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Prosthodontics: achieving quality esthetic dentistry and integrated comprehensive care.

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.

Dental Porcelain↗

Esthetic alternative for fluorosis blemishes with the usage of a dual bleaching system based on hydrogen peroxide at 35%.

Esthetic dental procedures in pediatric dentistry represent sources of satisfaction and realization, as much for the patient as for the professional. Lack of dental esthetics may develop psychological problems in infant as well as in adolescent patients. Blemishes produced by fluorosis appear as a challenge to the pediatric dentist and alternatives for treatment are desired. The scope of this present paper is to relate a clinical case with esthetic solution for blemishes in teeth enamel due to fluorosis. A dual system of bleaching was used (photo/chemically activated) based on hydrogen peroxide at 35% (Hi-Lite-Shofu) in a male eight-year-old patient with white fluorosis blemishes on teeth 11 and 21. The bleaching system used was efficient in bleaching teeth with white blemishes due to fluorosis, thus masking the blemishes and providing a more uniform appearance.

Child↗

Periodontal esthetics and soft-tissue root coverage for treatment of cervical root caries.

As the pace of change accelerates in periodontics and esthetic dentistry, an increasing number of procedures are being developed that require knowledge and treatment from both fields. The synergy developed by combining these two fields of dentistry allows for better esthetic outcomes for our patients. Two of these procedures include esthetic crown lengthening and soft-tissue root coverage. As demonstrated in this article, soft-tissue root coverage can be performed on previously restored roots and as an option for treating root caries.

Anti-Bacterial Agents↗

Ceramic abutments--a new era in achieving optimal esthetics in implant dentistry.

In the visible dental region in particular, implant-prosthetic restorations filling single-tooth gaps make exacting demands on function and esthetics. One crucial factor influencing the esthetic outcome is the emergence profile of the restoration. The introduction of aluminum oxide or zirconium oxide abutments, which can be milled to meet individual requirements, provides new opportunities for reconstruction adapted to anatomic findings. Tooth-matched coloring combined with customized preparation and dimensioning make for optimal mucogingival esthetics in implant-supported single-tooth restorations. The aim of the present article is to give a general survey and to illustrate the use of ceramic abutments with clinical case reports.

Adolescent↗

The esthetic space maintainer.

This article describes why it is important to replace the maxillary primary incisors when they are prematurely lost in children. The consequences of not replacing these teeth in relation to speech, esthetics, and self-image considerations are provided. A step-by-step description is presented for the fabrication of an esthetic appliance, which can be easily made to replace missing maxillary primary incisors. In addition, information is presented on when and how to remove the esthetic appliance.

Child↗

[Restoring esthetics and function of posterior teeth using direct composite restoration].

The growing demand for esthetic restorations in the posterior segments and the reports from all over the world concerning the possibility of a toxic effect of amalgam brought to the development of the composite resin materials. These allow excellent esthetic results without compromising the quality and long-term stability of the restorations. Out of the various types of posterior esthetic restorations, the most available are the direct ones. There are several substantial differences between fabricating amalgam or posterior composite restorations. The most significant difference concerns bonding to the tooth structures. The key to success in these restorations is the understanding of the reasons for failure, and the ways to prevent them. The failures are divided into two groups: biological failures--namely secondary caries, and mechanical failures--namely fracture and abrasion. The other key is understanding the materials used and their proper handling. This article illustrates in detail a step-by-step procedure the sequence of fabricating a posterior composite restoration in a posterior mandibular tooth, describing both techniques and materials used.

Bicuspid↗

Effect of prophylactic polishing protocols on the surface roughness of esthetic restorative materials.

Many polishing protocols have been evaluated in vitro for their effect on the surface roughness of restorative materials. These results have been useful in establishing protocols for in vivo application. However, limited research has focused on the subsequent care and maintenance of esthetic restorations following their placement. This investigation evaluated the effect of five polishing protocols that could be implemented at recall on the surface roughness of five direct esthetic restorative materials. Specimens (n=25) measuring 8 mm diameter x 3 mm thick were fabricated in an acrylic mold using five light-cured resin-based materials (hybrid composite, microfilled composite, packable composite, compomer and resin-modified glass ionomer). After photopolymerization, all specimens were polished with Sof-Lex Disks to produce an initial (baseline) surface finish. All specimens were then polished with one of five prophylactic protocols (Butler medium paste, Butler coarse paste, OneGloss, SuperBuff or OneGloss & SuperBuff). The average surface roughness of each treated specimen was determined from three measurements with a profilometer (Surface 1). Next, all specimens were brushed 60,000 times at 1.5 Hz using a brush-head force of 2 N on a Manly V-8 cross-brushing machine in a 50:50 (w/w) slurry of toothpaste and water. The surface roughness of each specimen was measured after brushing (Surface 2) followed by re-polishing with one of five protocols, then final surface roughness values were determined (Surface 3). The data were analyzed using repeated measures ANOVA. Significant differences (p=0.05) in surface roughness were observed among restorative materials and polishing protocols. The microfilled and hybrid resin composite yielded significantly rougher surfaces than the other three materials following tooth brushing. Prophylactic polishing protocols can be used to restore a smooth surface on resin-based esthetic restorative materials following simulated tooth brushing.

Analysis of Variance↗

The effect of air polishing on contemporary esthetic restorative materials.

Air polishing devices are designed primarily to remove soft deposits and stains from tooth surfaces. While improved strength and durability of esthetic restorative materials have resulted in increased usage, the effect of air polishing on these improved materials has not been determined. The purpose of this study was to examine the effect of air polishing on contemporary esthetic restorative materials. Four materials were tested: ceramic, hybrid composite resin, microfilled composite resin, and glass ionomer cement. Ceramics and hybrid composites exhibited the least change in surface roughness, followed by microfilled composites. Glass ionomers showed the greatest change in surface roughness. Results from this study suggest the surface roughness of all of the materials tested increased after exposure to air polishing instrumentation. Practitioners utilizing air polishing devices for prophylaxis procedures should exercise caution in the area of esthetic restorations.

Acrylic Resins↗

Restoring the single lower incisor implant with esthetics, antirotation, and retrievability.

The long-term success of restoring the lower incisor implant is partially dependent on retrievability of all components down to the implant. Because this implant is usually placed vertically or buccally in the bone, the ability to achieve esthetics without seeing the screw access hole becomes critical. The emergence profile of the crown overlying the implant fixture ultimately dictates the esthetics. The single crown can also become loose during function and, therefore, antirotation of the abutment is imperative. The Octa-Hex Implant Restoration System presents an alternative method of achieving gingival seal with a titanium-alloy connector to the implant, emergence profile with a custom-fabricated casting on this connector, antirotation from intimate contact with implant indexing, and retrievability by a fixation screw and cementation. With the lower incisor, this system offers retrievability without the screw access hole affecting esthetics.

Crowns↗

Directly placed esthetic restorative materials--the continuum.

Because new restorative materials have had little clinical testing, it is difficult to make specific material recommendations for the esthetic restoration of carious teeth. Although fluoride-releasing materials have long been used successfully to restore carious teeth, little clinical documentation has been presented to support their use to inhibit recurrent caries, and their use as an effective restorative material may be questioned. Glass ionomers, compomers, and resin-modified glass ionomers are esthetic fluoride-releasing materials designed to restore teeth by bonding to tooth structure. This article describes the continuum of directly placed esthetic dental restorative materials, the efficacy of amalgam replacement restorative materials, and the role that fluoride-releasing materials may play in the inhibition of recurrent caries in vitro and in vivo.

Composite Resins↗

An interview with Dr. Ronald Jackson, DDS, on esthetic inlays and onlays. Interview by Dr. Gary Severance.

Dr. Ronald Jackson is a graduate of West Virginia University School of Dentistry. After a general practice residency and service with the Navy in London, England, he began private practice in Middleburg, VA, in 1976. His practice emphasizes comprehensive restorative and cosmetic dentistry. In an effort to identify leaders in the field of restorative and cosmetic dentistry for Signature readers, I asked Dr. Jackson to meet with me to discuss his experience with inlays and onlays as well as his efforts to educate patients about the different types of restorations available to them. Dr. Jackson has published many articles and lectures extensively on esthetic inlays and onlays. He has twice been a featured speaker at the annual meeting of the American Academy of Cosmetic Dentistry and is scheduled to present at the 1995 meetings of the American Academy of Esthetic Dentistry and the American Society for Dental Aesthetics. Dr. Jackson is an accredited member of the AACD and holds visiting faculty appointments to the postgraduate programs in esthetic dentistry at the State University of New York at Buffalo and Baylor University Schools of Dentistry. He is on the editorial boards of three dental publications and consults to a number of dental manufacturers in the area of new product development and clinical testing of materials.

Aluminum Silicates↗

Perspective of facial esthetics in dental treatment planning.

Enhancement of facial beauty is one of the primary elective goals of patients seeking dental care. The lower one third of the face has a major impact on the perception of facial esthetics. Frequently improvements in natural beauty can be expected to follow restoration of ideal relationships between the denture and the facial soft tissues. By improving deficient facial proportion and integumental form, surgeons, orthodontists, and restorative dentists have the unique opportunity to address these esthetic needs. Comprehensive evaluation that relates the facial soft tissues to underlying skeletal form provides this possibility. Fundamental relationships exist that allow correlation of deficiencies in facial form to existing dentoalveolar anatomy. Classical evaluation of mounted casts and occlusal analysis does not offer this insight.

Alveolar Process↗

Expression plasty: a new approach to esthetic surgery.

Training in esthetic surgery focuses on correcting crooked noses, wrinkled skin, bald scalps, and other unsightly facial structures. However, little importance is placed upon facial expressions--eg, "weak," "serious," "feminine," etc. Surgeons have discovered, through experience, that a recessed chin gives one a "dumb" expression, that a drooping nose denotes an "aging" expression, and that baggy eyelids confer a "tired" expression; yet few efforts have been made to study this area in more depth. This article explores the field of facial expression and its place in facial esthetic surgery.

Esthetics↗

[Functional and esthetic results of osteoplastic frontal sinus operations and profile reconstruction with bitemporal coronal incision].

BACKGROUND AND OBJECTIVE: The majority of inflammatory frontal sinus diseases requiring operative intervention can now be managed successfully by endonasal surgery. In problematic cases, however, optimal exposure of the entire frontal sinus and possibly complete mucous membrane removal combined with sinus obliteration must be achieved. In these cases, external frontal sinus surgery is indicated. PATIENTS/METHODS: The operative approach and findings of 35 osteoplastic sinusotomy operations and 5 forehead reconstruction operations with porous polyethylene are reviewed. Median follow-up was 3.7 years, ranging from 1 to 7 years. Indications for surgery were trauma (12), infections (8), tumors (11), muco- or pyoceles (4), and frontal deformities (5). RESULTS: The overall functional and esthetic result was excellent. No recurrent infection was noted. None of the patients have required revision surgery so far, and no serious complications occurred. Abnormal forehead sensation was reported by 12 patients (30%). Temporary double vision was described in 3 cases (7.5%). CONCLUSIONS: Due to optimal sinus exposure and advantageous incision, osteoplastic frontal sinusotomy leads to excellent functional and esthetic results. Porous polyethylene demonstrates superior material properties and seems to be, in comparison with other implants, the current material of choice in frontal reconstruction.

Adult↗

[Autogenous bone transplants in repair of the traumatically damaged orbit. Functional and esthetic results in 42 cases].

BACKGROUND: Autogenous bone transplantation is a well established aspect of craniofacial traumatology. This study evaluated functional and esthetic success in repairing traumatically damaged orbits by autogenous bone transplantation. PATIENTS AND METHODS: We repaired 102 osseous orbital defects by autogenous bone transplantation, 98 by calvarium split graft and 4 by iliac crest transplant. Of 42 surgical patients 34 were followed up. RESULTS: Autogenous bone transplants have proven themselves for repair of traumatically damaged orbits. Calvarium split grafts are particularly suitable for this purpose. Good esthetic and functional results can usually be achieved with primary osseous defect repair. However, more protracted functional defects can often no longer be helped. CONCLUSION: Autogenous bone transplants can be broadly recommended for providing primary care.

Bone Transplantation↗

Gingival contour and clinical crown length: their effect on the esthetic appearance of maxillary anterior teeth.

Fractured, congenitally missing, or avulsed maxillary incisors can often jeopardize the esthetic appearance of the remaining maxillary anterior teeth after orthodontic treatment. In many cases the unesthetic appearance is related to the irregular clinical crown lengths of either the fractured teeth or those that have been substituted for the missing teeth. The results of five cases with either fractured or traumatically avulsed central incisors are reported. Selective tooth intrusion and restorative techniques were used during the finishing stages of orthodontic treatment to improve the final esthetic result. The advantages and disadvantages of the intrusion technique are discussed.

Adolescent↗

A simple procedure to assess esthetic preference for dentofacial treatment.

A procedure is described in which lateral facial photographs were cut apart and reassembled in ways that approximated desired esthetic change. Two groups of subjects were asked to complete the Sassouni "cut-up-paste-back" procedure. Group 1 consisted of 20 adult dental professionals; group 2 comprised 18 college students unacquainted with dental studies. Both groups made similar alterations on a photograph at the beginning and at the end of a 2-week period. Photographic alterations were highly similar to written descriptions of intended changes. The "cut-up-paste-back" procedure is a simple and inexpensive way to facilitate dentist-patient communication during treatment planning. The procedure also has applicability for research in facial esthetic preference.

Adolescent↗

Esthetics for denture patients.

Denture esthetics has been discussed in terms of the anatomic-physiologic and artistic phases. It is the responsibility of the dentist to apply the principles discussed in an effort to produce a natural appearing denture. Excessive dependence on auxiliary personnel in meeting the esthetic needs of the patient can only encourage the denturist movement and quick, low-cost denture clinics. Faced with this threat, we must not shirk our responsibilities.

Color↗