“Ethical” and minimal intervention dentistry

With modern dental techniques, dentists can create fantastic, natural looking smiles for patients using a combination of whitening, crowns, bridges and veneers. Some examples of this type of work can be seen on “extreme makeover” type shows such as 10 Years Younger.

However, life changing as these new smiles may be, they do not come without a cost! The cost may be both financial and biological. The financial cost involves the clinical time taken to whiten the teeth, prepare them and eventually fit the high quality restorations. The dentist will charge for his or her time and expertise and that of the laboratory technicians who fabricate the work. There is also cost involved in the short, medium and long term maintenance of the finished restorations. Crowns and veneers may chip or become dislodged and whitening treatments may require a “top up”. The longevity of a porcelain veneer is around 9 years and consideration may be given to renewal if the cosmetic effect has deteriorated after a period of time.

The biological cost is determined by how much tooth structure is removed in order to achieve the desired result. Conventional crowns, veneers and bridges require between 0.5 – 1.5mm of tooth removal to accommodate the necessary thickness for porcelain build up. Where dentine is involved, this tooth removal has a number of potential consequences.

The act of preparing a tooth may damage the nerve, causing subsequent pain or discomfort. This may result in the need for root canal therapy in some cases.

Dental cements bond more strongly to enamel than dentine, so veneer margins sited on dentine may eventually de-bond, requiring repair or replacement of the restoration.

If the margins of crowns or veneers are placed a long way below the gum for aesthetic reasons, the moist environment may eventually lead to cement failure and/or gum inflammation.

There is a longstanding adage among the more enlightened members of the profession, “The best dentistry is no dentistry.” For the reasons mentioned above, this still holds true and minimal intervention for maximum effect is the key.

At our Practice we will always provide the treatment we think is most beneficial in terms of aesthetics, biological and financial cost. A popular approach we use for patients who request ” straight, white teeth ” is the ABB Method. ABB stands for Alignment, Bleaching and Bonding. We can use Inman aligners, Invisalign or Clearstep to move the teeth into the correct or near correct position whilst carrying out simultaneous whitening. When the teeth are in the correct position, composite filling material is applied to the tips of some or all of them to enhance the final appearance. This may be desirable if some teeth are naturally short or worn or rough.

In this way, an ideal smile is created without injections, drilling or long term tooth damage – the Ethical Approach.