Smile design

What we do at our office

Dr. Tetri does the diagnosis and the planning himself. The options we compare are whitening, Invisalign treatment for teeth that are out of position, direct composite bonding, enamel contouring, gum treatment or reshaping, porcelain veneers, crowns, and the replacement of missing teeth. Veneers and crowns are made with our laboratory. For ceramic work the plan includes a digital design and a trial mock-up in the mouth. Because Dr. Tetri is a periodontist, the gum line is designed with the teeth, not after them. If teeth need moving, see Invisalign under Everyday care.

What happens at the visit

1. We listen first. You tell us what bothers you and what you want to keep.
2. We examine and record: photographs and, where needed, a digital scan, gum measurements, tooth structure, color, alignment, existing dental work and how your teeth meet.
3. We separate the problems. Color, position and missing structure are different problems with different fixes. Whitening changes the color of natural teeth but not of old fillings or crowns; aligners move teeth rather than masking where they are; bonding adds material; a veneer covers the front of a tooth; a crown covers more of it.
4. We compare the options by how much healthy tooth each one costs, whether it can be undone, how long it is likely to last, what it needs to keep it, and what you want.
5. We show you the proposal. Where a mock-up is part of the plan, you see it in your own mouth and on your own face before anything is done. A preview is a conversation tool, not a forecast of the final result.
6. We treat health first, then the smile. Decay, gum disease, cracks and unstable bite problems are handled before elective ceramics. Then we deliver, check the bite and your speech, and set a maintenance plan.

Risks and limits

• Any plan that removes enamel cannot be reversed; we say which teeth, which surfaces and how much before you agree.
• What preparation removes, and what can go wrong with a veneer or crown over the years, is on our veneers page; every ceramic we place needs maintenance.
• A preview does not reproduce how tissue heals, how color behaves after bonding, or how the result feels when you speak.
• Facial and dental proportions are planning references, not a mathematical definition of beauty; your own view of the result belongs in the plan.
• Smile treatment does not treat jaw pain, headaches, sleep problems or facial aging; those have their own diagnoses (see TMJ and bite under Complex care).

Questions patients ask

Can I see the result before you start?

Where the plan includes a digital design and a mock-up, you see the proposed shape and length over your own teeth before anything is done. It is a draft to discuss, not the final result.

Do I need veneers, or will whitening and aligners do?

Often less is enough. If the problem is color, whitening comes first. If it is position, Invisalign treatment moves the teeth instead of covering them. Veneers are the answer when shape, wear or old restorations cannot be fixed more conservatively.

How long does it take?

Whitening: days. Aligners: months, depending on how far the teeth need to move. Veneers: usually three visits over a few weeks, after any gum or orthodontic work has settled.

Will it last?

Natural teeth and restorations both need home care and professional review. Porcelain veneers show good long-term survival in published reviews, with the caveat that follow-up and definitions vary; everything we place needs maintenance.

Related under Complex care: Porcelain veneers · Periodontal care and surgery · TMJ and bite · Full-mouth rehabilitation.

Related: Porcelain veneers · Teeth whitening · Invisalign® clear aligners · What is a dental mock-up? · Cosmetic dentistry

Sources

• ADA MouthHealthy: Veneers
• ADA MouthHealthy: Teeth whitening
• Systematic review: Digital smile design and patient communication
• Systematic review and meta-analysis: Ceramic veneer survival and complications