Senior Citizens: An Untapped Market By: Ara Nazarian, DDS

With television shows like Extreme Makeover and The Swan, more and more patients are presenting to dental practices inquiring about enhancing their smiles with porcelain veneers. The majority of these patients are in their early 30s to late 50s. Because of this growing demand for “beautiful smiles”, many dentists are now marketing their elective cosmetic services to this population, either externally or internally. The rewards to both patient and clinician have been astonishing! However, one group of individuals who may be overlooked is senior citizens. Many times, these patients have not been informed by their providers of the advances in aesthetic dentistry because of fear of rejection when presenting cost, health concerns of the patient, or simply their age.

Cerinate Lumineers (Den-Mat) introduces an alternative to traditional veneers that can be easily marketed and implemented to this age group. The advantages of this system are that Lumineers can be made as thin as a contact lens and may be placed over existing teeth without having to remove healthy tooth structure. In cases where tooth reduction is necessary, it can be kept very conservative. These properties attract many seniors who may be concerned about complications with their medications to local anesthetic or about general health during a routine dental procedure.

Case Study: A man in his mid-70s (Fig. 1) presented to our practice for a periodic oral exam and cleaning. Upon clinical examination, the patient exhibited acceptable periodontal health. He had evidence of some normal wear on his anterior teeth but nothing that indicated severe bruxism or grinding. A failing gold-foil restoration was present on the incisal edge of tooth #9. There were no caries apparent clinically or radiographically on his maxillary anterior teeth, however the patient was concerned about the cracks and discoloration (Fig. 2).

In general, the patient was dissatisfied with his smile and desired a more youthful look that would exhibit straight, bright teeth that would look natural for his age. We reviewed the advantages of utilizing the Lumineers (Den-Mat) system for enhancing his smile and sparked some more interest in the patient. He was very attracted to the simplicity of the procedures necessary in obtaining his goals, and agreed to have a composite mock-up. This mock-up would serve as a blueprint for size, shape, and color of the final restorations incorporating principles of Golden Proportion.

Once informed consent was obtained from the patient, treatment was initiated by first removing the defective gold-foil restoration from tooth #9. Some definitive finish lines were also lightly prepared in enamel to prevent any interproximal darkening because we were altering the shade from D-2 to A-1. During the lab fabrication process, the patient was instructed to apply, stimulate, and rinse with a tissue conditioner (Under the Gum Irrigant, Dental Herb Company). By using this material, the protocols during the cementation process would be met because of the health of his gums. Because the patient had a sensitive gag reflex, a very quickset impression material was selected (Take 1 Super Fast, Kerr Corporation) to take the impression. A stump shade (Ivoclar Vivadent) was selected for each tooth to assist the laboratory technician in creating natural looking restorations (Fig. 3).

Before try-in of the Cerinate restorations, the teeth were pumiced with Pumice Preppies (Whip Mix) to remove any contaminants from the enamel surface. Once the fit was verified, a try-in paste was used to see if the patient was satisfied with the proposed color. After acceptance of the color was achieved, cementation protocols were immediately followed using the Tenure and Ultra-Bond Plus (A-1 Shade) luting system (Den-Mat). Using an LED curing light, the restorations were tacked at the gingival margin. While the restorations were firmly held still in place, the restored dentition was flossed and any excess cement was removed. When most of the excess cement was removed, the restored dentition was completely light cured from both sides. Any residual cement was removed with a No. 15 scalpel or finished with a fine diamond and polishing points. After complete polymerization of the restorations, the occlusion was verified and adjusted. The overall health and structure of the soft tissue and restorations was very good. The patient was extremely satisfied with the final results (Figs. 4 & 5).

Conclusion
All patients deserve to feel understood and get want they want no matter what age. Having a variety of different aesthetic materials to choose from allows the clinician to select the most appropriate restorative material necessary to overcome that obstacle. In this particular case it was Cerinate Lumineers from Den-Mat that assisted us in meeting the aesthetic demands of the patient.

Dr. Ara Nazarian is a graduate of the University of Detroit-Mercy School of Dentistry. Upon graduation, he completed an AEGD residency in San Diego, CA, with the United States Navy. Currently, he maintains a private practice in Troy, Michigan with an emphasis on comprehensive and restorative care. He is a recipient of the Excellence in Dentistry Award and Scholarship. His articles have been featured in many of today’s dental publications. Dr. Nazarian also serves as a clinical consultant for the Dental Advisor, testing new products on the market. He has conducted lectures and hands-on workshops on aesthetic materials and techniques throughout the United States. He can be reached at (248) 457-0500 or at ara20002@comcast.net.