The joining of dentistry and plastic surgery is becoming commonplace, so plastic surgeons should become more informed about dentistry.

When the term “extreme makeover” was introduced, it focused primarily on plastic surgery. Soon, it was revealed that part of an extreme makeover could include cosmetic dentistry. More consumers became interested in cosmetic dentistry as part of the extreme makeover, and as a result more dentists have focused on receiving greater training through advanced dental technologies.

The extreme makeover phenomenon has evolved into another area of consumer interest—the smile makeover. Many studies indicate that first impressions are influenced by your smile.

In addition, “dental plastic surgery” and “oral plastic surgery” have surfaced recently as terms describing the transformation that may result from aesthetic and functional dentistry treatment.

Here, plastic surgeons and dentists opine on the rise in popularity of cosmetic dentistry and how it can benefit plastic surgery patients.

James H. Wells, MD, FACS, a past president of the American Society of Plastic Surgeons: “Having been ASPS president during the beginning of ‘extreme makeover,’ the addition of dental makeovers added to the facial cosmetic plastic surgery was remarkable. While the soft tissue work and bony work combined makes significant differences in many patients, the correction of dental deformity and malocclusion added immensely to the excellent results presented in so many of the patients. Good dental health and appearance clearly help to make the smile a thing of beauty.”

LATEST CHANGES

Numerous advancements in dentistry have benefited plastic surgery patients.

Ronald J. Edelson, MD, a San Diego-based board-certified plastic surgeon: “I began working with dentists close to 25 years ago. We collaborated on facial-reconstruction cases that resulted from traumatic injury. As we worked together over the years, we exchanged ideas and I uncovered advancing, interesting approaches that could serve as adjuncts to treatment for plastic surgery patients. Through the collaborations with cosmetic dentists on my plastic surgery patients today, I have witnessed firsthand great significant results.”

When there is a deficiency in the smile, the eyes tend to notice it. The deficiency might be loss or deformity of soft tissue in the mouth or facial structure that might not frame a smile appropriately; also, it could be dark or stained teeth, or thinned or otherwise unattractive lips.

Wear and tear on teeth over time may reshape the teeth in an unappealing way.

W. Peter Nordland, DMD, MS, who maintains a private practice in La Jolla, Calif: “The smile can represent a beacon of self-esteem, health, and internal happiness. The advances in dentistry today have put oral plastic surgeons in a pivotal position of the cosmetic revolution.”

Ultimately, the goal of collaboration between plastic surgeons and dentists is to best serve patients. It may be difficult for some to imagine the coupling of dentistry and medicine. Indeed, it boils down to the informed consent for both disciplines—and to answer the core question posed by both groups, which is “What is best for the patient?”

Larry Addleson, DDS, FAACD, a past president of the American Academy of Cosmetic Dentistry: “The goal of the collaboration between dentists and plastic surgeons must be optimal patient care. Many patients who come to my practice are interested in plastic surgery and approach their smile makeover either before or after surgery.”

This phenomenon doesn’t affect just dentists. Many plastic surgeons are seeing the value of dental work as well.

Munish Batra, MD, FACS, a board-certified plastic surgeon located in San Diego: “In order to optimize the results of perioral rejuvenation procedures, I will often ask my associate … to get involved in a patient’s care. This can include minor implant-type work to more complex procedures, such as chin and jaw advancements.”

THE ENHANCEMENT

The cosmetic dentistry treatment plan may include one or more of the following procedures:

  • teeth whitening;
  • bonding;
  • veneers;
  • dental implants;
  • dental crowns;
  • orthodontics;
  • oral maxillofacial surgery; and
  • gummy smile enhancement.

The treatment plan may also consist of treatment for oral conditions and/or the improvement of old functional restorations, including a bad bite or malocclusion; periodontal disease; and repair of old tooth crowns, dental bridges, dentures, or fillings.

When treatment for oral conditions, functional deformity, and old tooth restorations is warranted, the term “full mouth reconstruction” applies.

In the end, cosmetic dental procedures may create an increasingly feminine or masculine appearance, as well as create balance and harmony to the face and suggest youthfulness.

Aged lips. Soft-tissue removal offers greater mobility of the lip. Veneers, a shell-like porcelain or ceramic material that adheres to the individual tooth, may also offer lip enhancement. Building out the arches with veneers can help create fuller lips and bring the teeth out a bit.

Oral surgery can change the distance between the nose and chin, affecting the appearance of the lips and mouth. Oral surgery may be performed in conjunction with cosmetic dental procedures to improve a person’s overall appearance.

Whether or not a patient is concerned about corner wrinkles in the mouth or asymmetry between the lips, lip enhancement can be achieved through several methods that can help benefit the plastic surgeon’s work. Removal of soft tissue in the mouth may be the least expensive procedure. However, the financial investment in veneers—at more than $1,000 per tooth—or oral surgery—which may cost as much as $20,000—may be worth it for patients.

The gummy smile. Crown lengthening and soft-tissue removal can help reposition the lips, providing better balance among the upper lip, chin, and the refined gummy smile. Lasers may be used to enhance a gummy smile. Gummy smiles can also make teeth appear shorter than they really are. Improvements to a gummy smile lengthen the appearance of teeth.

These procedures may cost $200 to $500, or may be included in other procedures performed simultaneously.

Unsightly gum regeneration. Tissue regeneration creates the illusion of perfected gums for those with periodontal disease. If the bone surrounding the gum has been destroyed, tissue regeneration involves bone grafting to help promote bone re-growth.

Advanced periodontics also includes guided tissue regeneration, in which a membrane is inserted to help in the bone-regeneration process.

To build on thin gums, soft-tissue grafts may be used to enhance the appearance of gums. The cost for tissue regeneration may seem expensive, and is usually performed in conjunction with periodontal disease treatment. This procedure may be partially covered by dental insurance. However costly it may be, the rewards can be substantial for patients suffering from unsightly gums.

Nordland: “Surgical reconstruction of lost structures has become a predictable reality over the past 20 years. In the near future, biologic tissue engineering will be available, with the ability to grow a patient’s own cells in culture to allow for an unlimited donor source. Specific proteins to turn on healing mechanisms that allow for more ideal tissue healing are being developed.”

Teeth lengthening. Aging and some dental conditions, such as tooth grinding, produce wear and tear on teeth, often resulting in shorter teeth. Long teeth suggest youthfulness. Dental treatment plans may include reshaping and lengthening the front central teeth through bonding or veneers. This result also includes a slimming effect on the face.

Tooth color. Dark, stained teeth, or chipped, worn out, and missing teeth, all suggest an aged mouth. Teeth whitening and veneers equate to a bright, white smile. Bonding or veneers offer improvement to chipped, worn-out teeth, whereas dental implants replace missing teeth.

Prior to treatment, selecting the appropriate colors and shades is important in order to complement the tone and color of the patient’s face and hair. Professional teeth whitening usually costs between $300 and $600 and requires maintenance to continue to receive its benefits over subsequent months.

Unattractive, missing teeth. Dentures are still used today to replace missing teeth, but can be problematic from both aesthetic and functional perspectives. Dental implants are artificial tooth replacements that may provide a fixation for a dental bridge or missing back teeth that would be required for a bridge.

Implants may also be used along with dentures to offer more stability for the denture. Dental implants are recognized to slow progressive jawbone loss. Single implant costs range from $450 to $5,000, depending upon the type of implant used. The cost of full-mouth reconstructive dental implants can range from $24,000 to $100,000.

Facial-structure repositioning through orthodontics and oral genioplasty. The combination of orthodontics and oral genioplasty can reshape the chin, which can be reduced or enhanced by using the patients bone to cultivate a renewed, more balanced appearance.

Chin reshaping can change the distance between the nose and the chin. Oral surgeons and orthodontists may work together to improve the appearance of a long face with large gums by swinging the lower jaw up and hiding the gummy smile. This creates the appearance of a shorter face.

In addition, restoring teeth to the proper position, width, and height via orthodontics can help to restore a more youthful appearance. Costs for oral surgical procedures can reach as high as $20,000, but some insurance companies and managed care organizations may provide similar services for as little as $6,000.

Gary Hirsh, DDS, MS, a San Diego-based, board-certified orthodontist: “I have witnessed stunning transformations in patients through interdisciplinary dental care. Often, these are life-changing experiences for patients, and in certain cases the results lend a 10- to 15-year-younger appearance.”

THE PROFITABLE COMBINATION PRACTICE

The Cosmetic Dentistry Treatment Plan


Procedures may include:

  • teeth whitening;
  • bonding;
  • veneers;
  • dental implants;
  • dental crowns;
  • orthodontics;
  • oral maxillofacial surgery; and
  • gummy smile enhancement.

Oral Conditions may Include:

  • bad bite (malocclusion);
  • periodontal disease; and
  • repair of old tooth crowns, dental bridges, dentures, or fillings

A practice can successfully integrate plastic surgery and dentistry. In fact, some dental practices actively seek partnerships with plastic surgeons and other professionals who focus on minimally invasive procedures.

Guy Lewis, DDS, of The Woodlands, Tex: “There are not a lot of cons involved with having an established plastic surgeon build on practice development together through a joint office or satellite office. Plastic surgery and cosmetic dentistry compliment each other.”

Lewis’ established practice includes 100 to 125 new cosmetic dentistry patients per month. Presently, he offers a host of services to compliment his practice, including an aesthetician, massage, and hot stone therapy.

Combination practices may operate efficiently by conducting an analysis in the following ways:

  1. Decide how expansive the practice needs to be: ie, is a satellite or full-service practice more appropriate?;
  2. Be very selective of the cosmetic dentist you choose to bring into your practice;
  3. Familiarize yourself with cosmetic dentistry via meetings with dentists in your local area or through referrals from organizations like the American Academy of Cosmetic Dentistry;
  4. Quantify the average time spent by all attending staff members in the operating room and for postoperative treatment, as well as how the costs associated with the procedures will be reduced using a combination of administrative personnel; and
  5. Evaluate any potential losses associated with cancellation of your agreement with your dentist partner(s), or else decide on a loose referral system that will benefit all parties.

Richard Greco, MD, FACS, a board-certified plastic surgeon in Savannah, Ga: “There is no question that satellite offices can add value to a practice. It is important to evaluate the benefits, [and] bring in a qualified dentist [who] has the ability to generate referrals for you and has a strong existing patient base.”

In particular, it is important that you carefully select your new dentist partner. Cosmetic dentistry is not a recognized field of dentistry. However, some organizations such as the American Academy of Cosmetic Dentistry offer advanced training in cosmetic dentistry.

Accredited members and fellows of the American Academy of Cosmetic Dentistry have passed a rigorous examination process to become accredited or achieve a Fellowship position, whereas members without a designation are simply undergoing training.

Smaller organizations, such as the Seattle Study Club, focus on advanced dentistry. Furthermore, dentists in different recognized specialties may perform interdisciplinary work in order to best serve the patient. At the same time, a combined plastic surgery and dental practice may make the best sense of all in your efforts to address the total image of the patient.

Leslie Ranft is a contributing writer for PSP. For additional information, please contact plasticsurgery@allied360.com.

ROUNDTABLE PARTICIPANTS

W. Peter Nordland, DMD, MS, maintains a private practice in La Jolla, Calif. He is one of the few Fellows of the American Academy of Esthetic Dentistry and is considered an expert in the field of oral plastic surgery. He can be reached at (858) 459-7374.

Larry Addleson, DDS, FAACD, is founder of The Art of Dentistry in San Diego. He has achieved both accreditation and fellowship within the American Academy of Cosmetic Dentistry (AACD). He can be reached at (619) 291-4325.

Gary Hirsh, DDS, MS, of San Diego, is a board-certified orthodontist focusing on the latest orthodontic procedures. He can be reached at (619) 461-4310.

Guy Lewis, DDS, is founder of the Texas Center for Cosmetic Dentistry and Spa located in The Woodlands, Tex. He is a general dentist with a special focus in cosmetic dentistry, and he developed one of the first dental spas in the United States. He can be reached at (281) 367-6453.

James H. Wells, MD, FACS, practices in Long Beach Calif. He is on the Board of Directors at Long Beach Memorial Medical Center (LBMMC). He serves as a clinical professor of plastic surgery at UCI and is director of resident rotations at LBMMC. He can be reached at (562) 595-6543.

Richard J. Greco, MD, FACS, of Savannah, Ga, specializes in cosmetic plastic surgery procedures and is board-certified in both general surgery and plastic surgery. He has also earned a Certificate of Added Qualifications in Hand Surgery. He can be reached at (912) 355-8000.

Munish Batra MD, FACS, is the founder of Docs, a nonprofit organization committed to plastic reconstructive surgery. He is also double board certified by the American Board of Plastic Surgery and the American Board of Surgery. He can be reached at (858) 847-0800.

Ronald J. Edelson, MD, is a board-certified aesthetic surgeon based in San Diego. He regularly donates time to the Cleft Palate Clinic at Children’s Hospital in San Diego, performing delicate operations on children born with facial deformities. He can be reached at (866) 907-2445.