In the movie "The Matrix," the character Morpheus explains that the Matrix is a computer construct, a dream, nothing more than electrical brain stimulation to produce perception, and what is perceived by the brain...is perceived as being real.
For years, decades, even centuries, our profession has lived in a "Matrix" of classical dentistry. Pierre Fauchard did his best in the 18th century to replicate nature, and until recently, that was our job too. But classical dentistry—like classical art—was not really a replication of the way teeth actually looked, but how they might ideally look.
Even classical Greek and Roman sculpture was not about true replication of reality but a distortion to a Greek ideal of beauty. No one, or at least very few people, really looked like Michaelangelos David, and thus for years we made teeth that looked like no one in particular, but echoed a classical aesthetic ideal proposed by G.V. Black and Angle and later by Frush, Fisher, and Lombardi. Our job was to mimic nature, or at least "ideal" nature. Technicians copied master European technicians like Willi Geller and others to develop real-but-ideal teeth and helped create the American dental aesthetic by emigrating their tastes and talents to our shores. Stains, tints, opaquers, and incisal colorants were part of their palette, as we prided ourselves on creating variegated color and startling ideal reality.
Times change societies change...tastes change...materials change. It was bonding in the late 1970s and early 1980s that changed our aesthetic perception. Drs. Irwin Smigel, Ron Goldstein, Buddy Mopper, and Norman Feigenbaum created and taught a new bonding aesthetic. We discovered that the choice of the material dictated the aesthetic. Those pioneers worked with composite bonding, not crowns, and the aesthetic became softer, rounder, less variegated in color, more opaque, lighter, and most importantly, dentist-derived. For the first time in a long time, dentists themselves were not deferring to technicians to determine artistic choices, but were creating the aesthetic themselves. We really began to look at the shape and color of teeth ourselves, and realized that the tyranny of technician-created aesthetics was only a choice, not a necessity. More significantly, much of those aesthetic choices had been derived from a different culture or a different time period, with different values, different perceptions, and different mores.
The current American dental aesthetic was born. We stopped accepting the heavy incisal line placed by many technicians as a mandated aesthetic because composite blurred it, or it stained after awhile anyway. We stopped making sharp line angles because the composite bonding had less shear strength. We started making more rectangular/nonovate teeth for men and women because that shape covered dark teeth better.
With the advent of composite bonding, we no longer lived in the classical age of dentistry; we began the impressionistic age of dentistry. Our job no longer was to mimic nature by making ideal natural teeth, but to go beyond nature, to a whiter, bolder, more monochromatic smile. Cosmetic dentistry was to become more about what patients felt teeth should look like, from the "Matrix" of what they saw daily in the media, rather than what teeth really looked like. When porcelain laminates became available, we and our technicians continued the aesthetic we had developed.
TODAY'S SMILE MAKEOVER
Let us review some examples to support the above theory. Remember when Vita shade A1 was a relatively light shade? Ten years ago? Five? Remember when we thought B1 was too light for most folks and we did our makeovers mostly in A2 and Universal shades?
|Figure 1. Cosmedent has expanded the shade range of its Renamel Microfill System by adding 3 new superlight shades.||Figure 2. Matrixx AH (Discus Dental) is available in 18 Color Perfect shades, including 3 bleach shades for today's demand for whiter teeth.|
|Figure 3. The IPS Empress Esthetic restorations (Ivoclar Vivadent) have 2 new shades to complement the product portfolio and satisfy the need for bleach shades.||Figure 4. The 4 Seasons (Ivoclar Vivadent) is a shade guide that has expanded with the developments to keep up with patient-driven demands for a whiter white.|
|Figure 5. Crest Whitestrips Supreme (Procter & Gamble) is one of the many take-home whitening system kits available at dental offices.|
Many smile makeovers now require lighter shades that did not exist 10 or even 5 years ago. The marketplace has forced manufacturers of composite resin and porcelain to make shades beyond the reality of just 10 years ago (Figures 1 through 5). Now we have composite colors like Point 4s B1 Opaque, Charisma's Superlight, Durafil's Superlight, Esthets Vitalescences Opaque White and Opaque Snow, Matrixx's Bleach Light and White, and scores of others. The last holdout, Vita, finally accommodated us by manufacturing OM1, its lightest porcelain. Finally, we have prosthetic matches to our patients' whitened teeth.
The publics perception of light teeth has changed. Dr. Michael Alfano, dean of New York Universitys College of Dentistry, recently said, Regis Philbin, an almost 70-year-old man, has raised the bar on white.
How did that happen? It happened because Mr. Philbin wanted the whitest teeth on television, and we had to create a new white color of porcelain for him. Fortunately, we had the experience. My technician, Jason Kim, had already developed a new white shade for Wayne Newton the year before. Now we don't have to create those shades; they are manufactured for us.
Who says Demi Moore's teeth are too white... you and I? We don't matter. The public seems to like them. In fact, in person her teeth, just like Regis... and others with a new white look, are not nearly as light as they appear in photos or film. I have laminated or bonded TV news anchors in a standard color like B1 who appear on TV to have much lighter teeth. Even more confusing to the public is the young model whose photo shoot involves so much powerful lighting that all incipient facial lines are washed out. As a corollary, her bleached or bonded teeth appear to be as white as this page. The typical magazine reader looks at that media-developed smile, which has no basis in reality, and decides that those are the teeth he or she wants. If the reader had the opportunity to see the young model in person, he or she might be surprised to see that the shade is much darker than what was printed on the page. Additionally, the massive infusion of light used at the photoshoot tends to white out the interproximal lines, so we are left with a band of white" in the magazine. This feeds into our childhood fantasies about the way teeth look.
Did you read Archie comics as a kid? Do you remember the Betty and Veronica smile, where the open mouth is completely filled with a sheet of white? This is the image of beauty we and our patients were raised with; this is what they expect. That look is replicated in models and newscasters and other celebrities, and so the public clamors for its impression of nice teeth. No matter... like Platos example of shadows on the cave wall that the media projects a representation of reality that is not truly reality. No matter at all, because in the media-driven "Matrix..." of our society, the media is reality. Is there anything real about TV's reality shows?
Who created this white craze that has enabled Proctor & Gamble to sell more than 20 million boxes of Whitestrips and generate revenues of more than a billion dollars with a $26 item? Who created the boutique spa whitening procedures in dental offices and made startup companies like Discus Dental and Ultradent and Rembrandt into world-class players in the beauty/dental industry? We did. We showed patients that it was safe, effective, and affordable to have white teeth. We, the profession, have been responsible for the shift to white in our society, because we, the profession, have been responsive to our patients aspirations, wants, and needs.
So, the next time you try in laminates or crowns that you perceive as being too light and gently tiptoe out of the treatment room in embarrassment, don't be surprised if your patient gasps in joy at her new too-white teeth, and don't be surprised if in the ensuing weeks her husband, sister, and friends arrive wanting the same too-white smile.
Relax your position. Remember Regis and tens of millions of other Americans have raised the bar on white.