Digital smile makeovers

- Resolving fluorosis and tetracycline tooth staining with whitening treatments.

These three digital smile makeovers illustrate and describe different ways a dentist can use teeth-whitening treatments to correct, mask or blend in tooth staining caused by fluorosis or tetracycline exposure.

Case #1: Lightening teeth that have tetracycline staining.

Dental history and concerns:

1) For the most part, this person is happy with the overall shape and alignment of their teeth. Their main concern is simply their dark color.

While we don't have a lot of information about this discoloration, its grey tint hints at tetracycline staining.

Treatment solutions:

Approach #1:

Attempting to lighten this smile using teeth-whitening treatments. - It's possible that this case might be treated just by utilizing some type of at-home or in-office tooth-whitening treatments (or a combination of both). This is what we have illustrated in our "after" picture.

a) The results probably won't be perfect. - While the outcome of any type of whitening process can be difficult to predict, it is a fairly simple and relatively inexpensive procedure. It's certainly one that's worth a try.

We'd be the first to say that its results are unlikely to be as cosmetically perfect as if some type of restorations, such as porcelain veneers, were placed. But, as we discuss below, there are advantages of a just-whitening approach and it can help to set the stage for a more life-like veneering outcome if that treatment is needed.

b) The whitening process will require some commitment. - Tetracycline tooth staining has a reputation for being difficult to treat. Being successful usually requires a highly motivated patient (and dentist). An extended number of treatments may be required.

c) Touch-up whitening will be needed. - The original bleaching effect gained can be expected to fade over time. But renewing it (probably just by performing at-home treatments) can be expected to be much easier and cheaper than the initial round of whitening.

Approach #2:

If tooth whitening doesn't produce acceptable results, place veneers. - Placing porcelain veneers could be another way to treat this same case. And when compared to teeth-whitening treatments, it can probably offer the more predictable cosmetic outcome, although at a much greater expense.

The downside to this approach is that no dental work lasts forever. Once veneers have been placed, there will be a time when they need to be replaced. So, even though their end result may be more ideal aesthetically, the time, cost, and maintenance requirements they impose may make the less-perfect solution (teeth whitening) the more attractive alternative.

Lightening the teeth first can improve the outcome of a veneering case. - There can be a benefit to whitening teeth (to whatever degree) before a set of porcelain veneers is placed. In fact, whitening treatments are sometimes used as the initial step of this process. Here's why.

When veneers are used to change the color of teeth (like dark tetracycline staining), they must be opaque enough to mask the color of the stained tooth underneath. However, it's a veneer's translucency that creates its life-like appearance. So, if the starting color of the teeth can be lightened first, at least a little bit, the porcelain veneers that are placed can be relatively less opaque and more translucent, therefore giving a relatively more natural appearance.


Case #2: Another case involving tetracycline tooth staining.

Dental history and concerns:

1) When this person submitted her photo for a digital makeover she said she simply wanted to see what her teeth would look like if they were whiter.

2) From only a picture, it's impossible to know exactly what process has caused her tooth discoloration. Since it appears that she is young, it's unlikely that the staining has just been caused by the exposure to chromogenic agents such as coffee, tea, cola or tobacco products.

It may be, due to genetics, that her tooth enamel is just naturally darker than other people's. It is also possible (and probably most likely) that during the time frame when her teeth were forming that she had an exposure to a compound (such as the antibiotic tetracycline) that resulted in the staining.

Treatment solutions:

1) There's no reason not to try tooth-whitening first. - The hope is that teeth-bleaching treatments (either performed at-home, in her dentist's office, or a combination of both) can lighten her teeth and give her the improvement she desires.

We'll admit that it might be somewhat unrealistic to expect that any process will lighten her teeth quite as much as we've illustrated in our "after" picture.

That's because so much of the success of tooth whitening is dependent on the underlying cause of the staining. And some types (like that caused by tetracycline) can be more difficult to treat than others. After an examination, her dentist could advise her as to what degree of results might be expected.

2) If whitening fails, then place porcelain veneers. - If whitening treatments cannot provide the results that this person wants, then porcelain veneers may have to be considered. This treatment will, however, have a much greater expense.

As mentioned above, the effort and cost associated with the "failed" whitening attempt would not have been wasted. Making a large tooth-color change with porcelain veneers is easier and more predictable, at least in terms of achieving a natural-looking result, if the teeth have been lightened first.

 

Case #3: Using whitening treatments to make the color of teeth with fluorosis more uniform.

Dental history and concerns:

1) The brown and chalky-white blemishes found on this young man's teeth are typical of a type of tooth staining termed fluorosis.

If that is the case here, the staining has been caused by the excessive ingestion of fluoride during that time frame during which his teeth were forming (when this person was just a young child).

Treatment solutions:

1) Teeth-whitening treatments are always worth a try. - By using standard at-home or in-office tooth-whitening treatments (or a combination of both), it might be possible to lighten the color of the unstained portions of this person's teeth to a shade that's similar to the chalky-white fluorosis staining.

The idea is that the white stains still remain but are less obvious because the remainder of the tooth is now whiter. The treatments may also have a lightening effect on the brown staining. But even if it does, it probably won't be to the extent that it will resolve it totally (hence the need for the next step).

The whitening process should be monitored by a dentist and it may need to involve an extended number of treatments. Even then, an outcome as we've described here may not be possible.

2) After the whitening treatments, place dental bonding. - If the bleaching treatments were able to make a substantial improvement with the overall appearance of the fluorosis, then those isolated regions that didn't respond (like the brown areas) could be masked by placing dental bonding.

3) If the whitening results aren't acceptable, porcelain veneers could be placed. - If the whitening treatments really didn't even come close to resolving the fluorosis in a manner that the patient found satisfactory, then placing porcelain veneers could be considered.

 

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