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PubMed2001

Predictable single tooth peri-implant esthetics: five diagnostic keys.

The creation of an esthetic implant restoration with gingival architecture that harmonizes with the adjacent dentition is a formidable challenge. The predictability of the peri-implant esthetic outcome may ultimately be determined by the patient's own presenting anatomy rather than the clinician's ability to manage state-of-the-art procedures. To more accurately predict the peri-implant esthetic outcome before removing a failing tooth, five diagnostic keys are discussed. These keys include relative tooth position, form of the periodontium, biotype of the periodontium, tooth shape, and position of the osseous crest.

Dental Implants, Single-Tooth↗

PubMed2001

Site development for anterior single implant esthetics: the dentulous site.

An inevitable loss of soft and hard tissue after tooth extraction often results in a compromised site for anterior implant esthetics. Various augmentation techniques have been advocated as corrective procedures, but these techniques are time-consuming and not always predictable. Therefore, the fundamental concept of site development for anterior single implant esthetics in the event of a failing tooth is to preserve the existing gingival and osseous tissue. This article identifies factors that affect tissue changes and describes an integration of surgical and prosthodontic approaches that can optimize the tissue maintenance in the anterior esthetic zone.

Alveolar Bone Loss↗

PubMed2001

Esthetic implant dentistry.

Consistency of results, reliability of treatment modalities, and long-term prognosis require scientific approaches to therapeutic procedures. Reliable and unbiased information rooted in academics and research assist the health care professional use current technology to develop the best course of action to restore or enhance the best esthetic outcome for the patient. Without anticipating potential failure, any immediate success is limited to initial satisfaction while ignoring the far greater elements of a future problematic outcome. This article proposes procedures for soft and hard tissue preservation, repair, or reconstruction in esthetic implant dentistry and emphasizes that an essential prerequisite to effective esthetic therapy is the establishment of a complete and accurate diagnosis.

Alveolar Bone Loss↗

PubMedDate not supplied

Using AMSA and P-ASA nerve blocks for esthetic restorative dentistry.

Esthetic restorative dentistry procedures represent an increasing segment of the services provided by the general practitioner. One important assessment criterion for a successful anterior esthetic restoration is how well it harmonizes with the lips to create a pleasing smile line. Unfortunately, traditional local anesthetic techniques interfere with this assessment by distorting the lips and face during anesthesia. The anterior, middle superior alveolar block and the palatal approach anterior superior alveolar block injections represent two recently defined techniques to anesthetize maxillary teeth effectively without numbness of the face, lips, or muscles of expression. Although safety and efficacy studies are only beginning to emerge, these injections appear to be useful additions to local anesthetic techniques, especially when anterior esthetic restorative procedures are being performed.

Anesthesia, Dental↗

PubMed2002

Distraction osteogenesis: a treatment tool to improve baseline conditions for esthetic restorations on immediately placed dental implants--a case report.

Replacement of two adjacent teeth in an anterior maxilla with deficient hard and soft tissues appears to be the utmost challenge in implant dentistry in the esthetic zone. In this case report, baseline conditions for implant placement were improved by alveolar distraction to enhance hard and soft tissues around the maxillary central incisors. Three months after the active phase of distraction, the roots of the central incisors were extracted and two screw-type dental implants were immediately placed into the extraction sockets. For immediate provisionalization, acrylic resin crowns were fabricated on UCLA abutments, providing the ideal emergence profile to support the periimplant soft tissue. Six months after implant placement, the prosthetic restoration of the case was finished with ceramic crowns cemented to individually fabricated zirconium oxide abutments. The described treatment strategy appears to have a great potential to restore natural esthetics in cases with major tissue deficiencies in the esthetic zone.

Acrylic Resins↗

PubMed2002

Optimal dental and facial esthetics in orthodontics--a multifaceted challenge.

The role of the orthodontist in resolving the patient's dental and facial esthetic concerns is a challenge due to the number of factors to be evaluated. The effect of growth and aging, and the existing dental, gingival, dentoalveolar, skeletal, and facial soft tissue components mandate a thorough investigation into all treatment options and modalities available to reach optimal esthetic goals. The orthodontist is further challenged with professional bias and patient bias and desires. Mounted study models, facial and intraoral photographs, cephalometric evaluation of dentoskeletal relationships, VTOs and STOs for trial treatment, computerized imaging, and clinical soft tissue evaluation are essential in proper diagnosis, treatment planning, execution of treatment, and assessment of post treatment results. With proper planning, the challenge of reaching dental and facial esthetic goals can be met without compromising the functional occlusal goals, periodontal health, TMJ health, and long term stability.

Aging↗

PubMed2003

Simple tools to facilitate communication in esthetic dentistry.

Communication is a critical element to obtaining satisfying results with esthetically driven treatment. Communication must first be established with the patient then among all the clinicians and technicians involved with the treatment to achieve the esthetic goals of the patient. This article will review methods to communicate esthetic parameters to allied specialists and the dental technician.

Communication↗

PubMed2003

Esthetic considerations with removable partial dentures.

The reduction in partial edentulism that has occurred due to successful preventive procedures and the predictable use of osseointegrated implants has reduced the need for removable partial dentures. However, for a variety of reasons, many patients can continue to benefit from partial denture therapy; and these patients deserve the best esthetic result possible. The primary esthetic objection to removable partial denture therapy is the unsightly display of the clasp assemblies. This article describes three strategies that can be used by the discriminating clinician to eliminate the display of the clasp assembly and provide an esthetic and functional removable prosthesis.

Dental Clasps↗

PubMed2004

Understanding the esthetic evaluation for success.

With any restorative procedure, a thorough evaluation, diagnosis, and treatment plan is essential for a positive outcome. When dealing with esthetic dilemmas, the some holds true. Without a sequential esthetic evaluation, diagnosis, treatment plan, and execution, an acceptable outcome is difficult to predict. The treating clinician should be able to visualize the esthetic problem, visualize the proposed changes, and devise a way to achieve the result while still maintaining mechanically, functionally, and biologically sound principles.

Color↗

PubMed2004

Dental implants in the esthetic zone. Considerations for form and function.

Successful esthetic results of dental implant placement in the esthetic zone require knowledge of various concepts and techniques. Careful preoperative treatment planning, augmentation of hard and soft tissues, and attention to the details of implant surgical and prosthetic techniques are areas that must be addressed when treating the anterior maxilla. This article will address the fundamental considerations related to implant treatment in the anterior maxillary esthetic zone, using both theory and case examples.

Bone Transplantation↗

PubMedDate not supplied

Esthetic removable partial dentures.

This article provides information regarding the many ways that removable partial dentures (RPDs) may be used to solve restorative problems in the esthetic zone without displaying metal components or conspicuous acrylic resin flanges. The esthetic zone is defined and described, as are methods for recording it. Six dental categories are presented that assist the dentist in choosing a variety of RPD design concepts that may be used to avoid metal display while still satisfying basic principles of RPDs. New materials that may be utilized for optimal esthetics are presented and techniques for contouring acrylic resin bases and tinting denture bases are described.

Cuspid↗

PubMed2004

Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations.

The placement of dental implants in the anterior maxilla is a challenge for clinicians because of patients' exacting esthetic demands and difficult pre-existing anatomy. This article presents anatomic and surgical considerations for these demanding indications for implant therapy. First, potential causes of esthetic implant failures are reviewed, discussing anatomic factors such as horizontal or vertical bone deficiencies and iatrogenic factors such as improper implant selection or the malpositioning of dental implants for an esthetic implant restoration. Furthermore, aspects of preoperative analysis are described in various clinical situations, followed by recommendations for the surgical procedures in single-tooth gaps and in extended edentulous spaces with multiple missing teeth. An ideal implant position in all 3 dimensions is required. These mesiodistal, apicocoronal, and orofacial dimensions are well described, defining "comfort" and "danger" zones for proper implant position in the anterior maxilla. During surgery, the emphasis is on proper implant selection to avoid oversized implants, careful and low-trauma soft tissue handling, and implant placement in a proper position using either a periodontal probe or a prefabricated surgical guide. If missing, the facial bone wall is augmented using a proper surgical technique, such as guided bone regeneration with barrier membranes and appropriate bone grafts and/or bone substitutes. Finally, precise wound closure using a submerged or a semi-submerged healing modality is recommended. Following a healing period of between 6 and 12 weeks, a reopening procedure is recommended with a punch technique to initiate the restorative phase of therapy.

Alveolar Bone Loss↗

PubMed2004

Predictable single-tooth peri-implant esthetics: five diagnostic keys.

The creation of an esthetic implant restoration with gingival architecture that harmonizes with the adjacent dentition is a formidable challenge. The predictability of the peri-implant esthetic outcome may ultimately be determined by the patient's own presenting anatomy rather than the clinician's ability to manage state-of-the-art procedures. To more accurately predict the peri-implant esthetic outcome before removing a failing tooth, 5 diagnostic keys are discussed. These keys include relative tooth position, form of the periodontium, biotype of the periodontium, tooth shape, and position of the osseous crest.

Alveolar Process↗

PubMed2005

Influence of the 3-D bone-to-implant relationship on esthetics.

There are biologic limits of the soft tissue dimension around implants; therefore, the limiting factor for the esthetic result of implant therapy is the bone level at the implant site. Clinicians must focus on the 3-D bone-to-implant relationship to establish the basis for an ideal and harmonic soft tissue situation that is stable over a long period. In some situations, missing bone is a limiting factor for esthetics; in others, it is possible to regenerate new bone around implants. As a certain amount of bone resorption occurs around implants as soon as the implant is in contact with the oral environment, the distance between an implant and adjacent tooth, as well as the distance between two implants, is as important as the bone volume on the buccal side of the implant head and in the papillary area, especially for the long-term result. This article discusses the 3-D bone-to-implant relationship and its influence on soft tissue esthetics around implants.

Alveolar Bone Loss↗

PubMed2005

Achieving quality esthetic dentistry and integrated comprehensive care with new generation techniques and materials.

BACKGROUND: Prosthodontics is the dental specialty responsible for diagnosis, rehabilitation and maintenance of patients with complex clinical conditions involving missing or deficient teeth and/or craniofacial tissues. The essence of the specialty is expert treatment planning. OVERVIEW/LITERATURE REVIEWED: In recent years, new approaches and technology have been introduced as a result of research performed in universities and by industry. The field of prosthodontics continues to evolve owing to a better understanding of the biology of the oral cavity and the introduction of new techniques and improved biomaterials. Improvements in periodontal and oral surgical techniques, implant procedures and materials, esthetic restorative materials, and jaw tracking recorders and articulators have led to enhanced functional and esthetic oral and maxillofacial prostheses. CONCLUSIONS AND CLINICAL IMPLICATIONS: The complexities of today's technical and clinical procedures and the higher expectations for more esthetically pleasing dentistry by the general patient population have placed a premium on teamwork involving general dentists, specialists and dental technicians.

Ceramics↗

PubMed2005

Anterior esthetic gingival depigmentation and crown lengthening: report of a case.

Excessive gingival display space and gingival hyperpigmentation are major concerns for a large number of patients visiting the dentist. Melanin hyperpigmentation usually does not present a medical problem, but patients usually complain of dark gums as unaesthetic. This problem is aggravated in patients with a "gummy smile" or excessive gingival display while smiling. Esthetic periodontal plastic surgery is especially rewarding in such individuals with compromised esthetics. A case is reported here on the cosmetic correction of "black gums" and "gummy smile." Periodontal plastic surgery combining gingival depigmentation and esthetic crown lengthening was performed in a single appointment using scalpel surgical technique. The outline of steps involved in the surgical procedure is demonstrated and a brief review of the various gingival depigmentation techniques is depicted here.

Adult↗

PubMed2005

The congenitally missing maxillary lateral incisor. Part 1: esthetic judgment of treatment options.

AIM: To determine how general dentists, orthodontists, combined dental specialists, and laypeople judged the relative attractiveness of a series of photographs of teeth that included cases with congenitally missing incisors to compare the esthetic appeal of various treatment options. METHODS: The photographs included cases with Maryland bridges, dental implants, and orthodontic substitution of the lateral incisors with the canines. Cases with no missing teeth were included as controls. The subjects rated each photograph independently, assigning a number between 1 and 5 for each of a series of 7 bipolar adjectives. Each photograph was given an overall score from 7 (best) through 35 (worst) for use in statistical analysis (ANOVA). RESULTS: Results indicated that general dentists, orthodontists, combined dental specialists, and laypeople differed in their evaluations of the photographs, which represented multiple treatment options for congenitally missing maxillary lateral incisors. CONCLUSIONS: Including esthetics of the finished result as an advantage or disadvantage for either restoration or canine substitution of the lateral incisors could be misleading to the patient because the judgment of esthetics of a smile can vary from one person to another or from one dental professional to another, as indicated in this study.

Analysis of Variance↗

PubMedDate not supplied

Tissue-directed placement of dental implants in the esthetic zone for long-term biologic synergy: a clinical report.

Implant dentistry steadily evolves as more is learned about the unique biologic interrelationship of the dental implant restoration and the surrounding hard and soft tissues. Important factors include the impact of the surface microtopography on biochemically-mediated cell differentiation, the unavoidable bacterial colonization of the implant-abutment (or crown) microgap, the vertical and horizontal dimensions of biologic width, and the histology of surrounding structures. The recipient site, implant design, surgical technique, and location of the restorative platform significantly influence the optimal esthetics and biologic stability of implant restorations. There are differing opinions among clinicians regarding the appropriate positioning of the implant restorative platform in the vertical and sagittal planes relative to the alveolar crest. An apical and palatal orientation of the coronal platform relative to the alveolar crest in the esthetic zone is generally advocated for favorable facial and proximal emergence profiles of the definitive crown. Tissue-directed implant placement primarily considers the long-term consequences of the implant restoration upon the surrounding hard and soft tissues. The goal is to develop optimal gingival contours and a definitive restoration in the esthetic zone that coexist in stable biologic synergy. The rationale and the specific prosthodontic and surgical protocols inherent in the tissue-directed concept are discussed in this report.

Dental Implantation, Endosseous↗