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STATEMENT OF PROBLEM: Optimal occlusion and esthetics are goals in prosthetic treatment. Implant dentistry is no exception. PURPOSE OF ARTICLE: The purpose of this article is to discuss how the choice to use screw-retained or cement-retained implants dramatically influences the occlusion and esthetics.
OBJECTIVES: This study was conducted to evaluate various types of contemporary resin composites and glass ionomer restorative materials for color differences that occur during light curing and after submersion in water. Additionally, translucency was evaluated through the use of a translucency parameter for each of these materials at these times. METHODS: A translucency parameter was calculated from observed colors of 2 mm thick layers of light, medium and dark shades of popular restorative materials on black and white backings. The colors of these materials were also calculated, based on Kubelka-Munk theory, for layers on a B2 shade backing. Repeated measures analyses of variance were used to identify statistically significant factors for color differences and translucency parameters. RESULTS: A statistically significant interaction was found between the products, shades and time intervals or times studied for both color difference and translucency parameter. There is relatively high variability in both lightness and translucency changes among these popular products, with some products increasing and others decreasing in these parameters with curing and subsequent water submersion. SIGNIFICANCE: Kubelka-Munk theory can be used to calculate the color of a layer of material on a backing other than those used to determine the Kubelka-Munk coefficients, thereby increasing the efficiency of research into the optical properties of esthetic restorative materials. The relatively large optical changes which occur as popular esthetic restorative materials are cured and subsequently submersed in water indicate that these changes should be taken into account during any initial clinical appearance match at placement of the unset material.
In this article the author argues for the importance of reintegrating the neglected pattern of esthetics into the teaching and practice of nursing. Approaching art as both a means and end, the essay illustrates, how art can inform the specialty. By exposure to selected literary works, nurses can vicariously achieve understanding of human conditions that they could not otherwise experience. Through the art act, nurses can examine the depths of their interventions, identify them, and creatively center themselves. Integrating esthetics into nursing education and collaborating with colleagues in the field of humanities can invigorate a discipline in search of identity and justification during a time of professional turbulence.
Historically, orthodontists have not reconciled the paradox that their diagnostic and treatment decisions are based largely on objective morphological considerations and their patients' decision-making centers on esthetic expectations and other subjective factors related to self-image and outcome. Key to the unraveling of this discrepancy is a greater understanding of the role of perception by self and others in orthodontic diagnosis and treatment. Esthetics can be defined as relating to feeling, and perception can be defined as the organization of environmental stimuli. Various physical, psychological, and social factors that affect perceptual judgments are described and related to the development and maintenance of self-image and/or concept. The impact of these self and/or other perceptions of dentofacial attractiveness on motivation for seeking orthodontic care are discussed. New quantitative approaches to relate morphological changes to perception of facial appearance are reported.
As we complete the 20th and progress into the 21st century, orthodontists worldwide are experiencing a gradual but significant change in their practices. The number of adult patients has increased substantially. Although adults cooperate better than adolescents, they present a different set of challenges for the orthodontist. Adults may have worn or abraded teeth, uneven gingival margins, missing papillae, and periodontal bone loss, all of which can jeopardize the esthetic appearance of the teeth after bracket removal. This article will discuss the solutions for managing these challenging orthodontic-periodontic-restorative situations to produce a more ideal esthetic result.
This investigation was designed to compare the esthetic effects of extraction and nonextraction treatments. Panels of 58 laypersons and 42 dentists evaluated randomly presented pre- and posttreatment profiles of 70 extraction and 50 nonextraction Class I and II Caucasian patients. The samples were similar at the outset; however, at the end of treatment, the extraction patients' faces were, on average, 1.8 mm "flatter" than the faces of nonextraction subjects. The flatter faces were preferred by both panels, dentists more so than laypersons. In general, nonextraction treatment was seen as having little effect on the profile, whereas the perceived effect of extraction treatment was a statistically significant function of initial soft tissue protrusion-the greater the initial protrusion, the greater the benefit. The point at which a reduction in protrusion produces a perceived improvement was explored by way of regression analysis. Both panels saw extraction as being potentially beneficial when the lips were more protrusive than 2 to 3 mm behind Ricketts' E-plane. It is concluded that extraction treatment can produce improved facial esthetics for many patients who present with some combination of crowding and protrusion.
Magnetic attachments are a popular means of retaining removable overdentures and maxillofacial prostheses.(1) When used in anterior regions, these attachments often are not esthetic because the metallic color of the cast coping or attachment can be seen directly or through the denture base. An esthetic magnetic attachment with a composite facing can be fabricated to overcome this problem.
Anterior single-tooth replacement is the ultimate challenge facing the prosthodontist or the restorative dentist. Use of dental implants as a modality of treatment has overcome the disadvantages of conventional restorative techniques. Implantologists aim at creating an implant-supported restoration that replicates natural teeth. This article focuses on the different techniques that enhance maximum esthetic outcome of implant-supported anterior tooth restorations at the different stages of treatment. In addition, it discusses one of the problems in esthetic implant dentistry, prosthetic-driven implant placement versus available-bone-driven implant placement.
Patients demand the esthetic replacement of missing teeth in an economic and expedient manner. When teeth are extracted, or have been missing for some time, the resorption process often limits the opportunity to replace those missing teeth with dental implants. The technique presented allows the restoration of missing teeth while maintaining the hard and soft tissues. It also prevents the patient from having to wear a removable appliance during the healing phase, and this maximizes the patient's comfort and esthetics. The new method described here has been used in 55 patients with a success rate of over 98%.
This article describes a teaching strategy that has been used with graduate students to enhance their esthetic knowing through representing, interpreting, and envisioning the lived experience of a caring presence in nursing practice. As students engaged in reflecting, writing, and discussion, the explicit and tacit meanings associated with a caring presence unfolded in esthetic knowing in nursing.
Esthetic implant-supported restorations in the anterior maxilla present a number of clinical challenges to the dentist, including the need to preserve or restore the periimplant hard and soft tissue architecture around the implant site. In this clinical case report, two implant systems were used to restore two missing maxillary central incisors to make use of the physical properties in each system. Two different surgical protocols were used to place each implant, and the deficient alveolar bone was restored with an autogenous bone graft. After a detailed clinical evaluation, a comprehensive treatment plan was developed to address the unique demands of the patient. Both teeth were fully restored with esthetic, implant-supported, single-tooth restorations, and clinical results were recorded postoperatively.
A "team approach" that includes different specialties from the initial stages of implant treatment is important to achieve predictable and esthetically pleasing outcomes in compromised dental replacement cases. This report describes a severely compromised case that was properly managed by the combined efforts of a team of specialists. Briefly, prior to tooth extraction, orthodontic forced eruption was applied to coronally displace the attachment apparatus (i.e., hard and soft tissues). Then, atraumatic tooth extraction together with immediate implant placement was performed. The "sandwich bone augmentation" technique was used to augment the deficient buccal alveolar ridge. A second stage surgery was performed 6 months after healing, revealing 100% of bone fill/augmentation. This technique allowed fabrication of a final restoration that respected the proportions of the natural dentition in a case that would otherwise result in a poor esthetic outcome.
PURPOSE: The importance of dentofacial attractiveness to the psychosocial well-being of an individual has been well established. Very little information is available regarding dental patient perceptions of a pleasing esthetic image. The purpose of this study was to identify factors distinctive to attractive smiles versus unattractive smiles, as perceived by patients. MATERIALS AND METHODS: Standardized format photographs (5 x 7 in, matte finish, at f-32 and 1:2 magnification) of eight male and eight female smiles, framing only lips and teeth, were viewed by 297 subjects. The smiles exhibited differences in symmetry, tooth shade, number of teeth displayed, and height of maxillary lip line, and included both restored and unrestored teeth. Respondents ranked the photographs in order from most to least appealing appearance. Respondents viewed each series of photographs in a similar lighting and time period. A questionnaire identified the respondent's age, sex, race, education, income, and home town. Twenty-five demographic groups were established from the information in the questionnaire. Data were analyzed using stepwise discriminant analysis to determine the combination of smile characteristics that best predicted the ranking. RESULTS: The same female smile was chosen as the most attractive by 24 of the 25 demographic groups. This smile is characterized by natural teeth having light shade, high lip line, a large display of teeth, and radiating symmetry. Two female smiles typified by darker shade and asymmetry were rated by all groups as being least attractive. Two male smiles were judged equal as the most pleasing esthetically. Respondents favored those smiles characterized by light shade, a moderate display of teeth, moderate lip line, and a symmetrical arrangement of teeth. One male smile characterized by darker shade was rated as least attractive. CONCLUSIONS: In all cases, tooth shade was the most important factor, followed in sequence by unrestored natural teeth and number of teeth displayed. No correlation was found to exist between specific demographic groups and smile variables.
With the evolution of adhesive dentistry and the increasing use of porcelain veneers, single-unit crowns generally are restricted to the replacement of pre-existing full-coverage crowns and the restoration of nonvital and/or severely damaged teeth. Porcelain-fused-to-metal restorations are still widely used to generate single-unit crowns and fixed partial dentures. Collarless metal-ceramic restorations represent the most successful evolution among efforts to meet maximum esthetic requirements using porcelain-fused-to-metal restorations. Extended metal frameworks and opaque aluminous ceramic cores are associated with unpleasant optical effects in the soft tissues surrounding such restorations. This problem is particularly evident in the presence of the upper lip, which can generate an "umbrella effect" characterized by gray marginal gingivae and dark interdental papillae. Based on the concept of the biologic width, a systematic approach is proposed for the elaboration of an "esthetic width," including: 1) positioning of preparation margins; 2) reduction of the metal framework; and (c) appropriate marginal design of porcelain-fused-to-metal restorations. Strategic features of pontics and a specific interdental design are suggested to compensate for deficient anatomical features of the soft tissue and the edentulous ridge.
Bimaxillary protrusion and severe labioversion of anterior teeth complicate impression procedures and increase the difficulty in making esthetic predictions for the immediate complete denture patient. The presented technique, performed in reverse order of traditional methods, is accomplished in stages in which the anterior and nonessential posterior teeth are extracted and interim removable partial dentures placed. An opportunity is thus created to evaluate esthetics, phonetics, and anterior tooth function before extraction of the remaining dentition and delivery of immediate complete dentures. This technique facilitated the determination of the need for alveoplasty of the anterior maxilla.
AIM: In this study, the reproducibility of a newly developed pink esthetic score (PES) for evaluating soft tissue around single-tooth implant crowns was assessed. The effect of observer specialization was another point of interest. MATERIAL AND METHODS: Twenty observers (five prosthodontists, five oral surgeons, five orthodontists and five dental students) were given photographs of 30 single-tooth implant crowns. Seven variables were evaluated vs. a natural reference tooth: mesial papilla, distal papilla, soft-tissue level, soft-tissue contour, alveolar process deficiency, soft-tissue color and texture. Using a 0-1-2 scoring system, 0 being the lowest, 2 being the highest value, the maximum achievable PES was 14. Each observer was requested to make two assessments at an interval of 4 weeks. At the second assessment, the photographs were scored in the reverse order. RESULTS: The mean PES of evaluations at the first assessment (n=600) was 9.46 (+/-3.81 SD), and 9.24 (+/-3.8 SD) at the second one. The difference between these two means was not significant statistically (P=0.6379). Implant-related mean PES for single-tooth implants varied from 2.28 to 13.8, with standard deviations between 0.46 and 3.51. Very poor and very esthetic restorations showed the smallest standard deviations. The mean total PES was 10.6 for the prosthodontists, 9.2 for the oral surgeons, 9.9 for the dental students and 7.6 for the orthodontists. CONCLUSIONS: The PES reproducibly evaluates peri-implant soft tissue around single-tooth implants. Thus, an objective outcome of different surgical or prosthodontic protocols can be assessed. Orthodontists were clearly more critical than the other observers.
The patient, a 58-year-old woman, had started orthodontic treatment to correct spacing between the maxillary anterior teeth 6 year prior to presentation with a chief complaint of tooth discoloration and spacing. The treatment had consisted of the use of a removable appliance to retract the maxillary anterior teeth. The patient continued to wear the appliance sporadically. When she presented, the maxillary incisors were in primary occlusal trauma with Grade 2 mobility. The patient discontinued wearing the appliance. The periodontal condition was addressed with initial therapy. As part of the treatment plan to stabilize the maxillary anterior teeth and provide the patient with an esthetic result, it was decided to do a limited occlusal adjustment of the maxillary anterior teeth to control fremitus, and to place a fixed, composite resin, polyethylene ribbon-reinforced splint, using a facial approach. The esthetic restoration of these teeth was accomplished with bonded porcelain veneers.
Restoring splinted mandibular incisors and canines with full crown restorations has always presented a challenge in creating an esthetic illusion of reality of normal individual teeth. This treatise is designed to present the rules for mandibular anterior esthetics that have been distilled from almost 4 decades of clinical practice of restoring dentitions that have been severely compromised by the deformities of disease or accident. The resultant formula systematically creates the desired results with a high degree of predictability.