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During the past 5 years, tremendous advancements have been made in the application of the principles of osseointegration to esthetic dentistry. Long-term predictability, combined with time-honored esthetic principles, can now greatly benefit patients previously burdened by removable dental appliances.
Sophisticated esthetic restorative dentistry cannot routinely be developed without close coordination with laboratory personnel. Direct communication between operatory and laboratory personnel and the patient is an integral requirement for predictable results. By effectively delegating many preparatory procedures to laboratory personnel, the efficiency and quality control of operatory procedures can be greatly enhanced. Coordination of each operatory procedure with the appropriate preliminary, concurrent, and subsequent laboratory procedures can provide the patient, technician, and dentist with a mutually appreciated functional and esthetic result.
The metal framework is the essential precursor to a successful porcelain fused to metal fixed partial denture. The framework should be rigid not by bulkiness, but by design. Pontics must be supported to span the edentulous space and replace the missing dentition while providing adequate space for a 1-mm porcelain veneer. The combined thickness of the metal and porcelain must be sufficient to achieve the desired color and vitality without producing a prosthesis that is morphologically overcontoured. To develop a framework that meets all the requirements of physiology, esthetics, and strength, a diagnostic waxup directs the positioning of connectors and allows planning of both form and support. A properly designed and positioned connector area should allow separation of the units by permitting the development of natural appearing labial embrasures. At the same time, the connector must, by engineered design, provide adequate structural strength to support the porcelain. Designing and fabricating the metallic framework for a fixed partial denture requires planning and an understanding of what is desired in the final form. An outline has been presented that details the connector form and placement and a technique has been suggested for developing a framework that provides optimal strength while allowing space for placement of esthetically contoured porcelain.
Esthetic saphenectomy, called "Gévaudanaise", allows removal of the internal saphena from its crook to the knee without contraincision or puncture of the leg. Perivenous dissection always removes the three tunicae of the wall. The steel cord of the excising instrument cuts the saphena at the knee without cutaneous perforation. Surgery is performed under ambulant conditions with local anesthetic, and combines esthetic considerations with decreased anesthetic and thromboembolic risk.
For the patient, the appearance of the finished restoration is of paramount importance. To avoid an esthetic failure, the dentist should pay attention to those various components of removable partial dentures which play a role in esthetics.
At the beginning of this article, we asked the question "Is there a problem?" The answer to this question is yes, but at different levels for individual dentists and individual treatment situations. Adequate esthetic mouth preparation for ceramic restorations requires far more than tooth preparation. This article has outlined the major areas of concern. Readers must recognize areas of individual need and explore them in greater detail in the dental literature. It is hoped that this article has stimulated readers to learn more about esthetic moth preparation for ceramic restorations.
Several excellent systems (porcelain to metal, high-strength core jacket, and laminated veneers) exist for the fabrication of realistic porcelain restorations. The usefulness of any of these systems is enhanced by being able to transfer shade information from the patient to the ceramist. Communication is thus facilitated and a leading cause of remakes decreased. Esthetics can be improved, as the dentist and technician can use both the wide color range of existing commercial porcelains to better advantage. Colors and effects that are seen can be duplicated not only at the surface with surface stains, but also within the restoration, as desired. Shade tabs that are more realistic and common to both the laboratory and the dental office make possible the broadening of the scope of the teeth that can be matched. Patients are demanding better esthetics in all forms of tooth color materials. This is one challenge of restorative prosthodontics.
In the light of sculptures by the Canadian Mark Prent a comment is made on the 'Esthetics of Ugliness' from the medical and socio-psychological point of view. The focal point of interest lies in the interaction between the work and the onlooker. The onlooker's concern with the problem of the 'Esthetics of Ugliness' is considered as a possibility of understanding better and, therefore, preventing or as the case may be curing mental disorders of the individual and society as well as the impedding and even disease-causing factors in human relations.
For many years, the ultimate goal of the periodontal/restorative team was to provide an environment for crowns that would provide long-term, successful results. Two essential goals of periodontal therapy were pocket elimination and an adequate zone of keratinized gingiva. The establishment of an adequate zone of keratinized gingiva, which is firmly attached to the underlying periosteum and osseous tissues, is critical for the long-term functional and esthetic results of implant restorative dentistry. Five cases are presented that illustrate the clinical management of soft tissue to achieve functional and esthetic zones of keratinized gingiva.
Esthetic restorations for the anterior primary dentition are discussed. Varied primary crowns--stainless steel, composite strip crowns, preformed ceramo-base metal crowns, and stainless steel crowns with composite facings--are evaluated as to their advantages and disadvantages. The repair of grossly decayed teeth, for example, nursing bottle caries, using complete endodontic therapy and stress relieved posts is described. Alternative esthetic anterior restorations, fixed and removable, are evaluated as to their efficacy.
The restoration of primary anterior teeth presents complicated esthetic and retention problems to the clinician. A technique is described for the chairside veneering of composite resin to stainless steel crowns, which results in well contoured restorations with superior durability and esthetics. A trimmed and fitted stainless steel crown can be veneered in three to five minutes. This provides the adaptability and gingival contour benefits of the stainless steel crown in conjunction with the cosmetics of the composite facings. The technique described produced composite veneers with a mean sheer bond strength of 3520 PSI (24.4 Mpa).
The field of dental implantology has expanded treatment options available to patients with incomplete dentitions. With the use of regenerative techniques and periodontal plastic surgery procedures, the periodontium and its surrounding tissues can be modified in an attempt to re-create normal function and esthetics. This article describes a combination of surgical procedures, including the placement of endosseous dental implants, guided tissue regeneration, and periodontal plastic surgery, used to restore function and esthetics in the maxillary anterior region.
Traditionally, dentistry has focused on biomedical and mechanotechnical approaches to patients' dental health care. Objective and quantifiable measurements, such as tooth form, occlusal function, color, and biological compatibility, are conventional indicators of success or failure. However, unlike most facets of dental practice, the attainment of an enhanced facial and dental appearance is influenced and measured by more abstract, psychological factors such as perception, ideal body image, self-image, and personal motivation. These complex concepts are affected by emotional and personality factors that develop during the life cycle. This article will explore a psychodynamic perspective of patients who are dissatisfied with the esthetics of their dental treatment, although the result may be functionally and esthetically acceptable.
Esthetic restorative practices have used bonded ceramic facial veneers to replace or augment defective, discolored, or missing enamel. These restorations have proved to be highly esthetic and extremely durable. Sometimes it is necessary to extend the veneers onto occlusal, lingual, or proximal surfaces to cover defective tooth structure. This article will define "full veneers," present indications, show preparation designs, and present clinical cases where full veneers have been used.
The maxillary anterior region presents a difficult and unique therapeutic challenge in the treatment of periodontal disease. The periodontist should use therapeutic procedures to prevent or minimize esthetic problems, such as increased tooth length and loss of interdental papilla, without compromising the main goals of periodontal treatment. This article presents various periodontal treatment modalities that can be used in the anterior maxillary area with acceptable esthetic results. A better understanding of the problem, the treatment steps, and the various options available may improve the communication between the general practitioner and the periodontist, producing satisfactory long-term results.
Edentulous ridge augmentation is a plastic surgical technique that is performed to improve patient esthetics when unsightly, deformed ridges exist. This article describes the etiology of ridge deformities and the many procedures that can be executed to achieve an esthetic, functional result. Historically, soft-tissue mucogingival techniques were described to augment collapsed ridges. Pedicle grafts, free soft-tissue grafts, and subepithelial connective tissue grafts are predictable forms of therapy. More recently, ridge augmentation techniques were developed that regenerate the lost periodontium. These include allografts, bioglasses, guided tissue regenerative procedures, and tissue expansion.
Clinical crown lengthening is a useful procedure to provide tooth length for proper restoration of a tooth without compromising the periodontium or the retentive qualities of the restoration. It is also useful for enhancing maxillary anterior esthetics. Crown lengthening may be as simple as a limited removal of soft tissue or as complex as orthodontic extrusion followed by flap with osseous surgery on a tooth requiring endodontic therapy. Total treatment could thus involve endodontic, orthodontic, periodontic, and restorative procedures. Careful evaluation, case selection, treatment planning, and surgical treatment following the principles outlined in this article can achieve results that meet the functional and esthetic challenges of current dental practice.
This review of complete denture esthetics addresses the process of tooth selection, tooth arrangement, and characterization of the denture bases. The guidelines discussed in this article are all gleaned from the classic prosthodontic literature. These principles, which were developed over the past century, coupled with state-of-the-art materials are artificial teeth enable contemporary dentists to fabricate complete dentures with a level of esthetics never before possible.