Biomedical subjects
Publications and source records attributed to J C Kois.
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
Three different procedures that involve the use of Triad gel are described. This light-polymerized resin material is versatile and easy to use in the dental clinic and laboratory. The procedures described include the transfer of ridge topography for ovate pontic sites, implant lab analog fixation, and solid/soft tissue cast fabrication.
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STATEMENT OF PROBLEM: Fracture is a clinical failure modality for ceramic veneers. Whether design of tooth preparation can affect the strength of ceramic veneers remains controversial. PURPOSE: This in vitro study evaluated fracture load and mode of failure of ceramic veneers, with 4 tooth preparation designs, that were bonded on extracted human maxillary central incisors. Identical parameters were also measured on unrestored intact teeth for comparison. MATERIAL AND METHODS: Fifty maxillary central incisors were randomly divided into 5 equal groups. Each group was assigned a different tooth preparation design: (1) no incisal reduction, (2) 2 mm incisal reduction without palatal chamfer (butt joint), (3) 1 mm incisal reduction and 1 mm height palatal chamfer, (4) 4 mm incisal reduction and 1 mm height palatal chamfer, and (5) unrestored (control). Forty teeth were prepared to accommodate ceramic veneers of equal thickness and incisocervical length. Stone dies were fabricated and veneers made from IPS Empress ceramic. Ceramic veneers were bonded and all teeth mounted in phenolic rings with epoxy resin. Fracture loads were recorded with a mechanical testing machine. RESULTS: Mean fracture loads (SD) in kgf were as follows: group 1, 23.7 (6.11); group 2, 27.4 (9.63); group 3, 16.4 (3.44); group 4, 19.2 (6.18); and group 5, 31.0 (10.38). Modes of failure were also analyzed for both ceramic veneers and teeth. One-way ANOVA with multiple comparisons revealed 3 significant subsets: groups 1-2-5, groups 4-1, and groups 3-4 (P <.05). Groups 1 and 2 had no ceramic veneer fractures; group 3 had 3 ceramic veneer fractures, and group 4 had 6 ceramic veneer fractures. CONCLUSION: Groups 1 and 2 recorded the greatest fracture loads that were comparable to an unrestored control.
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Multidisciplinary treatment was essential for this patient to optimally manage the occlusion and missing teeth. When the space distribution was completed, ridge management procedures for pontic site development were accomplished. The final restorative treatment required was actually minimized to a 7-unit fixed partial denture. It was apparent the multidisciplinary treatment was essential to predictably manage this patient by decreasing risk and ensuring a long-term strategy for enhanced patient satisfaction.
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The understanding of the relationship between hard tissue, soft tissue, and tooth position is critical for the fabrication of an aesthetic implant restoration. The biology as well as the mechanics of each patient's situation should be evaluated and used to its maximal potential to support the surrounding tissues. Implant sites should be assessed before and after loss of tooth to help maintain the site in a state of aesthetic predictability. If the site deters from the ideal, procedures using orthodontics, bone grafting, or soft tissue grafting should be instituted to receive a well-placed implant. These procedures facilitate the placement of a restoration that harmonizes with the adjacent dentition.
A biologic and esthetic rationale has been presented along with a simplified controlled technique to achieve predictable results (Figures 13A and 13B). The clinician is constantly faced with the challenge of developing room for esthetic material while preserving the biologic objectives. Using the three essential anterior tooth preparation keys (incisal edge, reduction requirements, and the biologic zone) enhances predictability. Developing the incisal edge relative to the dynamics of facial esthetics provides the initial starting point of tooth preparation. The reduction requirements are designed to satisfy the mechanical principles, address the pulpal concerns, and preserve the structural requirements of the tooth. The biologic zone can be developed by using the total dentogingival complex measurements and will clinically aid in the determination of cervical limitations to providing intracrevicular margin location.
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This article describes a technique that simplifies the making of an edentulous arch impression before the fabrication of a complete denture. Making an impression of an edentulous arch requires a unique combination of managing movable soft tissue commensurate with integrating different materials and a technique for accurate reproduction. The technique described requires a two-phase approach using a syringeable addition silicone during the border molding process and a condensation silicone wash material to capture the soft tissue while the functional border molding is repeated. These more recently developed products allow us to achieve similar results and are easier, faster, and more predictable than those products used previously.
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This article exposes common myths supported by restorative dentists that serve to limit our potential for achieving more favorable results. The need to alter occlusal vertical dimension (OVD) signifies a number of concerns that include: bite force measurements, rest vertical dimension, effect on temporomandibular joint loading, effect on tooth loading, and neuromuscular adaptation/stability. There appears to be sufficient scientific support to conclude that alteration of OVD can provide a biologically compatible adjunct to treatment. These alterations can improve dentofacial esthetics, create improved visual proportions in facial height, and provide an important treatment modality for force management of the masticatory system.
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A controlled step-by-step approach for the use of templates for placement of dental implants is discussed. The provisional restoration, the blueprint for the final restoration, is duplicated in a radiopaque radiographic template. This illustrates the outline of the planned restoration in relation to the hard tissues.
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