The laboratory and technical aspects of cosmetic dentistry

By Dr. Thomas Connelly

We know that all dentists are not created equally; we have seen the bad veneer makeovers glowing in the dark (Chiclets^® teeth), and the dental crown smiles with black lines showing through the gums. Did you know that the ceramist with whom we choose to work determines a big part of these dental nightmares? Dentists can use small “boutique”-style ceramists who create each tooth like a sculpture – or they can opt for a veneer from a national chain-type laboratory that spits veneers out of a machine for sometimes 90% less cost!

In 2002, I founded Oral Design Boston, a ceramics laboratory, on Newbury Street in Boston, Mass., with world-renowned ceramist Yasu Kawabe from Japan. From importing rare porcelain vacuumed furnaces from Germany and Hawaii, to testing microscopes and elaborate porcelain combinations, I was involved extensively in developing the technical and laboratory portion of high-end porcelain veneer fabrication. Understanding and managing every step in the process is vital to ensure superb porcelain esthetics when dealing with high-level cosmetic dentistry. Some of the most published cosmetic dentists do not understand the technical aspect of veneer fabrication and proper material specifications. Critical information is frequently omitted in the dental veneering process, simply because dentists have been able to “get by” without truly understanding each and every step.

Truly beautiful veneers are interpreted as beautiful teeth. These veneers are stealth to everyone’s eyes and subconscious. The optical properties of the porcelain are the key. When I write “optical properties,” what I am referring to is the way human eyes perceive light reflecting and passing through the veneers.

Here are facts I must elaborate on and simplify before I continue:

• White is actually the absence of color.
• Something that is white is reflecting light back at the person looking at it.
• Conversely, black absorbs all light and reflects none.
• All colors in between white and black absorb and reflect light in different amounts, giving that object a “color.”
• A ceramic toilet, a piece of Chiclets^® gum, a white piece of paper, and a white sock all reflect, scatter, and absorb light completely differently – yet they are all white.

So when we create porcelain veneers, we want to use porcelain that reflects light in the same manner and degree as human enamel reflects light. We also want the structure of the material (the lattice work, framing, building blocks) of the veneer to be assembled similarly to human enamel. Otherwise, even though a material may be white, as we see above, it doesn’t necessarily mean it will look like a tooth. We have choices when they decide which technician will make our porcelain veneers. We can choose veneers milled by a machine from a block of engineered solid glass Lucite. Or we can choose veneers made by hand, layer after layer, by trained artists out of feldspathic porcelain. There are many laboratories, materials, and technicians out there.Our processWe use hand-stacked, feldspathic porcelain by Jason Kim, Oral Design New York. The type of porcelain powder Jason uses is somewhat of a secret formula. It is believed to be a mixture of Creation porcelain (by Wille Gellar) and old school Ceramco porcelain powder. The mixture and ratio of these powders is a mystery, a formula that Mr. Kim and his closest ceramist apprentices keep as a trade secret!