How many times have you examined your old metal fillings in the mirror, wondering what can be done to make them look better?  Have you also questioned your dentist about the options he has to offer in this instance?

Your old amalgam fillings  have been placed in your teeth probably a long time ago by your childhood dentist when you were in your early teens.  Some of them are very big indeed, others are still functioning quite good even though they show multiple cracks and abrasions.

At an early age our adult teeth have not yet reached their later strength.  The development of our teeth is such that their final strength requires a long period of mineralization.  Therefore, teenagers’ teeth are more susceptible to fast developing decay.  In other cases the natural development can be disturbed by different diseases or events, leading to insufficient closing of fissures (the deep depressions in our tooth structures).  In particular cases, the absence of fluoridated water during the developmental stage of teeth will contribute to the fragility of their structure facilitating decay and cracking of the superstructure.

The placement of large and sometimes very deep amalgam or metal fillings dating from this early age was never a choice but a strict necessity.  Your dentist had simply no other possibility to repair and save your teeth.  Now, decades later, those not very attractive metal structures look like they do not belong anymore in someone’s mouth; who would like a more attractive and natural aesthetic?

In our practice, several times a week we are inevitably confronted with the justifiable desire of new patients for replacement of the old metal fillings with the new, modern, white, non-metallic materials.  On the other hand and with the same regularity we examine new patients who have already replaced many if not all of their metal fillings with white ones.

From the patient perspective the replacement with the natural color filling material is absolutely desirable and totally justifiable aesthetically.  By simply comparing the before and after pictures side by side the aesthetic improvement is dramatic enough such that replacement is unquestionable.  With closer analysis and critical observation however, some restrictions and limitations for the recommendation of total replacement of old metal fillings with new white ones must be discussed.

When confronting your dentist on your next visit with the replacement question, it would be of eminent importance to analyze together with the dentist the “pros” and “cons” – the advantages and disadvantages of each individual tooth retreatment.

Some simple and basic guidelines when observed can protect your teeth from future disasters.  One of these such limitations would be presented by the size of the old amalgam filling.  If your tooth was initially excavated to a high degree and your old filling represents more than 60% of your original tooth volume – a new filling will definitely be larger – the tooth walls will become much thinner and consequently your tooth will break or crumble under normal chewing pressure.  The new filling will look much better but will not last .  When the tooth splits or cracks, chances are quite high you will lose the tooth altogether; a split tooth cannot be repaired.

Another restriction hint will come from the necessary radiograph picture (x-ray) taken before such treatment.  If your old filling shows a relative extension towards the nerve chamber of your tooth and at the same time secondary decay has been detected – your dentist will need to excavate even deeper towards the nerve to clean the new cavity prior to filling.  This increased proximity to the nerve as well as reduced structural resistance is of course detrimental to the tooth and undesirable.

There are many other circumstances rendering the replacement non-advisable.  The close observation of the old metal fillings and the analysis of the present tooth condition will determine the ideal course of treatment and the alternative if the  metal to white change cannot be made.
The most conservative advice if the old filling is not visible with a large smile or if it still performs without absolute need for replacement would be to avoid the replacement at all – to check and recheck each filling at every three month hygiene appointment and monitor the integrity of each tooth.

If the structural condition of the tooth is becoming a questionable preoccupation, the alternative treatment after the initial repair / replacement, is a regular crown which is the safest, longest lasting and most reasonable alternative.
Talk to your dentist … do not simply demand replacement with white fillings at any cost.  His experience and guidance can save the life of your tooth and secure the proper, long-lasting functionality of the mouth.

If in doubt, a second opinion could also provide you with the professional and experience-based treatment alternatives, meant to offer your teeth the best, least traumatic treatment.

© 2011 All Rights Reserved, Dr Florian Braich DDS PhD

For over two decades, and even longer, the concept of rejuvenation of the face was exclusively considered to be in the hands of the plastic surgeons.  Any person aspiring to improve their physical appearance and shaking off years of the aging process will seek the services of the plastic / aesthetic industry and will be willing to undergo painful injections with all manner of substances such as Botox, Restylane and others.  Even illegally combined administrations have occasionally made waves in the press.

Considering the generally short duration of these improvements and the necessity of re-treatments, the costs and discomfort–or real suffering—of such repetitive applications had to be always taken into close consideration by the patient pursuing rejuvenation.

Other procedures such as epidermal abrasions, acid peels and so on have also been employed and continue their popularity even in these times, supporting the multibillion dollar cosmetic / aesthetic industry.

The desire to look better and feel decades younger is very understandable particularly in our times when, with the help of modern medicine, the expectation of a full life continues to increase.

The film industry, TV and show businesses are a vivid demonstration of the achievements of cosmetic medicine.  Some cosmetic results are spectacular indeed, but very many cases appear as stuffed, expressionless, overstretched and almost unnatural looking facial expressions.

Some plastic surgeons however have discovered the ultimate recipe for predictable success:  the cooperation and co-treatment with the Aesthetic Dentist.

It is an anatomical fact that the soft parts of your face, skin and muscles, the mechanism of your facial expression movements and appearance are supported by the skeletal understructure.  The jaw structure is majorly influenced by your teeth, their interaction and position.

Can your plastic surgeon improve with any procedure a face missing its teeth?  The answer is categorically, No.  Any cosmetic treatment cannot elevate a collapsing bite.  But what about a more common and very widespread case of worn down teeth – present in almost all ages due to grinding of the natural bite.  Your teeth will shorten constantly under wear due to their function.  Your bite, or occlusion, will diminish in time; your facial dimensions will follow suit and aging will become noticeable.  Compare your photos over the last 20 to 30 years; the facial dimension did change quite a bit, right?

The anti-aging principles developed by cosmetic dentistry today can produce permanent and stable rejuvenation and at the same time rehabilitate your dental system.  There are several principles and goals moving together to amazingly rejuvenate your face.  Remember, the positive changes are permanent, medically necessary, and you are not dependant on permanent, expensive and painful re-treatments of injections.  The rejuvenation you desire is only the side effect – the extra bonus – as a result of your dental rehabilitation.

Since antique times, as determined and described by ancient Egyptians, Greeks and Romans, the classical face was divided into three horizontal segments – the upper, median and lower face.  Our lower dimension, between the nose and the chin, is majorly if not solely determined by our teeth. Reducing the height of teeth or losing teeth causes this one third of the facial dimension to substantially decrease; the folds, wrinkles and all aging aspects will follow – the aging process is initiated.

To reverse this aging process – rejuvenating you permanently – your cosmetic dentist will remodel your bite and compensate in just a few weeks for decades of aging.

Another aspect of rejuvenation will be achieved by revitalization of your smile line – the proportional position of your front teeth.  Did you ever wonder how much your front teeth influence the position and support of your lips?  Why use painful injections to inflate your lips and eliminate wrinkles, an ever repeated process, when your front teeth can do the same – permanently and painlessly?

It has been established that by simply whitening your teeth – the color of your porcelain crowns or veneers can be determined by you in discussions with your dentist – can rejuvenate your smile by more than twenty years;  “before and after” photos are clear evidence.

An extra bonus – and possibly the most important one – is the substantial increase of self confidence.
A patient with the reconditioned front teeth will keep smiling and feel at his or her best all the time.
Can skin injections do the same?

As for the financial aspect of dental rejuvenation, the patient must consider some very clear facts:  the dental rejuvenation is just a bonus of a dentally necessary procedure to preserve your health.  A face lift is purely elective and is not a medically imposed treatment.  In many cases the final aesthetic results of a dental rejuvenation will render the additional cosmetic face lift unnecessary.  The majority of such patients will be psychologically rejuvenated to a point of physical happiness when nothing else appears desirable of change and particularly there is no longer any dependence on painful and expensive, short lasting procedures.

And finally, crowns and veneers – the base of your dental rejuvenation – can cost much less than a permanently running non-dental rejuvenation program.  Remember also, some cosmetic dental offices offer the cosmetic consultation at no charge.  This is the time to explore all your aesthetic options and meet your best and timeless decision.

The permanent dental rejuvenation in today’s economic environment poses the question: how far will your investment go?  Consider that the dental rejuvenation will rehabilitate your teeth, prevent dental destruction, treat your gums, elevate your bite and reestablish the facial dimensions from your younger years, spectacularly elevate your smile with a much brighter color, support your lips and cheeks, reduce wrinkles and again, most importantly, a lasting psychological rejuvenation – a grand palette of advantages to consider – is all this cost effective?  Without a doubt, it is.