I n the glamour lifestyle industry, we have an expecta-tion of an exceptionally beautiful, bright, perfectsmile. While there are many beautiful smiles, such asJulia Roberts’ unmistakable grin, nature isn’t always sogenerous. It’s great if you happened to win the genet-

ic lottery and just naturally have the perfect smile. We seeHollywood actors and actresses such as Demi Moore andSheryl Crow change their smiles right before our eyes withsome very natural and stunningly beautiful veneers. Lucki-ly, modern cosmetic dentistry allows anyone willing to in-vest the time and money into their mouths to also have awinning smile.

In my first article, I covered the elements of the perfectsmile. Today I want to take you further. I want to take youbehind the scenes of what a crown (AKA a cap) is, and howthis differs from a veneer. Crowns and veneers are the mainrestorations dentists use to create the perfect smile.

The major difference between a crown and a veneer isthe amount of tooth structure that is covered. Dentistschoose a crown over a veneer for a patient when there isn’tenough tooth structure to use a veneer. Veneers are mostfrequently used for cosmetic purposes only, but in certainsituations, a veneer can also fortify a tooth, as well as makeit look good. A crown is usually “cemented” in place, andsome styles of crowns are also bonded, but veneers are al-ways bonded in place. Bonding vs. cementation generallyresults in a much stronger connection between the restora-tion and the tooth structure.

A crown, or cap, is a dental laboratory-made restorationthat is permanently cemented in place to restore and pro-tect a tooth that has cracked, lost a large amount of naturaltooth structure, or has had root canal treatment. Often-

times a crown is used to restore a tooth when a large fillingfails and there isn’t enough tooth structure left to support anew filling. Crowns are most frequently placed on backteeth, or molars. They can also be placed on front teeth torestore a damaged tooth to make it look brand new.

Crowns are used for both structural and cosmetic rea-sons. In today’s hyper-fit world, we see our bodies aging rel-atively gracefully, however our teeth don’t get the chance toregenerate at all. Once they erupt into the mouth they willremain unchanged until a dentist changes them. In fact,teeth and the cornea (the lens of the eye) are the only partof a human’s body that doesn’t regenerate millions of timesthroughout our lives.

A crown may be made of gold, porcelain, zirconia, or acombination of metal and porcelain (porcelain-fused to-metal or PFM crown). Zirconia is a relatively new materialthat is actually a metal (giving it unsurpassed strength) butin its oxide form exists as a white powder, giving it beauty.When choosing the right material(s) for a crown, your den-tist must consider many factors, such as where in the mouththe crown will be placed, the types of forces the crown mustwithstand, whether or not the patient grinds or clenchestheir teeth, and if the crown will be used to support anoth-er dental device, such as a partial or a denture.

Crowns are prepared by the dentist by removing about amillimeter-and-a-half of tooth structure to allow for roomto cover the entire tooth. An impression is taken and usedby the lab to create a model and restoration. Newer im-pression materials taste better and set faster to make the ex-

By Dr. Joel Gould

your look ● the smile dr

There’s no capping your potential on the stage, runway, or screen, but the right dentalwork can make a huge differencein how you stand out

Putting aCap on it

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Model: Michelle Fleming

PORCELAIN CROWNS VENEERS

perience easy. You can think of a crown as a protective capthat completely surrounds the tooth, protecting it fromdamage, and restoring it to its former strength and beauty.

Veneers are commonly used in dentistry to improve one’ssmile. They can be used to correct misaligned, poorly-shaped and discolored teeth, and can drastically improvesomeone’s smile in only a few visits. Teeth are prepared toreceive the veneers by having anywhere between a half amillimeter, to several millimeters of enamel removed fromthe front and edge of the tooth. How much tooth structureis removed depends on what corrections are being made.This makes room for the porcelain veneer so that the fin-ished product appears natural and not bulky.

Veneers are usually all porcelain. You can think of themin a similar way that imitation acrylic fingernails are bond-ed to your existing fingernails to make them look longer,uniform, ideal, polished and appealing.

Once a veneer is bonded to the tooth, it has about thesame strength as a regular or natural tooth. Well-designedand properly-made veneers look completely natural, andcan last for 25 years or more. Most need to be replaced afterabout 10 or 15 years due to gum recession, decay, or break-age. Aged veneers can easily be removed, and new veneerscan be fabricated to change the smile back to its ideal.

There is no “one size fits all” or one specific technique inthe field of dentistry. Procedures can vary greatly from onedentist to the next. Variables such as what part of the toothand how much of it is removed can make a huge differencein the finished product. Also affecting the outcome is theuse of different porcelains by the lab and the use of differ-ent cements by the dentist. We have seen many changesover the years as dentistry evolves, and the entire veneer ex-perience is best in the hands of an experienced dentist. Ac-tual before and after photos are a great way to see what yourdentist and his dental lab can do, rather than seeing stockor generic photos. This may also give the patient an idea ofthe style of tooth she likes, and how her teeth could look.

Porcelain veneers are bonded to the teeth with a verystrong adhesive. Depending on what outcome we are look-ing for, these adhesives can be tinted with different colorsto try to match surrounding natural teeth. This process isvery tricky, and it can be very difficult to match someone’snatural shade. This is why we almost always do veneers inmultiples and usually include at least the front upper orlower six teeth. This allows a uniform and symmetrical ap-pearance that will look much more natural. When we are

doing an instant pageant makeover and creating the perfectsmile, we usually veneer the top ten teeth. Each case is dif-ferent and unique, and it’s quite common to veneer all theway back to the first molars, again depending on how broadthe smile is, and how far back teeth can be seen.

“Lumineers” are a brand name veneer. They are adver-tised as a reversible (or “no-preparation”) with very little re-moval of tooth structure. Lumineers are only about 0.2mmthick so they can be placed on top of your teeth without theremoval of any enamel or tooth structure, therefore the pro-cedure is reversible but has limited application.

Over the 25 years I have been practicing general andcosmetic dentistry, I have seen and placed many veneers,getting to know and understand how they age, and whenand why they fail. The most common problems I see infailed veneers are deboning while eating, and gum recessionthat exposes the discoloration of the tooth that was previ-ously covered by gum tissue. The “Supermodel Veneer” is anew type of veneer that I created with my dental laborato-ry, and its owner, Dimitriy Tarverdoff CDT of Dimitriy’sDental Studios in Los Angeles. I wanted to create a veneerthat was bulletproof. I also wanted to simplify veneer place-ment, making them more predictable and, most important-ly, longer lasting. This style of veneer is what I use for mostof my larger pageant makeovers.

So to re-CAP (dental pun intended) dentists choosecrowns or veneers, and sometimes both, depending on theindividual needs of the patient. Veneers are made of porce-lain, while crowns can be made from a combination ofmetal and porcelain. Both can be natural and beautiful, butultimately it’s the skill of the dentist, and the ability of thedental laboratory, that makes or breaks how natural cos-metic dentistry can look. �

Dr. Joel Gould has been practicing in Manhattan Beach since 2001.His general and cosmetic dental office treats patients of all ages andoffers a broad range of treatments. Dr. Gould owned several practices inVancouver, Canada for 10 years before moving to the Los Angeles area,and he has trained with several Beverly Hills plastic surgeons in the artand science of Botox and Juvederm. He collaborated with Dimitri’sdental studios to create the “supermodel veneer” which he uses in hisinstant smile makeovers. Dr. Gould recently launched his new conceptcalled “Modern American Dentistry,” a no-nonsense approach to mod-ern dental practice. With three locations, and five dentists, he has creat-ed a dental experience that is consistently comfortable.

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