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A set of devices and techniques has been developed to convey to the dental laboratory technician the information that is essential for the correct placement and alignment of anterior crowns, pontics, or denture teeth. The system brings a measure of accuracy and control to the esthetic aspect of prosthodontics that is taken for granted in other procedures.
A technique has been described that will allow for the esthetic placement of artificial teeth by precisely controlling the location of the approach arm of the l-bar clasp.
By incorporating orthodontics and other specialty disciplines into the restorative and prosthodontic treatments for the adult patient presenting for improvement or enhancement of esthetics, the dentist can correct reverse over-lapped (cross-bite) relationships, retrieve and reposition unerupted (impacted) anterior teeth, and improve irregular smile lines in three dimensions. The correction or improvement of incisal guidance, incisal planes, root proximity, and embrasure spaces will enhance long-term stability and successful prognoses. This article discusses several of the daily challenges encountered by the restorative dentist regarding malposed teeth in the anterior portion of the oral cavity. By using established principles of orthodontic therapy, composite resin bonding of brackets, improved wire technology, polymer plastic force modules, and additional advances in the methods of repositioning the malposed teeth, the necessary corrections can be made.
Two methods to achieve maximum esthetics of temporary restorations are discussed. Method 1 demonstrates the use of light-cured composite resin, acrylic resin, and acrylic resin stain. Method 2 describes the use of denture teeth, acrylic resin, and acrylic resin stain.
A technique has been presented for placement of an implant prosthesis without a visually detectable space between the prosthesis and soft tissue or visibility of the metal abutments. The prosthesis permits better phonetics and greatly improved esthetics including better lip support. Proper presurgical planning and careful assessment of the potential level of home care are especially important when this technique is used.
Achieving the most desirable gingival appearance enhances the esthetic result achieved with fixed prosthodontic restorations and is most often realized when gingival health is optimized before treatment and gingival trauma is minimized during treatment. Methods of optimizing gingival appearance by avoiding soft tissue contact are discussed as are factors considered important to maintaining good gingival appearance when subgingival margins are necessary.
A technique for making an esthetic complete denture as a surgical stent to be used in conjunction with hydroxyapatite augmentation surgery of the maxillary arch is presented. The technique involves the use of an articulator, a remount jig, and duplication of a surgically prepared cast.
Esthetic veneer crowns should be waxed to full contour before the veneer surface is cut back. This procedure ensures that patterns and metal copings will have the proper contours. A technique is described for making a coping that has an ideal thickness of 0.3 to 0.5 mm, that is stable, and that is unlikely to fracture.
Many esthetic and functional considerations are reviewed for the partially edentulous implant candidate. With the availability of adjunctive grafting procedures, it is time for the implant team to change the traditional treatment planning approach that allows patient anatomy to dictate implant position and prosthesis design. Dimensions of the edentulous space and evaluation of occlusal relationships are discussed. Soft tissue ridge contour and creation of favorable cervical harmony are also reviewed. Functional demands unique to the partially edentulous patient are outlined in addition to the challenges of creating a prosthesis with natural cervical form and emergence profile.
A cephalometric analysis of the submental-cervical region was carried out by examining and comparing 16 white adults who had ideal submental-cervical esthetics with 16 adult orthognathic surgery patients who were treated by submental lipectomy or liposuction and various orthognathic surgical procedures. A normative data base of the submental-cervical region was derived from the ideal subject group. The submental-cervical morphology of the preoperative patients differed significantly from the ideal subjects. The submental-cervical angle (Sm-Ce) and the submental soft tissue thickness at C point (IBM-Sm) presented the greatest disparity between the ideal subjects (118.0 degrees, 28.0 mm) and the preoperative patients (158.3 degrees, 42.1 mm, each P < .001). After surgery, Sm-Ce and IBM-Sm decreased to 132.8 degrees (P < .001) and 28.7 mm (P < .001), respectively. By the end of 6 months postoperative, the mean values of Sm-Ce and IBM-Sm were 131.1 degrees and 28.6 mm. The submental soft tissue thickness of the patients 6 months after surgery was not statistically different from the ideal subjects (each P > .05). Orthognathic surgical procedures with concomitant submental lipectomy or liposuction had a significant effect on the contour of the submental and cervical soft tissues.
PURPOSE: The purpose of this study was to determine the influence of buccal corridors on smile attractiveness when judged by lay persons. MATERIAL: Full-face color slides of 10 randomly selected smiling subjects (5 women, 5 men) were digitized. The maxillary posterior dentitions for all subjects were digitally altered to produce a range of smile fullness: narrow (28% buccal corridor), medium-narrow (22% buccal corridor), medium (15% buccal corridor), medium-broad (10% buccal corridor), and broad (2% buccal corridor). The 5 images of each subject were paired into 11 possible combinations, and the resulting 110 pairings were randomly projected to a panel of 30 adult lay persons who compared the 2 images in each pair for smile attractiveness. RESULTS: Statistical analysis with the Wilcoxon signed-rank and rank-sum tests showed that (1) a broader smile (minimal buccal corridor) was judged by lay persons to be more attractive than a narrow smile (larger buccal corridors), and (2) no significant differences were found in judging between male and female subjects or between male and female judges. CONCLUSIONS: Having minimal buccal corridors is a preferred esthetic feature in both men and women, and large buccal corridors should be included in the problem list during orthodontic diagnosis and treatment planning.
The contemporary dentist has a wide variety of options to use in the restoration of extensively damaged or previously restored teeth. Metal-ceramic and all-ceramic crowns are frequently used to restore esthetics and function. One of the essentials for success with either option is proper tooth preparation, which includes proper selection and preparation of the cervical margin of the preparation.
Preventing patient dissatisfaction is a primary goal when performing botulinum toxin-A injections. By taking the correct approach with careful patient selection, ensuring safety and minimizing the risk of complications and side effects, the practitioner can largely eliminate patient dissatisfaction with this therapy. Basic understanding of facial esthetics and concepts of beauty are helpful to optimize patient satisfaction.
OBJECTIVES: The aim of this in vitro study was to evaluate the effect of the in-office bleaching technique on the microhardness of six dental esthetic restorative materials. METHODS: Four composite resins (a hybrid, a flowable, a micro-hybrid and a nano-hybrid), an ormocer and a ceramic were tested, after the use of an in-office bleaching product. Fourteen specimens of each composite and the ormocer were fabricated and randomly divided into two groups of seven samples each. One group was polished and the other group remained unpolished. For the ceramic, seven polished samples were fabricated. Two samples of each group were used as negative controls. The specimens were bleached for 15, 30 and 45min. Five Knoop microhardness measurements were made on each sample, for each of the following periods tested: before bleaching, after 15, 30 and 45min of bleaching, 24h and 1 month after the bleaching procedure. Data were analyzed by the repeated measures analysis of variance with three between factors and one within. RESULTS: The differences in the microhardness values between the bleached and the control samples for the composites and the ceramic, were not statistically significant (hybrid: p=0.264; flow: p=0.584; micro-hybrid: p=0.278; nano-hybrid: p=0.405; ceramic: p=0.819). For the ormocer, although bleaching did not have any significant effect on the unpolished samples (p=0.115), it caused an increase on microhardness of the polished samples. SIGNIFICANCE: Bleaching with 38% hydrogen peroxide does not reduce the microhardness of the restorative materials tested. Therefore, no replacement of restorations is required after bleaching.
PURPOSE: The purposes of this article were to review the literature for treatment of teeth with external resorption secondary to avulsive injuries and to illustrate treatment of patients with teeth following different clinical scenarios to develop a predictable course of therapy. MATERIALS AND METHODS: Cases that demonstrate treatment of teeth with external resorption following injury during the growing period, external resorption treated with a delayed approach after tooth extraction, immediate grafting of the extraction site to repair labial bone loss, and immediate implant placement with provisionalization are shown. CONCLUSION: Based on a review of the literature, the decision to place dental implants to replace teeth with external resorption can be timed depending on the location and type of the resorption, with excellent esthetic results.
Patients afflicted with congenitally missing teeth are a unique patient population for consideration of treatment with osseointegrated implants. Frequently, these patients have limited development of the alveolar process and differences in spatial position relative to the opposing arch, which places emphasis on ancillary treatment with orthodontics and oral surgery. A thorough diagnostic workup should include an interdisciplinary approach to ensure optimal treatment and timing of treatment in those who are developing. This article outlines considerations for treating these types of patients and scenarios of treatment paths frequently taken to restore the partially dentate and edentulous to esthetics and function.
Long-term functional and esthetic success with implant-supported single-tooth restorations requires a comprehensive and interdisciplinary treatment approach. Important parameters include the initial clinical situation, the surgical approach, the provisional phase, and the choice of abutment material and design as well as the definitive restoration. This article presents the main aspects of current treatment protocols and discusses material options and clinical techniques to achieve predictable outcomes.
This clinical report compares the esthetic outcome of replacing the same left maxillary central incisor with 2 types of implant-supported restorations, a zirconia abutment with a Procera crown and a custom metal abutment with metal ceramic crown. There were only subtle differences noted and both restorations yielded a satisfactory result.