From Braces to Dental Implants, Adults Now Have More Options Than Ever to Improve Their Pearly Whites

No worries. With the advent of a number of new dental techniques, straight teeth and a beautiful, youthful smile is, in many cases, just an office visit away. In fact, the next time your child visits the orthodontist look around the waiting room. Chances are you’ll see a handful of adult patients waiting to be seen as well, because braces are not just for kids anymore! According to the American Association of Orthodontists, currently one out of every five orthodontic patients is an adult. And, if braces bring to mind metal railroad tracks sprawled across one’s mouth, imagine this: Today’s braces range from barely noticeable to invisible. However, braces aren’t the only way to improve your smile. With veneers, bonding and implants, the options are seemingly endless.

Forty-seven-year-old Ferdinand Ruplin of Stony Brook, having seen advertisements for Invisalign at his dentist’s office, decided to opt for the procedure. “It was fantastic.” The difference he says, “really is very significant.” Also significant is the fact Ruplin’s dental insurance paid 50 percent of the cost of Invisalign. The same, he says, his insurance company would pay for any orthodontic procedure. (Be aware though, that not all insurers cover adult orthodontics.) Ruplin describes Invisalign as wearing a succession of clear molds that incrementally moved his teeth into their optimum position with minimal discomfort.

Linda Conlon, formerly of Queens, turned to cosmetic dentistry to repair a chipped front tooth. At first she tried bonding, but years later when the bonding needed to be replaced, she opted for porcelain veneers, which were placed on both front teeth. Conlon says she experienced no discomfort and while her insurance wouldn’t pay for the cosmetic procedure, she says it was well worth the expense. Conlon says the veneers cost about $1,500 and the result is a bright, smooth and even smile.

Why the Wait?

Ruplin says he would have liked to have had his teeth fixed earlier, but when he was younger it was more common not to have braces. He’s right. According to the American Association of Orthodontists the increase in the percentage of patients on the whole from 1982 to 2004 is 135.17 percent. The growth in adult patients from 1989 to 2004 rose by 24.8 percent.

Another reason Ruplin finally chose to get his teeth fixed was that the Invisalign procedure allowed him to have the work of traditional braces done discreetly, without distracting clients during business situations.

For some patients, such as 41-year-old gymnastic coach Cheryl Borden of Huntington, vanity was not the reason for her dental work, but a positive upshot of what started out as an unpleasant situation. Borden believes that having had braces on her teeth as a child for more than five years, plus genetics, and not being a fan of milk, accounted for her teeth being in need of repair—but what drove her to the dentist was an injury sustained while coaching. “A tooth was shoved up into my jaw.” She chose to have crowns made for her two front teeth and veneers put on a number of other teeth.

The cost for the crowns on her two front teeth was about $2,000. Money, Borden says, well spent. Her teeth not only look better, she says, but her mouth feels better and her general dental health is improved.

Stewart Brody, D.D.S. who practices in Great Neck and whose patients include Borden and Ruplin, says some other reasons patients might consider cosmetic dentistry include removing stains caused by coffee and cigarette smoking (which can make one’s smile look older), periodontal disease, and the desire to replace silver fillings full of mercury content, with porcelain fillings. “It was common in the old days for actors and actresses to use crowns,” says Brody. “Today it’s instant orthodontics and porcelain laminates.” What’s new is not only the updated materials used, Brody explains, but also the fact that almost anyone can obtain a movie-star-quality smile and in many cases as quickly as in one visit. And, he adds, “Typically, with injections, there shouldn’t be pain during any of the procedures.”

Your Options

Bonding: Brody says, “The composite materials that are bonded to teeth not only look natural, they wear like natural teeth. In most instances, tooth bonding with modern composites is accomplished in a single appointment with your dentist.” Dr. Jeffery Caso, a dentist in private practice in Merrick says a number of reasons patients might opt for bonding include: single tooth issues, chips and color changes. Caso says the difference in cost between bonding and a veneer is significant. A single tooth bonding procedure may cost a few hundred dollars, while a veneer may cost $750-$1,000. Most patients can expect bonding to last 5-7 years, Caso explains.

Veneers: Veneers, according to Caso are stronger than bonding, less likely to chip, and not as likely to suffer color changes. Veneers should last a minimum of 10 years.

Crowns: These differ from veneers in that, “Crowns cover the whole tooth. Veneers just cover the front surface,” says Caso. Veneers are more conservative than crowns, preserving more of the natural tooth for better dental health. The cost for a crown versus a veneer is comparable, but there are reasons one might get a crown, rather than a veneer: a tooth that needs to be crowned, Caso says, might have a lot of decay, a root canal, or be a severely broken tooth, while veneers are done on mostly healthy teeth.

Orthodontics: Invisalign: Brody explains, “Invisalign works through a series of invisible, removable, and comfortable aligners that no one can tell you’re wearing.” The length of time Invisalign is worn varies from patient to patient, just like traditional braces, but on average is about a year to 18 months. Caso says the benefits of Invisalign is that good hygiene can be maintained because the Invisalign device is removed to brush and floss teeth, unlike braces, which are affixed to teeth and can sometimes challenge perfect dental hygiene. “The downside of Invisalign,” Caso warns, “is you need compliance.” Meaning the device must be worn when and as instructed. Because of this he says, “Most of our Invisalign patients are older people.” The perfect patient, he says, would not be the teen that might forget to put it in. The cost of Invisalign can run $4,500-$6,000.

Traditional Braces: With the popularity of Invisalign one wonders why adults may need traditional braces at all. Orthodontist Dr. Marc E. Paternina, who practices in Mineola, explains, “There are cases that are not cut out for Invisalign.” His office does offer Invisalign and most adults request it, but he adds, there are complex problems that may require a more traditional approach. Dr. David Amram, an orthodontist with practices in Medford and Port Jefferson, says one such “complex” situation might involve implants. When a patient is getting implants the roots of the neighboring teeth often need to be diverted to allow space for the implant. Amram says while Invisalign is good for moving teeth above the jaw line, “Invisalign is not great for moving roots.”

Implants: According to Brody, dental implants are sophisticated screws made of a medically pure metal, Titanium. The screws are placed in the jawbone and rest under the gum for 3-6 months. During this time the screws fuse to the jawbone and become Osseo (bone) integrated. After the appropriate healing time, they are used to replace one or more missing teeth by fabricating some sort of dental prosthesis. Caso explains, “Implants are replacements of missing teeth.” There is a surgical cost of approximately $1,500 followed by the six-month healing period—outlined above—during which time a temporary removable replacement device must be used. Finally, the restorative procedure, which can also cost $1,500, takes place.

Insurance Coverage

Before proceeding with any cosmetic dentistry procedure, review your coverage. As for orthodontics, Drs. Brody and Caso say in most cases, those with orthodontic coverage will have the same coverage for the Invisalign system. Brody notes that while it’s rare for companies to pay for veneers, most will pay for white fillings in teeth that have a carious legion or a bona fide cavity. Caso says, “If bonding material is replacing a fracture or decay, then yes, insurance should cover it.” In the case of implants due to a serious injury or loss of tooth most insurance companies should cover the procedure. Both dentists have observed recently that a select number of insurance companies are offering coverage for cosmetic work. Their best advice to patients is to research exactly what benefits you have before beginning cosmetic procedures.

—Delmonico Prussen

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