Health
Dental makeover

By Katherine Nichols
Advertiser Staff Writer

Ben Vegas is a singer, songwriter and producer who meets 3,000 to 4,000 people each week. By his own admission, his teeth were yellow and crooked, making him self-conscious about his appearance. But that changed when he got porcelain veneers.

Before (left): Singer, songwriter and producer Ben Vegas had dark, crooked teeth before porcelain veneers. After: Using porcelain veneers, Ben's teeth were straightened and his smile brightened. The veneers also improved his biting function. Photo courtesy of Wynn Okuda

A veneer is a thin layer of porcelain bonded to the surface of a natural tooth using the latest adhesive technologies. It can change the size, shape and/or color of a tooth, and is just one of many options in the field known as aesthetic dentistry.

The selection is so varied in price and complexity that dentists who specialize in this area can almost always find a way to improve your smile. A list of the flaws that can be reversed (if you are an appropriate candidate for a particular procedure) include: discoloration, gaps, small or large tooth size, crowded or crooked teeth, dark fillings, missing teeth, short or worn teeth, exposed metal between teeth and gums.

Veneers alone can close spaces, realign teeth without braces in two visits as opposed to two years, lengthen worn teeth and fix "gummy" smiles, in which too much of a person's gum is exposed.

Dr. Dennis Nagata, a dentist in the Liliha area, and Colleen Shibata, his treatment coordinator, said with these alterations, patients' "self-esteem improves dramatically. Their whole personality changes. They dress differently. They cut their hair. They start taking care of themselves."

While veneers have notably improved many smiles, there are a few disadvantages. Teeth must be shaved down in order to accommodate the veneer. The process is expensive. And it's irreversible. Once you get veneers, there is no returning to your original teeth.

Dentists estimate that teeth must be shaved .5 to 1.5 millimeters to prepare for veneers. And though cost varies depending on what needs to be done, veneers run between $850 and $2,000 per tooth. The best labs charge the most. Wynn Okuda, a dentist in Honolulu, said price also depends on the "quality of the whole process and the time the doctor spends on each tooth."

Okuda, for instance, hand-sculpts a three-dimensional rendition ("wax up") so patients can see the outcome before the process begins. His patients then wear temporaries for several weeks so they can see if they want any adjustments, allowing them significant input into the final product.

"The end result is basically a natural work of art," said Okuda. "I don't want my patients walking around having people say, 'Oh, you had your teeth done.'"

Before (left): Josie Vegas said her "gummy" smile affected her self-esteem for more than 30 years. After: Minor gum surgery and porcelain veneers transformed Josie's smile. Photo courtesy of Wynn Okuda

Nagata agreed that one of the primary benefits of veneers is that they "can really mimic nature." So if just the two front teeth need to be fixed, the color and texture can be matched to existing teeth.

Some patients complain about their ability to enunciate the letter "s," but Vegas said her speech improved after a few days.

"You do have trouble talking in the beginning," said Nagata. "But after a while you get used to it."

Veneers have only been in the mainstream market since 1982, so their longevity is still somewhat untested. Okuda said he tells his patients that they can expect veneers to last five to eight years and possibly longer. People who carefully maintain their veneers with good hygiene and two or three checkups a year can expect the most longevity. Nagata says they can last up to 20 years.

Though many people associate cosmetic dentistry with front teeth, most dentists who specialize in this area stress the importance of bite alignment and good health for the entire mouth. Improved appearance is often an added bonus.

Patients can now choose to have all-porcelain bridges, crowns or fillings. With porcelain crowns, the dark line between the gum and tooth disappears. "Light transmits through the tooth just like a natural tooth, eliminating the darkness and greyness by the gum line," said Shibata.

For those who need minor straightening, but don't want to make the dramatic leap to veneers and also don't want to wear fixed, traditional metal braces, several Island orthodontists are experimenting with a new, clear, removable appliance for aligning teeth, made by a company called Invisalign. The orthodontist takes an imprint of the patient's mouth and sends it to a lab in Sunnyvale, Calif. Digital imagery then creates a series of plastic retainers or aligners to move the patient's teeth incrementally.

Dr. Kimi Caswell is one orthodontist in Honolulu who is trying the new method. Though she's pleased with the progress so far, she reserves final judgement because she has not yet had a patient complete the course. Most orthodontists are still "skeptical," she said. Unlike traditional braces, aligners will not alter bite. Something orthodontists do to enhance the possibility of success is choose the patient carefully. "If we pick cases that are too difficult," said Caswell, "we're not going to get good results."

Puaokahaukea Duffield, a therapeutic aide at Kapunahala Elementary School in Kane'ohe, was Caswell's first aligner patient. On a recent visit to Caswell's office, Duffield, 22, picked up her seventh installment of 11 for the lower teeth, and the seventh of nine for the upper (depending on the teeth, some patients may have more than 20 computer-generated plastic aligners). Each installment is worn for two to three weeks at a time. Six months into the process, Duffield said, she has noticed a big difference.

Duffield knows it's working because "when you get a new one, it's a little tight," she said. Caswell estimates that the process will take three to four months longer than traditional braces for similar problems. It's also more expensive, costing $4,500 to $5,000 for the package.

But to Duffield, who got married two months ago and was thrilled that she could quickly remove her "braces" for photographs, the advantages are worth the time and cost and the fact that she struggles with pronouncing the letter "s." She likes having the ability to take the appliances out to eat, brush and floss. The best part? According to Duffield, "nobody knows."

The field of aesthetic dentistry is changing constantly. "It's not just about the teeth," said dentist Jonathan Cross, who recently returned from an advanced porcelain veneer seminar in Las Vegas. "There are a lot of things that go into smile design. It's amazing what can be done nowadays."