Bonding is a procedure by which restorations are retained to a tooth by micro-mechanical adhesion.  Tooth structure is made porous so a plastic resin can lock onto the surface of the tooth.

• Bonding can be applied to any material.  The most commonly bonded materials are tooth colored resin fillings (composites), and ceramic porcelains.  There are a wide variety of manufacturers and colors for each.  Metals (e.g. gold) can also be bonded.
• Decay and leakage can be identified at its earliest stages as a brown stain at the margin. (fig. 1)
• The marginal seal of the filling is the most important part of bonding.  A good seal keeps bacteria from entering the tooth. (fig. 2)
  

  Figure 1	Figure 2

• Bonding fillings can strengthen a weakened tooth reducing the chance of tooth fracture.
• Amalgams fillings do not do this.  Silver (amalgam /mercury) fillings are not bonded and can allow a tooth to develop fractures. (fig. 3)

Figure 3

Dr. Prus has been involved with dental bonding since before it became available commercially to dentists in the 1980s.  He was involved in developing some of the protocols for bonded porcelain inlays, veneers and crowns.  Because of his clinical and research experience in cosmetic dentistry, he has developed a complete understanding of the techniques that work best for his patients.

While CDE is located conveniently in the Hudson Valley, it teams up with the finest cosmetic dental labs throughout the country to create the ideal smile that suits your style perfectly and naturally, in balance with your facial appearance, and distinctive in its beauty.  A true understanding of the important roles of tooth shape, texture, position, size and color creates the blended harmony that becomes your beautiful smile.  The art of your smile is all in the details.

Untrained Technician	Trained Technician

The outstanding feature of these beautiful restorations is the naturalness of their appearance.  The artistic styling of these esthetic restorations is the result of careful planning, thorough communications with the patient and the ceramist to know exactly what they want and need, and also the lab ceramist's skills, to create that dream by skillfully blending layers of porcelain with light and color, and a lifetime pursuit of health through prevention.  Health makes beauty endure for years.  You will continue to look more youthful and radiant. You will feel happier, healthier, sexier and enjoy the comfort of your beautiful smile for years.

Cosmetic dentistry at CDE starts with health, both for the mouth and your body. With a base of strong healthy teeth and gums, the smile of your dreams can be your smile for a lifetime.

Beautiful, natural teeth may only need cleaning and polishing to radiate your ideal smile.  If your teeth are healthy but discolored, a tooth whitening process, called bleaching, can easily and comfortably brighten you smile, making it more youthful and attractive.  Tooth whitening is fast and cost effective.

Tooth and soft tissue (gum) contouring is simple and fast and, on occasion, may be all that is needed to create balance and harmony in a smile.

More advanced cosmetic dentistry can realign out of position teeth by placing porcelain veneers or crowns over the teeth in a smile makeover to recreate a balanced, straight smile that is both beautiful and healthy.

Teeth can also be realigned without veneers or crowns through orthodontics, which applies porcelain brackets and wires and moving them into balanced position or uses clear positioning trays to guide the teeth into proper positions.  This system is called Invisalign.

Occasionally, an advanced treatment, orthognathics, is used to create a balanced, properly functioning mouth.  Orthognathic dentistry is used when the bones of the mouth are too far out of position to allow for proper redesigning of a smile by any of the preceding techniques, and need to be repositioned to maximize proper function and aesthetics.  At this point standard cosmetic dental procedures can be successfully performed with excellent results.

All these techniques in cosmetic dentistry are available through CDE.

Bonded fillings (composites) are placed directly in or on a tooth by the dentist in one visit.  They are made of a flowable resin base mixed with fine granular quartz or silicate particles to give it structure.

Start   Composite Filling      Finish

• They are relatively easy to place.
• they have many different textures and colors. Some materials wear better than others.  Some materials are more natural looking than others.
• They usually wear faster than porcelain or metal fillings.
• They are relatively inexpensive.
• They are routinely used in minor tooth repair in the front teeth.

Proper shaping of bonded restorations is critical for proper function and durability.

• Contacts between teeth must be kept tight to prevent food from lodging in the gums, which causes inflammation, bone loss, damaging the support structure of the tooth.
• Biting surfaces must be shaped properly so they do not interfere with proper movement of the jaw.

All-Porcelain Restorations are the most aesthetic restorations available in dentistry.  There is a variety of all-porcelain materials

• Totally porcelain with no strengthening core.  These are the most aesthetic and natural looking.  They cannot be used on darkly stained teeth without an opaque base to block the unwanted color.
• Porcelain with a zirconia or alumina core.  The core adds internal strength.  It can also block unwanted tooth color.  They are very aesthetic.

There are four main types of all-porcelain restorations:

• Crowns: Cover the entire tooth
• Inlays: fit into a pre-shaped space cut in a tooth
• Onlays: fit like an inlay plus cover over other parts
• Veneers: replace the front surface of a tooth to change its appearance

All-porcelain restorations are preferred in many cosmetic situations:

• They allow the most light into the tooth, preventing dark margins (seen as a black line near the gums).
• They can be blended to match existing tooth structure and become ‘invisible’.
• They allow for easy detection and repair of decay (initially seen as staining at the margin).

A smile makeover is a more advanced cosmetic dental treatment that can reestablish the harmony of the teeth with your face.  It redesigns the the teeth to harmoniously blend with the various dimensions of facial esthetics.  Subtle and sophisticated applications of dental ceramics can be crafted to elegantly and naturally flow within the symmetry of your face in a seamless blend to create the smile that is perfect for you.  They can also be done in combination with any of the other cosmetic procedures:

• Selective recontouring of tooth shapes
• Bonded in-office tooth colored fillings
• Ceramic restorations: all-ceramic crowns, veneers, inlays and onlays
• Selective soft (gum/gingiva) and hard tissue (bone) contouring for visual balance
• Fixed (crowns, bridges, implants) or removable (dentures) prostheses
• Tooth whitening (bleaching) procedures
• Orthodontics
• Orthognathics

Smile makeovers are best performed as a multi-step process:

• Full oral examination with xrays, photographs and models
• Full discussion of patient’s needs and values
• Plan course of treatment best suited for patient
• Initiate any preliminary cosmetic procedures
• Create diagnostic wax-up of the finished design.
• Prepare the teeth and place temporary restorations based on wax-up design to assess function, form, fit
• Create and place final restorations based on the idealized temporary restorations.

If the teeth are acceptably aesthetic except for being discolored, a tooth whitening process, called bleaching, can easily and comfortably brighten a smile, making it more youthful and attractive.  Tooth whitening is fast, comfortable and cost effective.  Speed of results depends on the strength of solutions and the starting color of your teeth. There are three main levels of whitening:

• In-office: strongest, yielding quickest results (1-1.5 hours).  Teeth must be pre-evaluated to assure comfort and results.
• At home whitening with trays provided by office: less rapid (several weeks or more), but very effective.  Teeth should be pre-evaluated to assure comfort and results.
• Over the counter whitening solutions: it is the weakest and takes longest, but it is also the least expensive alternative.

You can also consider a combination of systems for optimal, long-term results.

Orthodontics (Invisalign or Braces) is a vital component to many esthetic treatment plans.  Orthodontics adds these benefits to cosmetic dentistry

• places the teeth and their supporting structures in visual and functional balance
• allows for more uniform restorations,
• allows for more natural and more cleansable tooth/crown contours
• creates more harmonious gingival contours.

Cosmetic treatment performed after orthodontic care is more beautiful and sustainable.  Uniformly spaced and positioned teeth are easier to keep optimally healthy as well.

The most advanced treatment that is used to create a balanced, properly functioning mouth is orthognathic dentistry.  Orthognathic dentistry is used when the bones of the mouth are too far out of position to allow for proper function of a smile by any of the preceding techniques.  The bones of the maxilla and mandible are repositioned to maximize proper position and function.  Repositioning of the bones is performed by a highly trained oral-maxillofacial surgeon.  At this point standard orthodontic and cosmetic dentistry can be successfully performed with excellent results. 

When orthognathic dentistry is necessary, but not used, it is likely the final cosmetic results will be less appealing.

The use of implants in contemporary cosmetic dentistry is a great step forward in ultimate aesthetic dental care.  Implants allow for replacement of missing teeth in the aesthetic zone without having to resort to removing tooth structure to construct a fixed bridge.

Properly positioned implants, with ceramic crowns placed over them, can perfectly mimic the natural tooth they replaced.

Precision in implant placement is greatly assured with CAD-CAM software programs which essentially eliminate human error. This is a significant benefit for the patient requiring multiple implants.

It sometimes occurs that the soft tissue around the teeth may grow excessively hiding a portion of the crown of the tooth.  Sometimes the bone can have excessive volume around the necks of teeth.  Whenever either of these occurs, selective recontouring can restore the visual balance between the teeth and the hard and soft tissues.  Visual balance is important in esthetic dentistry.

It is also possible that delicate and precise shaping of the contours of selective tooth surfaces can create an ideal aesthetic smile.  In these circumstances reshaping tooth contours is one of the most cost effective means of achieving a more youthful and elegant smile.

Customized home care instructions are probably the most important ingredient in maintaining a beautiful, healthy smile.

Dr. Prus takes great pride in having created a unique process of home care instruction for his patients at CDE.  He carefully advises them on how to maintain their mouths in total health.  Bacteria from the gums travel throughout the body and it is important to keep them from forming and harming other parts of the body.

Once patients have learned the process of effective home care, their gingival tissues are always maintained in excellent health.  The process is easy to understand and easy to do.  Each patient receives instructions that are tailored to their specific dental situation.