On this day, there’s the face of a pleasant but curious fiftyish woman; on the computer screen is the other face-the one Dr. Ellenbogen plans to give her.

The woman’s teeth have worn down over time, and she wants them more like they looked 15 years ago. Ellenbogen hits "reshape" on the keyboard and extends the digital patient’s front teeth. She doesn’t like two canines that jut out; he hits "recontour" and files down the protruding teeth. She wishes her smile were brighter; he draws a blue line around eight front teeth. As the dentist taps a key, the highlighted teeth get whiter.

The patient leaves, preparations made for veneers and bleaching. But she could have asked for more. "She could say, ’I want this edge to be a little more round,’ and I could do it on screen, the lab would replicate it, and that would be the veneer she gets," says Ellenbogen. "For those protruding teeth, the old option would have been braces. Now she doesn’t have to go through that."

Ellenbogen specializes in cosmetic dentistry, but he’s not cutting-edge. Creating the perfect smile has gone as mainstream as his Tysons office park.

A decade ago, not all that many dentists did cosmetic work, according to dental associations; now it’s nearly 85 percent. A lot of that increase is due to the demand for whiter teeth. But cosmetic techniques have improved every aspect of dentistry, from stopping decay to fixing the bite to restoring missing molars.

Bleaching is a relatively easy, inexpensive way to whiten teeth. But there are two downsides: impermanence and some inconvenience. Also, despite the claims, most people’s teeth don’t turn as white as an oxford shirt. If your smile has a natural gray or yellow tinge, it may get lighter, but no one will mistake you for Regis Philbin.

Crest Whitestrips and Natural White 5-Minute, two kits sold in grocery and drugstores, worked reasonably well for our testers. (For a complete rundown of all options, see "Brighten Your Smile" in the February 2002 Washingtonian or click ).

Take-home trays, sold by dentists and made to fit over your teeth, cost $350 to $550. Treatment takes one to two weeks, and though they can make teeth temporarily sensitive, results are good-the best you’re likely to get, dentists say. Touch-ups are easy; just reuse the trays for a few hours.

In-office bleaching, which adds a powerful activation light, is much faster-just one visit-with similar results. But it’s more expensive, $550 to $750.

Veneers are permanent and can treat major discoloration in one or more teeth. A veneer is a new tooth surface-of resin (liquid plastic) or ceramic-bonded to the enamel. They range from near-paper-thin to as thick as two millimeters, depending on their purpose (they’re used for shaping and aligning as well as for changing color).

If you and the dentist go with resin, the dentist shaves off an appropriate amount of tooth surface, applies the resin under a high-intensity light, then sculpts it into place. If you choose ceramic, the dentist takes impressions and measurements, preps the teeth, and most likely fits you with temporary resin veneers. When the ceramic ones arrive from the lab a week or two later, the dentist grinds or glues them on-unless he or she is one of the few with an in-office lab, in which case all this might take one visit.

The color you get depends on the color and thickness of the veneer and on any visible color from the bonding material and your tooth below. Bear in mind that other teeth will change color as you age, smoke, or drink dark liquids; eventually they may not match the veneers beside them.

Which material is better? Resin is inexpensive and takes one visit to apply, but you need to find a very skilled dentist to sculpt it into place. And resin is more porous; over time, it can discolor and break down. Ceramic, dentists agree, wins in durability, authenticity, stain resistance-every aspect but price. Around Washington, ceramic veneers cost about $900 to $1,800 each; resin veneers run $500 to $800.

Using bonded resin or veneers, a dentist can widen the two teeth, filling in the space and matching the color. Veneers cost two to three times as much but look better and last longer. You and your dentist will want to take into account any other things you may want fixed in the same area: discoloration; cavities; odd tooth shapes, sizes, or alignments.

A word of caution: "If your gap were really as big as Letterman’s, you wouldn’t necessarily want these solutions," says Dr. Brad Olson of Waldorf, who often makes a wax mockup of a proposed change. Were he to make a mockup of veneers or bonding for a very large gap, the patient would likely say, "Oh, no-those teeth are too wide!" Instead, Olson would suggest orthodontia.

One is with veneers. Your dentist can fashion the end of each veneer to extend over the edge of a short tooth a slight amount. This can affect not only a few teeth but your whole smile: "Veneers can also make the upper lip look fuller and help erase little wrinkles above the upper lip," says Northwest DC dentist Nancy O’Donoghue.

The other way to fix an overly gummy smile is to cut away some of the gum tissue. In a gingivectomy, the dentist uses a scalpel or laser to remove, usually, two to three millimeters; anesthesia may not even be needed. "It’s like trimming excess cuticle from your fingernail," says Dr. Eugene Gadaire of downtown DC. "It’ll make a world of difference."

The process can take 5 to 15 minutes a tooth. Prices vary: Ellenbogen charges $75 a tooth; Bethesda prosthodontists Ingber, Prestipino & Kravitz charge $200 a tooth up to a maximum of $500 for eight, which may include trimming a little bone material. Gadaire and other dentists don’t charge extra if they’re doing an hour or two of work overall.

A bridge is a crown, or fake tooth, attached to the healthy teeth on either side; it "bridges" the gap. You want something there to keep nearby teeth from leaning in and the tooth opposite from eventually growing into the space.

A Maryland bridge (developed at the University of Maryland) is simple and inexpensive when compared to an implant. A bridge is much faster to install-it usually takes two visits. The average three-unit bridge costs $3,000 to $3,500 locally; a single implant can run $4,000 or more (you’ll get a better deal on more than one).

On the other hand, your dentist will have to grind down to a nub the teeth on either side of the gap in order to attach the bridge. Maryland bridges last only 10 to 15 years and have to be recemented or replaced. Also, it’s tough to clean under the bridge- O’Donoghue recommends a Waterpik.

An implant consists of three parts: a titanium "root," a crown on top, and an abutment to connect them. Because the implant stands alone, there’s no need to grind down the teeth on either side, as you would for a bridge, and you can floss between them.

"There’s nothing longer-lasting than an implant-it’s stable, it’s predictable, it’ll never get a cavity," says Kravitz. Though implants have been around for nearly four decades, techniques and aesthetics improved markedly in the 1990s. Implants can also act as a sturdy base for larger bridges and for dentures.

A dentist, periodontist, prosthodontist, or oral surgeon places the titanium root in or on the jawbone and lets it sit for a few months. A healing cap is then placed on top, at the gum line. (Sometimes this is done at the time of surgery.) Once healing is complete, the abutment and crown are affixed.

Besides this waiting time, implants have other considerations. Though there’s a 90-percent success rate, the body sometimes rejects an implant. Surgical risks include infection and a temporary numbness or burning sensation.

"With an abscessed tooth, I’d do a root canal rather than take it out," says Drumm. "With a missing tooth-near the front, I’d do an implant; near the back, among totally virgin teeth, I’d do an implant." But if one or both adjoining back teeth have crowns or large fillings, Drumm and Dr. Donald Kreuzer would suggest a bridge.

Kreuzer, a Northwest DC periodontist who specializes in bridges and implants, says too many dentists are doing implants without enough training-just a weekend seminar in one type or brand, which may not be the right type for you. Thirty to 50 manufacturers make implants, using different materials and designs, says DC periodontist Sally Cram, a consumer adviser for the American Dental Association.

"With anything invasive or expensive, get a second or third opinion," Kreuzer adds. "Get the costs, downsides, and alternatives explained clearly. I hate to say it, but they may be trying to talk you into something because it’s cool to do or lucrative."

What medical conditions make implants out of the question or difficult? Uncontrolled diabetes, heavy smoking, and use of Fosamax, an osteoporosis drug that, for unknown reasons, causes implants to fail. During the implant-healing period, Kravitz says, patients can switch to another drug, then resume Fosamax when the titanium root is set.

Not having enough bone in the upper jaw used to mean that bone had to be transplanted from a patient’s chin or hip in a painful operation. But now it can often be grown easily right in the jaw. It’s similar to planting seeds in a garden, only the seeds in this case are Xenograft-heated and sterilized cow-bone material with the proteins extracted. It looks like snowflakes.

You don’t have to replace mercury amalgam fillings unless they’ve come loose or have broken. The American Dental Association, the National Institutes of Health, and other scientific organizations maintain that the mercury in them is far too little to do any harm.

These days, advances can help you avoid new fillings: With strong lenses and intraoral cameras, dentists can catch decay earlier than ever. With a technique called air abrasion, which works like a micro-fine sandblaster, they can get rid of just the decay, without removing much, if any, enamel-if decay is minimal. A drill (still needed if the cavity is large) digs deeper, takes more tooth surface with it, and requires anesthesia and a bigger filling.

If you do need a filling-for a cavity or fracture, or to replace a worn filling-and the break or cavity is within the cusps, or points, of a chewing surface, you’ll need an inlay. If the break or cavity goes beyond the cusps, you’ll need an onlay. An onlay replaces a good chunk of the tooth; think of it as half a crown.

Fillings can now be made of many different materials. Which is best? Amalgams are the least expensive option, and their strength is a plus. But silver-mercury amalgams aren’t pretty and might make your teeth sensitive to heat and cold. Ditto for gold fillings, which, though highly durable, are expensive and require two visits (they’re made in a lab).

Composite resins and glass ionomers-made with glass and polyacrylic acid-match the tooth in color and require less drilling but can take longer at one visit. Ionomers, which release fluoride slowly over time but can be fragile, are better suited to cavities at or below the gum line; resin-modifed ionomers, though tougher and still fluoride-releasing, aren’t wear-resistant enough for permanent teeth but work well for children’s.

Ceramic inlays and onlays look great and don’t create sensitivity but cost more than amalgams and usually take two appointments because of the lab work. Small and medium-size ceramic fillings have a good track record, and researchers regularly create more-durable mixtures.

A newer type of filling is called CAD/CAM, short for the computer-assisted method of its design, which cuts the potential for human error. These tooth-colored ceramic mixtures offer less durability than amalgams but more than porcelain.

"Porcelain" is a bit of a misnomer-it’s not as fragile as it sounds, and it’s only one of many types of ceramic and ceramic-metal mixes in use.

That said, dentists use common sense: "No one’s going to recommend large porcelain fillings on an ice chewer," says Tenleytown’s Dr. Eugene Giannini. And you need to use common sense, too. Wear proper equipment when biking, skating, and playing sports: "A veneer won’t keep you from chipping a tooth," he adds. Don’t bite hard into peanut brittle, ice, or a frozen candy bar. As Ellenbogen points out, "Those things you probably shouldn’t bite with your own teeth, either."

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