I have cement points placed in the front of my teeth. Are there aesthetic alternatives?

Patient Question

Emma Wilson 🇬🇧: Dr. Samuel, I recently had some dental work done and the dentist placed what they called “cement points” on the front of my anterior teeth. They’re quite visible and affect my smile appearance. I’m wondering if there are more aesthetic alternatives available that would serve the same purpose but look more natural. What options might I have to improve the appearance while maintaining the necessary function?

Dr. Rockson Samuel’s Response

Dr. Rockson Samuel: Thank you for your question, Emma. I completely understand your concern about the appearance of cement points on your anterior teeth. The good news is that modern dentistry offers several aesthetic alternatives that can provide the same functional benefits while significantly improving the appearance of your smile.

Understanding Cement Points and Their Purpose

Before discussing alternatives, it’s helpful to understand why cement points might have been placed:

1. Common Purposes:

   • To build up worn incisal edges
   • To provide a stop for bite registration
   • To serve as a guide for occlusal adjustment
   • To protect exposed dentin
   • To temporarily restore fractured edges
   • As part of orthodontic treatment (bite ramps)

2. Traditional Materials:

   • Glass ionomer cement (typically white or off-white)
   • Zinc phosphate cement (opaque yellow/white)
   • Conventional composite (often not optimized for aesthetics)

These materials, while functionally effective, can be visually prominent against natural tooth structure, especially in the anterior region where aesthetics are paramount.

Aesthetic Alternatives to Consider

Based on your concern, here are several aesthetic alternatives that might be appropriate, depending on the specific function the cement points are serving:

1. Tooth-Colored Composite Resins:

   • Nano-hybrid composites: These offer excellent polishability and color matching
   • Microfilled composites: Provide superior aesthetics with high polish retention
   • Benefits: Conservative, reversible, can be shade-matched precisely to your natural teeth
   • Longevity: Typically 5-7 years with proper maintenance
   • Process: Single visit, minimal or no tooth preparation required

2. Porcelain Veneers:

   • Indication: If more extensive coverage or significant aesthetic enhancement is desired
   • Benefits: Superior aesthetics, stain resistance, strength, and longevity
   • Considerations: More invasive, requires some enamel reduction in most cases
   • Longevity: 10-15 years or longer with proper care
   • Process: Usually requires 2-3 visits and temporary veneers while the permanent ones are fabricated

3. Full Ceramic Crowns:

   • Indication: If the teeth require more substantial protection or restoration
   • Benefits: Complete coverage, excellent aesthetics with modern materials
   • Considerations: Most invasive option, requires significant tooth preparation
   • Longevity: 10-15+ years depending on material and maintenance
   • Process: Usually requires 2 visits and temporary crowns

4. Direct Composite Edge Bonding:

   • Indication: Specifically for incisal edge reinforcement
   • Benefits: Minimally invasive, immediate results, easily repairable
   • Technique: Multi-layering approach for natural translucency and appearance
   • Longevity: 3-7 years, may require occasional polishing or repair
   • Process: Single visit, artistic approach to recreate natural incisal characteristics

Material Selection Considerations

Modern dental materials offer remarkable aesthetic properties:

1. Optical Properties:

   • Translucency: Materials that mimic the natural translucency of enamel
   • Opalescence: The ability to reflect blue light and transmit orange/amber light
   • Fluorescence: Natural teeth fluoresce blue-white under UV light; modern materials replicate this

2. Color Matching Systems:

   • Multi-shade layering: Using different shades to create depth and vitality
   • Tints and characterization: For incorporating subtle color variations
   • Finishing techniques: Creating surface texture that mimics natural enamel

Specific Recommendations Based on Common Scenarios

Without examining your specific situation, here are recommendations for common scenarios:

1. If the cement points are for bite registration/stops:

   • Clear occlusal indicators placed palatally (behind the teeth) instead of facially
   • Tooth-colored composite resin bite ramps
   • Removable appliances for nighttime use if needed for protection

2. If they’re for protecting worn edges:

   • Aesthetic edge bonding with layered composite
   • Incisal edge veneers or “skirt” veneers that cover just the edge and a small portion of the facial surface

3. If they’re part of orthodontic treatment:

   • Clear aligner therapy with built-in bite ramps instead of cemented points
   • Lingual (behind-the-teeth) attachments rather than facial

4. If they’re addressing sensitivity:

   • Desensitizing agents and bonding agents that are clear or tooth-colored
   • Dentin sealers with overlying aesthetic composite

Next Steps

I would recommend:

1. Consultation with a Cosmetic Dentist:

   • Bring photographs of your current situation
   • Discuss the functional requirements that led to the cement points
   • Ask to see before/after examples of similar cases they’ve treated

2. Digital Smile Design:

   • Consider a consultation that includes digital imaging to preview aesthetic options
   • Some practices offer virtual try-on of potential restorative solutions

3. Phased Approach:

   • You might start with a conservative composite solution
   • This allows you to evaluate both aesthetics and function before considering more permanent options

Would you be interested in scheduling a consultation to evaluate your specific situation? I’d be happy to examine your teeth and discuss which of these alternatives would best meet both your aesthetic desires and functional needs.

Further Reading and Resources

For more information on related topics, you might find these resources helpful:

• Dental Bonding: Affordable Solution
• Smile Makeover: Comprehensive Guide
• Digital Smile Design: Modern Approach
• Dental Veneers: Transform Your Smile