DR NATALIA DE RABAGO : “Cosmetic dentistry for dummies”

We can certainely say that regarding your journey, apple never fall far from their tree right ?

Well, If you mean by that that my father and my husband are also dentists so yes for sure…there is going to be a strong DNA for my children as the third generation of doctors !

So , since I finished my degree, and I did my postgraduate Master’s in in the New York University, I joined my father in a company where we train dentists that come from all around the world,  and are mostly spanish speakers originally. So we teach them about many different topics and the one that I’m running is about cosmetic dentistry. And this is the part of the dentistry that that I really like to to do.

My husband by the way , is also a MD specialized in aesthetic dentistry . We have two kids. So hopefully one is going to be a dentist, and maybe the other one will be lucky and do something else like being an accountant or a banker or a singer, whatever really I mean as far as they are happy.

What brought you in Dubai ?

So when I was in New York University, as I told you, I did my masters in cosmetic dentistry. I met my husband there and we decided to move to Dubai because of work. Basically, we wanted to experiment a little bit around the world before going back to Spain which is our hometown. We felt that we were young so we wanted to see around. And Dubai was a very good place for us to work as dentist. We decided to move here and It has been seven years now. We are very happy. And hopefully we will stay here for a little bit longer.

Have you kept some connections with New York University and your student life there ?

Yes absolutely and I’m still doing some courses for them. Sometimes even collaborating with my father : we take all the doctors in training with us and we bring them to New York University for one intense week , usually happening every June. And we usually have  like about 30 people in one group . They are not coming only from Spain. They’re coming from all around the world as I told you so the course is running in English. So we get to meet a lot of people from everywhere. And I get to see also the University and my colleagues that are still there at least once once a year which is great.

You are a cosmetic and aesthetic dentist …what is exactly comestic dentistry ?

Actually, I think that there is a little bit of misinformation around there. Because first of all, we think that dentistry is just about something that is hurting in your mouth : you go to see a general dentist, set up your appointment hoping he will fix your pain and that’s it.

When it comes to aesthetic, you think that the orthodontist is the specialist doing that in most of the cases…but cosmetic dentistry is a combination of treatments which are not reduced to seeing an orthodontist. As I told you we need to work as a team. So we need the orthodontist to work with us for these kinds of cases. But it’s not only about moving teeth, sometimes we need to move teeth differently or not only. We don’t get this desire effect or this desire to smile. We need to go a bit farther and we need to change things like shape , color, and sometimes plenty of things that sometimes can not be improved only with Orthodontics.

So this is when I come into the room and I tell the patient look, my colleague orthodontist is going to be moving your teeth to close the gaps. But at the end, your teeth are already damaged because of aging,  because of eating because of too many things. So at the very end, you will need to have some other additional treatments. And when we talk about additional treatments, it can be from a very minor restorations : minor fillings, bonding, composite bonding . We are talking about widenings. We are talking about smudging directories. And then we are talking also about ceramic veneers. So it’s not only about ceramic veneers but about the combination of many things.

So Cosmetic isn’t also all about veneers …?

Not at all :  I don’t think that there is one treatment for one patient, I really think that you need to see the overall and then you need to know about few plants or plan A, B, C and D and then you combine them. Of course there are patients that the only solution is linear. So of course there are patients that the only solution are composites or just whitening. But if you can find the combination of them I think that this will be the great success.

What is the process for a smile makeover ?

So this is one definition of their smiles when I talk about this. When I see the patient for the first time and I ask precisely “what are you looking for” ? Are you looking for a perfect smile? Or a perfect imperfect as my love? Do you want this perfect straight white smile made in Hollywood ?

Or do you like something more natural like a this perfect natural with tiny imperfections,  like every smile is for real, not exactly the same as the other. So this is what we call with perfect imperfect smiles and I love that one. Okay, I want that one. Okay, one perfect imperfect for  you.

I wish it could be that easy…but not every patient knows what he wants and we have sometimes to adapt and assess the reality of the situation in the mouth, technically speaking before even thinking about the overall aesthetic.

So when we have people with let’s say gaps or small teeth,  the first thing that we need to see is how big are the teeth because sometimes we have gaps but the teeth are in the correct proportion. This means that the measurements length and width are the correct one so then there is nothing to do with me I just sent to the orthodontist they will close the gaps . So even if it takes time if the teeth are healthy and in correct proportions, I will always recommend the patient to go through orthodontics because it’s less invasive.

When we have patients with this diastema that we call the gaps, but we measure the teeth and the teeth are tinier than they should be meaning within length is not the correct one,  this is when we need to get in touch with the orthodontist and sometimes we need to combine treatments. So we need to close a little bit the gaps not completely because if we leave a little bit of gaps then I would not have to be that much aggressive with my preparations . So what I will do is that I will tell my colleague orthodontist, I will tell him or her leave this space two millimeters to this tooth one millimeter so I will give the numbers to the lab, they will just close the gaps as I told them leaving what I tell them and then as soon as everything is ready, the patient will come back to me and we will place the veneers.

Since the very beginning I told you cosmetic is not only about ortho, as is not only about veneers, it’s about combination most of the times . If you want a quick solution but also you want to be conservative, then we can work with the ortho team and then we can combine both.

What is the Digital Smile design that everybody is talking about ?

So digital smile design is what many people are coming for and are looking for. This is just about designing your smile in a digital way . So basically we have to take pictures of you – we have our own studio – we just take some pictures and then we upload them into the software and then we design the ideal Ismail for you. We need to be very precise because we can not design something that then we will not be able to achieve practically.

There are usually  two ways of using the digital smile design:

-the first way is to show to the patient the 3D Simulation for him to see and visualize  how he’s going to be at the very end. Again, you have to be realistic and you cannot promise things that cannot be delivered.

-the other way of doing it is just to do it for yourself, me as a dentist. I just work on it as a back up to plan the case. Because it’s a very, very interesting tool. The patient can see the result but they have to undertand that this is only a 3D simulation 100% digital . And we are just dentists working with real mouth, real teeth and real patients. So we work with computers, but we don’t do Photoshop, nothing like that. So the patient needs to understand that a digital smile is first and foremost digital.

What are the different types of veneers and if you do have a favorite one, why is that  ?

Many different materials and treatment options are available in esthetic and restorative dentistry.

Various newer products, such as pressed ceramics, offer enhanced functionality; however, in thinner dimensions, they lack the inherent esthetic beauty of traditional materials such as feldspathic porcelain. As patient demands for better esthetics have increased in recent years, so too has the need for restorative materials that closely mimic the patient’s natural dentition.

Initially used for the creation of porcelain dentures, feldspathic porcelain has emerged as the premier esthetic material for custom veneer restorations. In recent years, the use of hand-layered powder / liquid feldspathic porcelain has been revived based on its highly esthetic values and little-to-no preparation requirements. By keeping preparation to a minimum, less tooth structure is lost and procedures are much less invasive, which is exactly what patients desire.

Feldspathic veneers are my favorite ones because of their very natural look. It’s very difficult to work with but that’s why we have very skilled lab technicians. The patient needs to understand when and why we choose composite veneer or ceramic veneer. So again it depends on the case : with a ceramic veneers we can achieve better results that are non reversible and we are polishing a little bit the tooth,  but the the results are much much better than with a composite veneers.