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As we grow older, the subtle changes to the structures of our faces begin gradually and then pick up speed after about 40.  Our chins move back, our jaws recede and our cheeks hollow out and wrinkles appear.  Depressed yet?  Not a chance! There is a new world of cosmetic dentistry out there and we would like to introduce you to the latest procedures that can make your smile dazzle at every age!  

Several dentists we interviewed on behalf of told us that when teeth are in the right position, they fill out the volume of the face.  

Additionally, when you see more teeth it creates a brighter, more refreshed and youthful appearance.  

Procedures vary widely, from changing a few teeth to a total remake of a person's bite.  Most procedures involve adding length or bulk because teeth tend to shorten from normal use and, in some patients, years of night grinding.  By slightly thickening side teeth for example, dentists can create a wider area over the lip, smoothing wrinkles.  

Typically, cosmetic dentistry involves placing porcelain veneers over existing teeth; however, some dentists use a white-colored bonding material that can be added to teeth to re-sculpt their shape.  Lengthening front teeth is a key component of many procedures.  

According to a 1978 study by scientists at the University of California School of Dentistry, people under the age of 29 show an average of 3.37 millimeters of their upper teeth with lips gently parted in a resting position, compared with less than half a millimeter when they reach their 50s.

There are so many new advancements in cosmetic dentistry today. We interviewed Beverly Hills Cosmetic Dentist, Dr. Kourosh Maddahi, who graduated at the top in his class at UCLA, then received his dental doctorate from USC.  He is well known for his skill and artistry in cosmetic and restorative work and creating "The Hollywood Smile".  

He explained to us that there are three main aspects that affect the youthfulness of a smile: The harmony of the teeth, the color of the teeth and the shape of the teeth.  

He first looks at the harmony of the teeth and then of the face. "No tooth should be longer or shorter than the others, since that attracts unwanted attention to the teeth and distracts from the overall smile" he said.  "Here are the elements of a smile that I evaluate:

•Lip support: if the upper and lower lips are in proper proportion and in the right place.

•The complexion of the skin: the lighter the complexion, the lighter the teeth. If a patient doesn't have a lot of natural contrast, such as in dark skin tone, then the color of the teeth and the complexion come into play.
Otherwise they can look fake and unnatural.  

•Whether a patient uses the following: green tea, coffee, or smokes. If they do, when choosing the color of the veneers, I go a shade to two lighter for the color of their teeth, to compensate for any staining that will occur.  

•How much teeth structure or gums/ gum line shows. Too much gum showing detracts from the beauty of the smile and the person.

•Relationship of the upper teeth to the lower teeth. Overbites and underbites create challenges as to the degree of improvement possible.

•If they have red hair, real or fake: I need to go one-two shades lighter on their teeth or grayness is reflected because of the red hair.

•If the shape of the upper teeth follows the curvature of the lower lip when they smile. That's how I know if someone's teeth are too long. I must see if there is proper curvature.

•The actual arch of the upper and lower teeth. You should have a nice arch form from the back to the front to form a nice smile. This determines the thickness of the veneers/crowns. If you see a black hole when people smile at the back of the teeth, then I would need to compensate by making the outer side of their molars thicker to broaden the appearance of their arch."  

Dr. Maddahi points out that a great cosmetic dentist must be able to see the end result when he/she examines someone's mouth.  "That's what separates good from great...seeing the end result even before you begin any work" he said.  "Then I work backwards from the end result I envision to the existing smile. Otherwise you are exploring, then things can come up that you don't expect, rather than pre-planning so there are no surprises.

The discovery of additional decay or fractures or other unexpected problems is correctable because they can be reworked and covered. The most important consideration is how the teeth will be covered to achieve the desired result. "I see the end result first in my head first, and then nothing can interfere with reaching the right goal for my patient," Dr. Maddahi said.  

We asked him why many restored teeth look a bit faux and unrealistic.  He explained that the some teeth look fake after a procedure because either they are too long or too thick. Not because they are too white.  

"In the past ten years, the white that we used to think was good has been replaced with a much whiter white." he said.  "This has been driven by the entertainment industry. These newer shades of white did not exist ten years ago. Studios are demanding good teeth now on their actors. This is a relatively new thing that started about five to seven years ago. Up until about 5 years ago, patients were satisfied with whiter teeth. Now patients know the limitations of whitening. Today my patients ask for "That Hollywood Smile" because they are more educated through online research and know there are more options."

We concluded our interview with Dr. Maddahi by asking him to tell us about all of the new breakthroughs in the world of cosmetic dentistry.  He happily shared the most common procedures he provides in his practice:

1.Whitening is now being done mostly with laser light. Trays are for 20 min touch ups at home, but not used in the dentist's office anymore.  Two weeks of the trays have been replaced by 1-2 hours of laser light tooth whitening in the office.  

2.Re-contouring of the teeth for minimal chips and unevenness is more common now.

3.Porcelain veneers and crowns are used more than tooth bonding. Bonding stains 10 times more than porcelain, and tends to chip and break.  

4.Metal fillings are a thing of the past. They have been replaced with porcelain and smaller fillings with tooth-colored bondings.

5.Gum line restoration is something that wasn't done a few years ago, but is a common practice now.  

6.Replacement of missing teeth with dental implants. This rejuvenates the face and makes it fuller again. Dentures and missing teeth both make the face sink in. With implants a person can have normal facial structure.

7.Straightening some degree of crooked teeth without braces. This is for minimal correction that doesn't change the bite or function of the teeth.    

8.Dr. Maddahi also provides referrals for lip rejuvenation/fillers to complete and balance the total smile.  

No matter what your dental concern, Dr. Maddahi insists that "Everything can be fixed! "Even bone grafting can be done if necessary, by taking bone from the hip or another area of the body to create a tooth," he told us.  His final statement was this, " The good news is that there is no longer any reason, apart from the expense, why a person can't have a beautiful healthy dazzling smile at any age!"

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