. However, that's the exception, rather than the rule.

"Whenever you are having an aesthetic change made, you are trusting the "eye" or the visual sense of your care provider. Always make sure you like their reviewing pictures of their other patients! And again, whiten 3 weeks before the procedure so your bonding can match a whiter shade." says Vincent Devaud.

Dental Bonding Process: A dental composite material is first selected to most closely match the texture, luminosity and color of the whitened tooth. The composite is applied into the cavity or onto the surface of a tooth - wherever the observable defect lies - where it is then sculpted into shape, contoured and hardened with a high-intensity light. In most instances, anesthesia is not
The restoration should blend invisibly with the rest of your natural teeth to create a healthy, bright smile.

Dental Bonding Maintenance: Care for your bonded teeth as you would your normal teeth.

Dental Bonding Costs: Costs generally run from $100 to $400 a tooth.

Disadvantages: The material used in dental bonding is not as strong as your real teeth, so biting on fingernails or chewing on pens can actually chip the material. Bonding only lasts a few years before it needs to be repaired and is not as strong as crowns, veneers, or fillings. It is also not as stain resistant as crowns.

Aesthetic Dental Implants

One of the most critical aesthetic additions to healthy, young-looking smile can be the use of dental implants - or, in regular language - replacing missing teeth from the root level. Losing an entire tooth from the root level can play havoc with facial features, often creating a visible "shrunken" appearance that makes one look older.

However, the dental implant procedure is a complicated one and must be performed by an oral surgeon, who is usually referred by your dentist. In essence, the surgeon will remove any existing tooth structure before drilling into the bone that supports the tooth and inserting the physical "implant." After a set period of time (from days to weeks) the bone will begin to grow onto the implant thereby securing it within the mouth. After the implant is secure, your dentist will place a crown on the tooth. Some newer procedures complete the implantation process - from implantation itself to the placement of the crown - in a single day; but this is not yet a widely-performed procedure.

Implants Consultation and Preparation: If you are missing teeth, or have teeth that are so structurally unsound at the root level that it would be preferable to replace them, your dentist will let you know and recommend an oral surgeon who will perform the work. At the time of your consultation, your dentist will decide how to proceed with your implant: allowing time to clear the tooth root, place the implant, allow for bone growth and add a crown to finish.

Dental Implants Process: There is an initial consultation with your dentist, at which pictures, casts, measurements and x-rays are taken. At this point, a discussion of teeth whitening will take place - and when (or if) it should take place. This information will be shared with your oral surgeon prior to the day of your surgery. There are four basic steps to the process:

  • 1. Clearing the extraction site - this may happen at your dentist's office when they pull the original tooth, or it may happen in surgery.

  • Once the extraction site is cleared, a titanium rod (the dental implant) is inserted into the bone that supported the original tooth.

  • Typically, time is given for the bone to graft to the implant to secure the rod in place.

  • After the implant is secure, a crown is placed at the tooth level, restoring both the tooth and the underlying structure as if there were never any damage at all.

As stated above, the entire process can either be compressed into one day, a few days, or it can take up to 4 or 5 weeks, giving the dental implant time to become secured within the mouth. The treatment process for your situation will depend on your dentist, your oral surgeon, your budget and your individual oral health evaluation.

Dental Implants Maintenance: There will be follow-ups with a dental implant; all procedures are not successful. Your dentist will provide you with a treatment plan and it is critical that you follow it. Implants are successful 75% of the time.

Dental Implants Costs: Dental implants are quite expensive - starting at around $4500 and running all the way up to $10,000 if special techniques are necessary..

Gingival Graft Procedures

If you have suffered from periodontal disease or were born with an especially high tooth-line (you show too much teeth), or you do not show enough teeth (low gum line), you and your dentist may wish to consider a "gingival graft." In this procedure, gum tissue is added where the gum line meets the tooth to foreshorten the appearance of the tooth itself.

Dental Implants Consultation and Preparation: If it's determined that a gingival graft would improve your looks, your dentist may perform the procedure if he or she has received proper training. A periodontist may be required if your dentist doesn't perform the procedure. You'll discuss this with your dentist before any treatment planning begins.

Dental Implants Process: A small amount of gum material will be removed from a selected area in your mouth and then applied to the gum/tooth area in question. It is stitched into place. Both the removal area and the surgical area should heal without incident, the mouth is one of the fastest and most reponsive organs in the body.

Dental Implants Maintenance: This is typically an in-office procedure, so you'll go home the same day. No flossing or brushing the affected area. Stick to soft foods for a week or so, but you should be back to normal in about two weeks.

Dental Implants Costs: $600 to $1000 per tooth.

Full-Mouth Reconstruction or Full Smile Makeover for Whiter Teeth

This is the big time in cosmetic dentistry; where several procedures are combined to create an entirely new functionality and/or aesthetic for a smile. It is costly, time-consuming and, depending on the severity of the problem, sometimes the best possible option for correcting dental damage or aesthetic abnormalities.

"A complete smile makeover is a team effort," says Vincent Devaud, "you'll want to know about all of the specialtists - and feel certain that you and your lead dentist are in agreement about expectations. Also, be critical about the initial presentation of the proposed changes - make sure you ask questions and are happy with the smile before work begins."

Process: After consultation and the treatment of any immediate, pain-causing dental issues, your dentist will perform a complete examination and take all necessary measurements, pictures, casts etc. Then your dentist will work with his laboratory (or someone like Vincent Devaud) and create a "wax-up" or likeness of how you will look in your new smile and how that smile will look itself. It is likely that if any teeth whitening is to be done, it will be done at this point, while there is still time to select a shade for the final restorations or augmentations.

Then the work begins: removing teeth, performing any restoration, augmentation or reduction that can be used with existing teeth. A second "wax-up" is then created to be used as temporaries before final specifications are sent to the laboratory for creation.

Finally, the lab will deliver whatever final dental components are necessary: crowns, veneers, bridges etc. Your dentist will schedule various try-in appointments depending on the specific nature of the case. When you and your dentist are happy, he or she will place the finished restorations, veneers or other items.

Maintenance: Taking care of your new smile will depend largely on the combination of techniques used to rebuild your mouth. You should receive a comprehensive follow-up plan from your dental team.

Costs: Full-mouth reconstruction or full smile makeovers start at around $25,000.


The desire to have a healthy white smile is universal and lies behind a billion-dollar international business. But the "how" to goal about achieving that goal is completely personal. From over-the-counter whitening methods, to new professional whitening technologies that whiten even the most difficult genetic or tetracycline stains, to veneers, crowns, or even full smile makeovers, the smile of your dreams is within your grasp.

Your decision to opt for cosmetic dentistry is a serious one, but can yield years of satisfaction, self-esteem and confidence. Just make sure you heed our suggestions: carefully selecting a dentist, choosing the least invasive technique and following up with periodic care. The results can leave your smiling for a very long time.

Reviewed by Master Ceramist, Vincent Devaud
Since 1989, Vincent has owned & operated a high-end aesthetic-oriented laboratory, as well as an in-house patient clinic & teaching center. Vincent is a well-known enhanced smile celebrity expert in the dental field & is considered a pioneer in dynamic natural smile solutions.

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