Act fast
The sooner you get to stains, the less likely they are to stick. “The tannins and polyphenols in foods such as coffee, tea, marinara sauce and red wine adhere to the surface of your tooth in under an hour,” cautions Jonathan Levine, D.D.S., founder of GoSmile, a dental-products company in New York City. Combined with plaque, which can trap dark pigments and harden into tartar in 8 to 24 hours, stains will become increasingly tougher to tackle over time, so break out the toothbrush as soon as possible after eating culprit foods.

Chew on this
No brush? No biggie. In a pinch, any gum that’s sugar-free (an absolute must for dodging tooth decay) can help keep your pearly whites gleaming. “Both whitening and regular gums work on the same principle—saliva flows over your teeth, flushing away stains,” says Lana Rozenberg, D.D.S., founder of the Dental Day Spa in New York City. Even rinsing with a swig of water or chomping on some crudités does the trick; heavy chewing generates saliva. But make sure you stick with non-sugary options. Sorry, trick-or-treaters, that means caramel chews and nougats don’t count.

Make fluoride your friend
Don’t count on a whitening toothpaste alone to safeguard your smile; it doesn’t have a high enough concentration of peroxide or stay in contact with teeth long enough, according to Debra Glassman, D.D.S., a cosmetic dentist in New York City. Abrasive ingredients like silica or baking soda in whitening pastes gently polish away surface stains caused by foods, but a whitening toothpaste that also contains fluoride is your best bet; it helps strengthen the tooth’s enamel, which is more porous after bleaching. This will also soothe sensitivity and prevent stains and plaque from ruining your smile, Dr. Glassman says.

Brush up on brushing
While most of us probably abide by the twice-a-day mandate, a cursory 30-second cleaning isn’t really cutting it to rid teeth of plaque or bacteria that stain enamel. You actually need to brush for a full two minutes—and cover the entire terrain. “Think of your mouth as divided into quadrants,” Dr. Levine suggests. Then brush each one (upper right, lower right, upper left, lower left) for approximately 30 seconds. But be careful not to overdo it: Scrubbing teeth too vigorously and for too long, especially if you use a hard-bristled brush, can wear away the enamel. Instead, opt for a soft-bristled brush (replace it every three or four months), and keep an eye on the clock. You’ll be able to give all your teeth equal attention, so choppers stay spotless. Now, if only keeping the kitchen clean were this easy.

Composite fillings are made up of a resin that contains tiny pieces of quartz. This can be sized and shaped to imitate the surface of a tooth. The result is very natural looking and many people are electing to replace old metal fillings with composites.

The first step to a composite filling is removing the current filling and any other decay or weakness that may be present. The composite is then molded into shape, adjusted for bite and sealed into place with a bonding material. The procedure takes longer than a standard filling but generally has longer lasting results, as a composite can restore a tooth to near its original integrity.

Composite fillings are very durable and will last for years. They provide comfort while eating and will blend with the other teeth to make a nice, bright smile. Many patients feel more confident after receiving composite fillings and have far fewer problems in the long term than with old style metal fillings, which have a tendency to leak or fall out especially if the tooth is further damaged or just weakens with age.

Any cosmetic dentist can install a composite filling, however, it is in the patient’s best interest to research and choose a dentist that is very experienced and only uses the very best materials. Everyone deserves a healthy, beautiful white smile and composite fillings are a good step toward this goal.

“I love coming to your office. The staff is so friendly and professional. I have referred other with complete confidence.”
     Vicki Wallace 1/14/10

“Your team’s competence is exceeded…service is awesome…Staff are more than friendly and my family thinks of you as family and loves you all dearly! Enjoy the snow!”
     David Hogen12/19/09

“I love the office. It makes you very comfortable. Connie was extremely pleasant and helpful. She is an asset to your team. Dr. McLellan was detailed in explaining the procedure to me.”
     Mark McAndrews 12/21/09

“The people there were very nice and made me feel comfortable. I hadn’t been to the dentist in a couple of years and I was nervous to go but everyone was so nice and explained everything that was going on. I am glad that I decided to come to this practice.”
     Jenna Ware 12/12/09

“All the staff was very professional and informative. They made the experience very comfortable, and nearly enjoyable considering it is a dentist office and that’s saying something. Thank you!”
     Lana Burchert 11/12/09

Scott Finlay DDS & Associates, is a general dental practice in the Annapolis area that handles the comprehensive dental needs of patients from age 2 to 102.  We pride ourselves in customizing your dental experience with your complete health and comfort in mind.  For more information visit www.AnnapolisSmiles.com.

Scott Finlay, DDS

Clinicians have better choices to conserve valuable tooth structure.

Direct resin restorations are often the ultimate challenge for the restorative dentist as a clinician and artisan. The culminating re sult measures the dentist’s abilities in patient management, smile design, and the understanding of the mechanical and physical properties of dental resins. Chairside, the dentist morphs into the laboratory technician. Resins, opaquers, and tints are layered as a ceramic artist would with porcelain. Today, there is no single direct restorative material that fulfills all the prerequisites for a predictable result: function, esthetics, and biocompatibility, but the combination of materials and techniques can produce a beautiful, synergistic result.1

In an environment of responsible esthetics, it is the clinician’s obligation to design predictable, functional, healthy, and durable restorations that conserve as much of the patient’s original tooth structure as possible.2 Historically, the tendency may have been to digress to heavy-handed preparations of the teeth with complete or partial coverage with ceramic materials. Preparation designs were driven by the clinician’s understanding and choice of materials, instead of by an understanding and diagnosis of the functional design of the system being restored and the existing conditions of the surfaces of the teeth that remained. Our antidotal experience has deepened our appreciation in the conservation of tooth structure. Restorations do not last forever, and clinicians need to weigh the consequences of the latent effect of removal of tooth structure.3 Essential to this approach is the preservation of enamel. The quality and quantity of enamel that remains significantly affects the flexural strength of the teeth and the durability and strength of the bond of the restoration.4,5

Contemporary development of ceramics and resins provide the clinician with alternative choices for a conservative design. The choice of materials is often influenced by the clinician’s experience and skill. The scope and magnitude of the case will also mitigate this decision. Admittedly, direct resin restorations can present a laborious, time-consuming effort. With proper case selection, however, direct resins do remain a viable option for a functionally durable and esthetic result.6

Technique Illustration

The application of direct resin for multiple anterior teeth is a valuable exercise in understanding of the nuances of micro and macro elements of smile design. Although this may be an infrequent restorative selection for many clinicians, simply successfully completing this procedure once will greatly enhance the operator’s ability to predictably complete indirect restorations. Appreciating the concepts of stratification and layering of composites will give the operator insight into the effects of layering ceramic materials and their optical effects, and understand how the influence of the contours and surface effects will help to ensure restorations that predictably emulate nature.7,8

A key element for case selection for direct resin restorations can often hinge on the risk assessment for occlusal forces. Forensic evidence of occlusal disease on the existing dentition will help to define the magnitude of this risk. The ability to move a patient to a Dawson Class I or IA occlusal classification will ensure the predictability of a case. A classic indication for this type of restorative solution is a post-orthodontic case that may exist as a Dawson Class II or IIA that can be equilibrated, with proper analysis, to eliminate any interference in closure to centric occlusion, with deterioration of the facial surfaces of the anterior teeth that support the need for restoration.9

Only after a complete examination and the assessment of the biological, structural, and functional elements can a restorative design be initiated. Model analysis and a diagnostic wax-up will help to illuminate the deficiencies in anterior tooth contours that require restoration. The esthetic examination, through a facially generated diagnostic process, will guide the operator through the essential elements of macro and micro esthetic design parameters. In cases where ultra-conservative preparation design is possible, the foundation shade of the remaining dentition will have an influence of the translucency of the layering resins selected in the restoration. Dental whitening provides an excellent technique to alter this underlying tooth shade, before restoration.10

The selection of resins can then be completed, based on the tooth structure that we are trying to replicate. Dentin is an amorphic layer of the tooth with significantly different optical properties than enamel. Enamel is an essentially transparent crystalline structure that acts as an optical filter over the dentin. With stratification layering of resins, our concept is to use materials that have similar optical properties for each of those layers that we are replacing.11-13 It is important when choosing the appropriate layering resins to do so before preparation. Dehydration of the tooth structure will greatly impact the perceived shade of a tooth. This is best accomplished by creating a custom shade tab, with layers of the anticipated resin in the thicknesses that seem appropriate. Evaluating the cured appearance of the custom shade tab adjacent to the naturally hydrated teeth with which the operator is attempting to harmonize will help ensure the most natural result. Once this shade formulation is discovered, it is critical for the operator to have confidence in it and trust it. The tendency is, during the clinical layering of resin, to begin to modify that formulation based on the appearance at the time of application, which is a visually inaccurate reference to the teeth relative to their naturally hydrated state.14,15

Preparation design is dictated by the inadequacies of the current tooth structure relative to contour, discolorations, and composition. Preparation depths of 0.3 mm to 0.5 mm may be considered reasonable, but may include areas of no preparation because of deficiencies in tooth contour, or more preparation due to previously existing restorations, discoloration, or excessive tooth contour. Resins can then be layered and contoured as desired.16

Contouring, finishing, and polishing resin restorations can often be the greatest challenge. After tremendous effort in design, preparation, and application of the resin, the result can fall short by the elimination of critical line angles, morphology, and surface texture through over-polishing. With patience and experience, this can be accomplished to create a beautifully natural result that harmonizes with the balance of the dentition. One technique to visualize this process is through the use of diagnostic models and photographs. After the initial application of material and contouring, it is often beneficial to stop, take impressions, photograph the case, and reschedule the patient for additional detailing. Operator fatigue often leads to a loss of perspective and a less than optimal result.17-19

Analysis of diagnostic models and photographs give the operator an excellent fresh perspective on the elements of the case that need additional detailing. Observation of line angles, facial embrasures, and surface contours can be better visualized. The operator can then create a specific list of items to be detailed that can then be carried to the operatory at the patient’s next visit to be more effective and efficient in detailing and polishing.

Material Selection

Beyond the obvious parameters of shade and opacity that mimic natural tooth structure, the desired key properties for composite resin materials are strength and the ability to create a sustainable surface luster. In the past, these properties could only be met with a combination of two families of resin materials: hybrids and microfills.20 Hybrids offered the strength and wear characteristics that were required for durability and microfills offered the glass-like luster and translucency needed to mimic the enamel layer. The advance of resin science has launched the development of nano-hybrid composite materials that, through the management of particle size and composition, has given the profession a universal material that can meet functional and esthetic requirements.21-23

IPS Empress® Direct (Ivoclar Vivadent) is a nano-hybrid composite that meets these criteria of functional strength and esthetics. It is a light-cured, radiopaque composite, and is offered in 32 different shades and five different degrees of translucency. The interesting property of this material is the luster of surface finish that previously was difficult to obtain and maintain with traditional hybrid restorations. IPS Empress direct also offers the simplicity of stratification by replacement of tooth layers with a resin that mimics those substrates’ physical and optical properties.24 Figures 1 View Figure, 2 View Figure, 3 View Figure, 4 View Figure, 5 View Figure, 6 View Figure, 7 View Figure, 8 View Figure, 9 View Figure show the excellent results that can be achieved.

Conclusion

In an age of responsible esthetics, the onus is placed on the operator to provide a restorative solution that not only meets the functional and esthetic goals of the patient, but with a design that conserves tooth structure. Direct resin veneers can be a very conservative treatment modality to enhance the smile and restore the confidence of our patients. The frequency with which a dentist may perform these restorations may be limited in many cases, but the insight gleaned is valuable in broader modalities of both direct and indirect restorations. The advent of nano-hybrid composites provides a universal material that will meet treatment requirements in many cases. IPS Empress Direct is a unique system that possesses that attributes of strength, shade compatibility, and finish luster that was not as easily achieved in the past. With the understanding of occlusal concepts and material selection, a predictable result and a happy patient is a validating experience for the dentist.

References

1. Ardu S, Krejci I. Biomimetic direct composite stratification technique for the restoration of anterior teeth. Quintessence Int. 2006; 37(3):167-174.

2. Peters MC, McLean ME. Minimally invasive operative care. II. Contemporary techniques and materials: an overview. J Adhes Dent. 2001;3(1):17-31.

3. Downer MC, Azli NA, Bedi R, et al. How long do routine dental restorations last? A systematic review. Br Dent J. 1999;187(8):432-439.

4. Milicich G, Rainey JT. Clinical presentations of stress distribution in teeth and the significance in operative dentistry. Pract Periodontics Aesthet Dent. 2000;12(7):695-700.

5. Reeh ES, Douglas WH, Messer HH. Stiffness of endodontically treated teeth related to restoration technique. J Dent Res. 1989;68:1540-1544.

6.LeSage BP. Aesthetic anterior composite restorations: a guide to direct placement. Dent Clin North Am. 2007;51(2):359-378.

7. Peyton JH. Direct restoration of anterior teeth: review of the clinical technique and case presentation. Pract Proced Aesthet Dent. 2002;14(3):203-210.

8. Marus R. Treatment planning and smile design using composite resin. Pract Proced Aesthet Dent. 2006;18(4):235-241.

9. Dawson P. Functional Occlusion: From TMJ to Smile Design. Mosby: 2007;104-111.

10.Denehy GE. A direct approach to restore anterior teeth. Am J Dent. 2000;13(Spec No):55D-59D.

11. Blank JT. Simplified techniques for the placement of stratified polychromatic anterior and posterior direct composite restorations. Compend Contin Educ Dent. 2003;24(2 Suppl):19-25.

12. Dietschi D, Ardu S, Krejci I. A new shading concept based on natural tooth color applied to direct composite restorations. Quintessence Int. 2006;37(2):91-102.

13. Terry DA, McLaren EA. Stratification: ancient art form applied to restorative dentistry. Dent Today. 2001;20(9):66-71.

14. Terry DA. Color matching with composite resin: a synchronized shade comparison. Pract Proced Aesthet Dent. 2003;15(7):515-512.

15. Terry DA. Dimensions of color: creating high-diffusion layers with composite resin. Compend Contin Educ Dent. 2003;24(2 Suppl):3-13.

16.Terry DA, Geller W. Selection defines design. J Esthet Restor Dent. 2004;16(4):213-226.

17.Jefferies SR. The art and science of abrasive finishing and polishing in restorative dentistry. Dent Clin North Am. 1998;42(4):613-627.

18.Goldstein RE. Finishing of composites and laminates. Dent Clin North Am. 1989;33(2):305-318, 210-219.

19. Barghi N, Lind SD. A guide to polishing direct composite resin restorations. Compend Contin Educ Dent. 2000;21(2):138-144.

20. Pereira CL, Demarco FF, Cenci MS, et al. Flexural strength of composites: influences of polyethylene fiber reinforcement and type of composite. Clin Oral Investig. 2003;7(2):116-119.

21.Drummond JL, Lin L, Al-Turki LA, Hurley RK. Fatigue behaviour of dental composite materials. J Dent. 2009;37(5):321-330.

22. Ilie N, Hickel R. Investigations on mechanical behaviour of dental composites. Clin Oral Investig. 2009;13(4):427-438.

23. Mahmoud SH, El-Embaby AE, AbdAllah AM, Hamama HH. Two-year clinical evaluation of ormocer, nanohybrid and nanofill composite restorative systems in posterior teeth. J Adhes Dent. 2008;10(4):315-322.

24. Antonson DE. Composite resin materials: nano-what? Dent Today. 2009;28(5):124-127.

Scott Finlay DDS, FAGD, AAACD

A smile can be given freely, yet it represents a priceless
asset. The impact that a smile has on how others
perceive us is undeniable. Making the choice to improve
or restore a smile can be a life-changing commitment,
and choosing the right professional to perform the task is
crucial.

“What few people truly appreciate is that the desire for
a beautiful smile is not a superficial pursuit of vanity,” says
Scott Finlay, D.D.S. “Aesthetics is only a reflection of health.
There are very few enhancements to an individual’s smile
that won’t dramatically improve health, dental function
and quality-of-life.”

For more than 23 years, Dr. Finlay has been creating
and enhancing smiles as a leader in the field of cosmetic
dentistry. After earning his dental degree in 1986 from
the University of Maryland/Baltimore College of Dental
Surgery, Dr. Finlay completed an additional year of
intensive postgraduate education at a Washington, D.C.-
area trauma hospital. Since then, he has completed training
programs through the Dawson Academy in St. Petersburg,
Florida, the NYU Dental School in Manhattan, the UCLA
Dental School in Beverly Hills and the Las Vegas Institute
for Advanced Dental Studies.

Dr. Finlay is one of only 300 dentists in the world
Accredited by the American Board of Cosmetic Dentistry
(ABCD), which serves as the gold standard for excellence
in cosmetic dentistry. He is the only Accredited dentist
in the greater Annapolis area. Dr. Finlay currently serves
as an Examiner for the ABCD, acting as a judge and
mentor for cosmetic dentists nationwide. In addition,
he is a senior faculty member for the Dawson Academy,
an internationally renowned post-graduate education
academy for dentists. He is also a recognized Fellow in the
Academy of General Dentistry. Juries of Dr. Finlay’s peers
have repeatedly selected him as the “Top Cosmetic Dentist”
in the Annapolis area. He has been featured on several
television programs as an expert in dental aesthetics,
including Baltimore’s FOX 45 Morning News and the
shows A Better Life and A Bride 2 Be. (Video segments can
be viewed at www.AnnapolisSmiles.com).

Dr. Finlay’s practice in Arnold, Maryland is a state-ofthe-
art cosmetic dental facility offering a comprehensive
list of services to children and adults. The office’s decor
is warm and inviting, and each patient can relax during
his or her treatment by watching a movie or television
show on a 32″ LCD screen. The practice prides itself on
providing five-star service via both its facility and the skills
of a tenured team of caring, passionate dental professionals
committed to exceptional care.

When Dr. Finlay began practicing dentistry, his goal
was to change lives. “My vision was to create a practice
that would offer the latest and most advanced procedures,
a staff of highly skilled professionals, and work with the
highest integrity to ensure that a patient’s best interests
always come first,” he explains.

“Patients often share with me the positive change they’ve
experienced from having a brighter, more attractive smile,”
notes Dr. Finlay. “That thrill feeds my passion for cosmetic
dentistry.”

Scott Finlay, D.D.S
& Associates, PA
1460 Ritchie Highway, Arnold, MD 21012
410-757-6681
www.AnnapolisSmiles.com

Annapolis, Maryland – Local American Academy of Cosmetic Dentistry (AACD) accredited member cosmetic dentist, Dr. Scott Finlay is a volunteer for the AACD Charitable Foundation’s Give Back A Smile (GBAS) program. The program helps heal the effects of domestic violence by providing free consultation and dental treatment to restore the smiles – and the lives – of survivors of domestic violence.

“Through the Give Back A Smile program, AACD members like me assist survivors by treating their dental injuries that were sustained from domestic violence, so that they may reclaim their smiles, their self-esteem and, ultimately, their lives,” said Dr. Finlay of Annapolis, Maryland.

Finding Help through GBAS

• Domestic violence survivors who have suffered dental injuries from abuse from a former intimate partner or spouse can contact GBAS toll-free at: (800) 773-GBAS (4227).
• Survivors must make an appointment with a counselor, domestic violence advocate, social worker or therapist to complete the advocate section of the GBAS application. 
• GBAS conducts the initial review of the application however the dentist has the final say as to the eligibility of the applicant. 
• If eligible, the AACD connects the survivor with a local GBAS volunteer who provides treatment at no charge to the recipient. 

Helping the Community by Helping Individuals
“Because more than five million people are affected by domestic violence every year in the United States, there is clearly a need for a program like Give Back A Smile to help survivors rejuvenate their lives through the caring hands of a local dentist,” Dr. Finlay said.

In July 2001, the AACD was one of only eight organizations in the world to receive the Award of Excellence and the prestigious Associations Advance America Summit Award for its GBAS program. The American Society of Association Executives (ASAE), of Washington, D.C, sponsors this yearly national competition to recognize the charitable organizations that make the most effort to advance American society. To date, Give Back A Smile has restored the smiles of more than 600 domestic violence survivors for a total dollar value of over $5 million.

For complete details about the Give Back A Smile program, visit www.givebackasmile.com or call toll-free: (800) 543-9220. Those interested in finding help with the Give Back A Smile program can also visit the Web site, call the National Hotline: (800) 773-GBAS (4227), or send an e-mail to givebackasmile@aacd.com.   Dr. Scott Finlay is an accredited member of the AACD and more information is available about his practice at www.AnnapolisSmiles.com.