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Esthetic orthodontics is a viable treatment option for patients seeking cosmetic enhancement. Today, the use of preadjusted orthodontic brackets and straight wire allow general dentists to create optimum esthetic results in a short period of time. Two cases are presented to demonstrate a clinical technique to enhance a patient's smile through adjunctive orthodontic therapy.
Provisional restorations fulfill many functions in restorative dentistry. Quality provisional restorations can provide the clinician, the patient, and the laboratory technician much valuable information prior to fabrication of the definitive restoration. Such diagnostic provisional restorations fabricated with acrylic resin are easily adjusted and modified until both esthetic and functional results are approved by the patient. Once this approval has been obtained, the definitive restorations can be fabricated with confidence, using the esthetic form of the provisional restorations as a blueprint.
UNLABELLED: After removal of caries or a faulty existing restoration in a posterior tooth, frequently the pulpal floor is a dark substrate. Composites are translucent by nature, and even the more opaque shades transmit nearly 60% of visible light, meaning that composites require a certain thickness to maintain their intended shade, especially if the underlying substrate is particularly dark. Depending on the intensity of the dark substrate, even relatively thick composite restorations may not be capable of disguising the discolored dentin underneath. The substrate absorbs a significant part of the light that would otherwise reflect toward the occlusal surface, and the restoration has a nonvital monochromatic grayish color. Opaquers and tints (color modifiers) may be extremely useful to overcome this situation. In this study, composite restorations were placed in extracted teeth to demonstrate that the final esthetic results rely upon the optical properties of the background as well as those of the composite material itself. Preparations with simulated dark pulpal floors were restored without the use of opaquers and tint modifiers. After tooth hydration, the final shade was recorded with photographs. The restoration was removed and a new restoration was placed, but this time with a technique involving opaquer and tints. This article compares and discusses the outcomes of these two procedures. CLINICAL SIGNIFICANCE: This demonstration shows a simple technique that can help dentists obtain predictable esthetic results in their daily practice with posterior composite restorations.
UNLABELLED: Alterations during tooth structure formation, mainly on anterior teeth, are known to severely compromise esthetics. This article presents a case report in which the etiology and clinical characteristics of anterior teeth affected by enamel hypoplasia are analyzed. The restoration treatment sequence is also discussed, demonstrating that the use of a hybrid and a microfilled composite associated with tooth hybridization (interdiffusing zone) can be used to conservatively rehabilitate a smile. CLINICAL SIGNIFICANCE: This article presents a simple and conservative technique for restoring disfiguring areas of enamel hypoplasia to achieve an optimally esthetic result.
The success of an esthetic rehabilitation depends on the understanding of the patient's needs and on effective communication among the entire dental team. The involvement of the dental technician since the beginning of the treatment plan is one of the keys for success. This article describes a systematic approach to oral rehabilitations involving esthetic areas. Technical suggestions for the construction of the diagnostic wax-up, the provisional, and the final ceramic restorations are illustrated in a logical sequence.
Restoration of endodontically treated teeth is a routine procedure in everyday clinical practice. Placement of posts and cores is often required for replacement of the missing coronal aspect of teeth. Use of traditional post-and-core systems (gold and titanium) in conjunction with all-ceramic restorations results in poor esthetics because of the reflection and lack of light transmission. For a highly esthetic outcome, there is a need to use a material that transmits and refracts light in much the same manner as a natural tooth. The purpose of this study was to clinically evaluate the light transmission of a (1) ceramic post (Celay), (2) polyester post reinforced with zirconium fibers (Snowlight), and (3) zirconia post (Cosmopost), in comparison with a cast-metal post and core covered with opaque porcelain (control). The light transmission of these systems when used in conjunction with IPS Empress all-ceramic crowns was evaluated.
A survey was conducted on 84 patients who chose to have breast reconstruction after mastectomy. A self-rating questionnaire was sent to each patient by mail to collect as much information about the patient as possible: individual status, reasons for requesting breast reconstruction, acceptance and advantages of having the new breast, satisfaction with the overall esthetic results, amount of patient information regarding breast reconstruction, and the source of this information. Once the questionnaire was completely filled out, it was returned by mail to the persons conducting this study. Fourty-three patients (51% of sample) replied with a completed questionnaire. When all the data for this survey were collected, an interesting factor emerged: 33 patients (76.7% of those who replied) reported being substantially satisfied with the esthetic results of their operation. When asked about the reasons for requesting breast reconstruction, 16 patients asserted their request was based on the desire to prove to themselves that they had overcome the disease, and 16 to improve body image. When asked about the advantages of breast reconstruction, 17 patients believed the operation would help improve inner feelings about the loss of the breast. Thus breast reconstruction is indeed an element of prime importance to mastectomized women, especially for their physical and psychological rehabilitation.
AIMS AND BACKGROUND: This paper describes the evaluation of a personal series of 106 breast cancer patients, aged 28-75 years (average, 54), treated between 1988 and 1971, to determine the success of a conservative protocol proposed as a means of combining radicality with a better cosmetic result, less alteration of the body image and an improved quality of life. METHODS: All the patients were operated with quadrantectomy and excision of axillary lymph nodes, followed by radiotherapy: 50 Gy to the whole breast plus 10 Gy on the tumor bed (boost irradiation). Adjuvant hormone and/or chemotherapy was also administered in 71/106 cases. The mean follow-up was 22.3 months. Cosmetic assessment was subjective and objective (asymmetry, loss of volume, retraction). All patients were photographed. RESULTS: The subjective judgements were: excellent 79, satisfactory 25, and poor 2, compared with objective assessments of 72, 20 and 14, respectively. Patients with poor esthetic results were almost all either T2 or treated with chemotherapy. CONCLUSIONS: Conservative treatment of breast cancer using integrated irradiation and surgery can therefore attain the required objective of eradication of the cancer while maintaining a satisfactory esthetic and therefore good psychologic outcome.
Restorative dentistry, especially esthetic techniques, demands the dentist be artist and scientist. Artistic elements such as shape of form, symmetry and proportionality, position and alignment, surface texture, and color must be considered. Conservative esthetic dentistry provides a new dimension to treatment that is rewarding and gives the dentist another means of artistic expression.
The metal-ceramic and all-ceramic esthetic restorations available today bear little resemblance to their predecessors of 2 and 3 decades ago. Metal-ceramic crowns and fixed partial dentures are successful when the dentist understands what biologic and mechanical demands will be placed on the restoration. Tissue management and tooth preparation affect long-term function and esthetic success.
Most individuals undergo some degree of psychological shock, depression, and loss of self-esteem after the loss of their teeth. Optimum success in the treatment of the edentulous patient can no longer be limited to the proper fit, function, speech, selection, and arrangement of teeth. In addition, today's dentists must use treatment strategies that include proper psychological management, caring, and recognition of the importance of the patient's perception of what is personally esthetic. This article addresses the esthetic considerations of this restorative challenge.
The importance of attractive dental and facial appearance is at an all-time high for the American consumer. Because of this emphasis on appearance, the esthetic impact of the orthodontic appliance is a matter of great concern to prospective patients. This article presents an overview of the esthetic features of currently available orthodontic appliances.
Esthetic dentistry was once a specialty of the family dentist and the orthodontist. Today it is a field for the prosthodontist, periodontist, oral and maxillofacial surgeon, and others. When jawbones are malpositioned, unesthetic facial contours can result, and dental compensations occur that can be additionally unattractive. Orthodontic attempts to correct malocclusion or other disharmonies of the dentition in affected individuals without surgical intervention can cause tooth instability and result in less than satisfactory cosmetic results. The treatment of orthognathic surgeons is especially well suited for full-face esthetic appearance--the picture the patient views each day in the mirror.
This study collected information on various aspects of esthetic dentistry, including the time used and income produced while delivering treatment to noncarious teeth. A mail survey was sent to 521 randomly selected dentists in the six-state New England area (approximately 7% of the total active dentists in that region); the response rate was 74%. The results indicated that dentists are providing a substantial amount of esthetic treatment on noncarious teeth.
Traditional periodontal treatment focused on eradicating disease but gave less consideration to the ideal esthetic relationship of periodontal supporting tissue to the teeth and face. The "perio-esthetic" approach to treatment looks at health, beauty and function as equal elements in determining treatment. It fosters communication and understanding between the general dentist, periodontist and patient.
Successful orthodontic therapy in the growing patient involves the coordination of mechanotherapy, growth modification techniques, knowledge of hard and soft tissue growth patterns and patient motivational techniques. These cases represent differing types of Class II malocclusions in which the causes and treatment solutions were quite varied. The differing esthetic needs used treatment plans designed after a careful, problem-oriented assessment of the patient's needs. In each case, the success involved appropriate timing, differential diagnosis, excellent patient cooperation and the design of treatment plans to satisfy occlusal and esthetic goals. Teamwork between general practitioners and orthodontists is critical in meeting patients' needs.
BACKGROUND: Current trends in orthodontic care emphasize alternatives to the extraction of premolars, despite a lack of support from the refereed literature for many of the nonextraction treatments. DESCRIPTION OF THE SITUATION: Anecdotal reports published in non-peer-reviewed journals have called into question the esthetic effects of extraction treatment. As calls for evidence-based treatments increase throughout dentistry, reports on the effects--both positive and negative--of different orthodontic options have appeared in growing numbers. CLINICAL IMPLICATIONS: Given the results of a variety of reports in the peer-reviewed literature, it may be concluded that orthodontic treatment involving extractions can produce improved esthetics for many patients who have some combination of crowding and protrusion. However, careful diagnosis followed by evidence-based treatment decisions should be the accepted clinical norm as the specialty of orthodontics embarks on its second century.
BACKGROUND: Materials used in restoration of cervical lesions include resin-modified glass ionomer cements, polyacid-modified resin-based composites and resin-based composites. In this study, the authors evaluated the clinical performance of these materials over a two-year period. METHODS: Thirty patients were enrolled in this study. The authors placed in these patients 130 restorations, 24 of which were Vitremer (3M Dental Products, St. Paul, Minn.), 38 were F2000 Compomer (3M Dental Products), 46 were Dyract AP (Dentsply DeTrey, Konstanz, Germany) and 22 were Valux Plus (3M Dental Products). Enamel margins were not beveled, and no mechanical retention was placed. Two independent, calibrated examiners evaluated the restorations baseline and at one and two years after placement using modified U.S. Public Health Service criteria. RESULTS: Retention rates at the end of two years were 100 percent for Vitremer, 67 percent for F2000 Compomer, 68 percent for Dyract AP and 70 percent for Valux Plus. The retention rate of Vitremer was significantly higher than that of the others (P < .05). In other categories, however, Valux Plus had the most favorable performance (P < .05). No secondary caries was detected around any restoration. CONCLUSION: Vitremer, with its high retention rate, seems to be the most appropriate material for restoration of noncarious cervical lesions, though it does not have the esthetic properties of resin-based composites. All materials used in this study were in need of improvements. CLINICAL IMPLICATIONS: Resin-modified glass ionomer cement, polyacid-modified resin-based composite and resin-based composite behaved differently in the restoration of noncarious cervical lesions. Therefore, clinicians should take factors such as esthetic needs and localization into account in selecting materials for such restorations.