What are the attributes of a youthful smile?
Dr. Cotca: I think that an enviable smile has to do with the Golden Ratio of proportions, or the rule of proportions that allows for a youthful look. This mathematical proportion is known to be extremely pleasing to the human eye. Of course, everybody’s smile makes it unique—the roundness and the silhouette has to be there.
When you’re reconstructing, you have to have the expert knowledge and understanding of what is a youthful smile and what the ratios are, but also the integration within the actual facial profile of the patient. It’s not just an aesthetic approximation, but rather it’s a very intricate coordination of where the jaw is, what the vertical dimensions ought to be, and then of course, you look at the aging process.
Which celebrities do you think have the most enviable smile?
Dr. Cotca: Amy Grant is one of the celebrities with a coordinated smile, either genetic and/or acquired, which retains a more youthful coordination and ratio. A lot of other celebrities I’ve seen tend to flatten out their smile and make things more even. Having the differentiation between the incisors, not just in terms of front, back and rotation, but also rather the actual dimensions that allow for an aesthetic profile that gives a youthful component to it.
For the majority of celebrities with observed reconstructions, they tend to go in a direction where it’s walking away from that youthful profile. The other celebrity whose smile gives a youthful profile is Julianne Moore. If you look at past photos of her from before she’s had dental work done and more recent photos, some of the profiles between treatments or changes, you can still see the coordination of the front two incisors.
What do you advise patients who’ve worn braces in the past that are still unhappy with their smile?
Dr. Cotca: It think it starts with clarifying and understanding. The blank assumption that any treatment you may have had could have fixed everything without maintenance or additional intervention—that’s misleading. In terms of orthodontics early on, it won’t and it can’t fix everything. Technically it can’t because there’s an aging process, a developmental process, that continues to occur which reaches beyond the teeth themselves, and those systems and variables need to be integrated cohesively.
There needs to be a correlative progression as you age. If you fix something at one stage, it doesn’t mean you never have to go back and readdress the health and position of your teeth later on. It’s a realistic reminder that every treatment is a progression to a more therapeutic and beneficial result, but it’s not the end all.
What are the latest procedures or techniques that your clients are requesting the most?
Dr. Cotca: When patients walk into my practice, of course they mention veneers because that is what they read in the media. But at the same time, patient’s clinical needs involve addressing muscle conditions like temporo-mandibular disorders and addressing pain within the aspect of discomfort, for instance, like biting the cheek, TMJD or bleeding gums. In those instances, you have to consider where the systemic profile lies.
Laser therapy has done incredible things in getting patient’s gums healthy. We are in a very, very fast paced environment, we are also fortunate enough to live longer, but all of that comes with a lot more systemic conditions than what we used to have maybe 10 or 20 years ago. For that reason, manifestations from those conditions will creep in to the oral cavity. We uniquely address those issues with laser therapy, which works as well in treating gingivitis and periodontitis. You can’t place the veneer and have a beautiful smile when you have unhealthy, bleeding gums.
What are some ways to easily and quickly get a brighter smile?
Dr. Cotca: When we talk about a brighter smile, we have to talk about clean teeth. When we talk about clean teeth and clean surface, we have to talk about how there has to be no calcification there, no plaque. If you want a quick, brightened smile, the most effective and efficient way to achieve it and maintain it, is with getting the gums healthy, having a spic and span oral health program at home that does not allow for plaque to be deposited or remain on the teeth for more than 15-30 minutes after eating, and having either an in-office whitening or a combination of an at-home whitening treatment, all under the care of a dentist.
Many patients may think whitening strips will solve the problem, but I’ve found them to be problematic in general. First of all, they don’t deliver in terms of the evenness of the whitening process, so some spots, some areas of the teeth will continue to remain the same color or maybe will have significant less improvement than other spots which gives a very visual disharmony. Then the issue becomes wanting to get that area just as white as the rest.
This will require much longer use, so now you’re exposing the whole tooth with risks of toxicity implications depending on the length of time. I don’t ever recommend touch ups once you’ve achieved the results that you want. I only recommend touch ups every one or two years for one or two days. Not for a month or 40 days. Even water carves out rock over time.