A patient has broken a tooth or has a cavity. The dentist may place a silver/mercury filling in a tooth to patch the broken or diseased part of the tooth. These fillings turn black over time, permit the seepage of saliva underneath or around the filling over time and ultimately may weaken the remaining natural tooth. Sometimes a gold or porcelain with metal crown is used to repair and strengthen the broken or diseased tooth. Classical dentistry repairs front teeth with porcelain to metal crowns that often show black lines around the gum area of the tooth. These crowns also frequently cause the gum tissue to recede or become inflamed because some people have sensitivity to the metal which contains little or no gold or noble metal. Front teeth are often repaired with white resin so that the injury or decayed part of the tooth is repaired. Classical dentistry makes little or no effort to make the repair invisible and often the filling shows an outline of the injured or decayed area.
Esthetic Dentistry, like Classical Dentistry, involves the repair of missing, broken or decayed teeth. However, the dentist performs the needed dentistry while making every effort to conceal the repairs so that the procedures and the materials used match the tooth or adjacent teeth as completely as the manufacturers of the materials, the skill and talent of the dentist, and the talent of the laboratory ceramicists can make them.
Most dentistry performed in the United States is really Esthetic Dentistry as the teeth have a problem and need to be repaired. Most of the time when patients refer to "Cosmetic Dentistry" they are really referring to "Esthetic Dentistry".
Esthetic dentistry does not involve the use of silver/mercury fillings or gold for crowns when repairing a tooth or teeth. Many times the dentist will not even use porcelain with any metals when crowns are needed. This area of dentistry repairs teeth with completely metal free fillings, onlays or crowns preferring to make extensive use of direct resins for "filling teeth", or laboratory processed resins or porcelains when a tooth requires a more extensive repair with an onlay or a crown. The newest materials used (for the back of the mouth) for crowns are made of zirconium with porcelain on the outside. Zirconium is an extremely strong material that is almost equal in strength to metals. Almost all of the replacement of old or existing dentistry or dental treatment that involves worn or short teeth is considered Esthetic Dentistry in that there is some problem with a tooth or teeth that is expected to be fixed.
It is my belief that when dentistry performs excellent treatment in the areas of periodontics, orthodontics, endodontics, restorative dentistry, implant dentistry along with laboratory creativity and excellence, then the sum of all of the treatment is esthetic dentistry.
This area of dentistry does not deal with broken or diseased teeth but rather attempts to make relatively healthy teeth look better. Very, very little dental treatment is truly cosmetic in nature as most adults over the age of 35 have problem teeth that require a repair. When a person thinks that generally healthy teeth can be made perfect or more beautiful then this is Cosmetic Dentistry. Examples of problems that a patient may not like but in which the teeth are healthy are:
Cosmetic Dentistry is almost entirely metal free even in the back of the mouth and makes extensive use of bonded porcelains or bonded laboratory processed resin onlays. Fillings that are placed in front teeth use almost perfectly matched shades of resins (in many cases 4-9 different shades) and they are almost completely invisible to the naked eye.
There are some dentists who do not believe that cosmetic dentistry has any place in the profession of dentistry as the teeth are healthy and no pathology exists. Most dentists disagree with that position and believe that it is the patients right to improve the appearance of their mouths.