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This clinical report describes a procedure for influencing the esthetics of a Kennedy Class III-Modification 1 removable partial denture. The acrylic resin base is eliminated, and the retentive clasp placed on the first premolars is modified. This technique is simple and inexpensive, and in the treatment presented, it resulted in complete patient satisfaction.
The reestablishment of normal tissue volume, contour, and architecture around dental implants may require the use of osseous or soft tissue augmentation techniques. This article describes 2 patient treatments that highlight the use of connective tissue grafts to enhance the esthetic outcome of dental implant treatment.
Replacement of a missing anterior tooth with an implant-assisted restoration rather than a fixed partial denture is considered common practice. Implant placement with a 2-stage surgical approach in the anterior area of the mouth may be imperative and require an esthetic provisional replacement for the missing tooth during the healing phase. This provisional restoration should help optimize the health of hard and soft tissues around the implant without exerting pressure on the residual ridge and maintain the position of the adjacent and opposing teeth. This clinical report presents a technique for fabricating an anterior fixed provisional restoration with composite reinforced with a leno-woven polyethylene ribbon.
Secondary correction of residual unilateral cleft lip nasal deformities is necessary in a number of patients for functional and cosmetic purposes. Myriads of techniques and modifications have been reported. Most of these publications, however, deal with the correction of the esthetic aspects of the deformity, and little attention has been given to the functional problems associated with the deformity and to the functional outcome of these procedures. A comprehensive protocol of care for correction of residual nasal deformities describing our preoperative anatomical and physiological evaluation, our surgical techniques, and postoperative outcome is presented here. The first 30 consecutive patients managed with this protocol were evaluated clinically and physiologically with rhinomanometry. Significant functional improvement was identified in 73.3% of our patients. It is recommended that airway obstruction be evaluated and addressed in all patients with residual cleft nasal deformities. Component rhinomanometry provides objective information about airway obstruction, and postoperative testing and comparison with preoperative data provide for an objective evaluation of results and assist the surgeon to evaluate the outcome of all procedures critically and to modify or improve them appropriately.
Tissue glues and adhesives have achieved increasing popularity as alternatives to small wound closure. When applying these substances, it is often difficult to avoid contact with the surrounding skin and foreign objects such as surgical gloves. A technique for the application of Dermabond is described in this report. Twenty wounds less than 10 cm in length were reapproximated using a fine-tip tuberculin syringe applicator. The wounds were evaluated immediately after the application, and 2, 4, and 6 weeks after surgery. Use of the tuberculin fine-tip technique allowed reapproximation of the wound edges with no clinical evidence of surrounding tissue damage. There were no apparent decreases in wound strength or associated discoloration or fuzziness onto the skin. Esthetic results were considered good to excellent by patients. Dermabond can be accurately applied with a tuberculin syringe, avoiding the surrounding tissue damage and foreign object adhesion reported in the literature.
The Wise pattern is a convenient tool for marking the outlines of the areola recipient site, and for marking the lower skin flaps of the "skin brassiere" in most of the currently used operations for mammary hypertrophy and ptosis. We find it useful, at times, to draw the pattern outline before making a final decision on which procedure to do. Rather than limiting the surgeon's judgement, these preoperative marks leave a wide spectrum of options open to meet the esthetic requirements, while keeping the basic landmarks properly located.
The subepithelial connective tissue graft can be used to enhance the esthetic appearance and gingival contour of the peri-implant tissues. A technique is described and illustrated to create a soft-tissue root prominence and mask the grayish color that may be present as a result of a thin facial alveolar bony plate and/or thin labial attached gingival tissue over dental implants.
In this article, the use of hermeneutic photography as an esthetic technique to enhance data generation is discussed. When photographs are used as an entrée for interviewing participants, they often elicit participants' stories and illustrate themes of experience. A discussion of the uses of hermeneutic photography as a method and suggestions for the use of photographs within nursing research are presented.
Burn injury often has produced deformity both of contours and cover in face and neck. Hypertrophic burn scar contracture of the lower face and neck is one of the most difficult subjects to solve because it produces problems with function and appearance. In planning the correction, the restoration of normal form and function is the best way in reconstruction. From January 1998 to January 2002, we had 7 patients who had scar contractures of the lower face and neck. We reconstructed their deformities with free radial forearm flap and skin graft. We could get restoration of the facial form to normal shape, position, and quality of the facial skin cover homogeneity. No remarkable complications have been found in all 7 patients. For better outcomes, there are some considerations. The lowest margin of the flap should be limited to at least 1 finger breadth above the hyoid bone because low setting of the flap may deteriorate the cervicomental angle. The skin graft is undertaken in the cervical region. Adhesion between the flap dermis and wound bed may be necessary for reconstruction of the labiomental sulcus. Burn deformities of the lower face and neck area were resurfaced with free radial forearm flap and skin graft. Flaps did not look completely normal, but those were compatible with the adjacent skin. We could have an adequate functional resurfacing and optimal esthetic outcomes while minimizing recurrent contractures.
Mild-to-moderately severe enamel fluorosis (EF) is an unsightly maturation-phase dental disorder. Despite extensive epidemiological studies on EF, little is known about individual treatment options. This study was carried out to determine whether a simple microabrasion technique is effective in improving the esthetics of EF. Patients with a variety of severities were treated using a water-cooled fine diamond polishing bur at high speed to remove the surface enamel layers. Photographs of the affected teeth before and after treatment were shown by computer to a panel of three judges (two lay and one experienced), who rated the appearance of the teeth using a newly developed visual analog scale. The severity of EF was rated randomly and blind for 52 individual teeth (26 before and 26 after treatment). Reteated-measures analysis of variance was used to analyze the results. The lay judges rated the appearance of the teeth with EF as significantly more objectionable before treatment. All judges found a significant improvement in the severity of EF after treatment. Using a newly developed visual analog scale, our study indicates that EF of an objectionable nature can be significantly improved with a simple microabrasion technique, thus conserving tooth structure and minimizing the cost of treating EF.
The adult dental patient today, as a discerning consumer, is seeking the highest quality care in the realm of esthetic dentistry, and frequently these expectations can be met through the modalities of bonded composites, porcelain laminates, porcelain bonded to etched metal support structures or modified conventional crown and bridge prosthodontics. However, there are occasions where the individual tooth, teeth, or the arches are so aligned that the pulpal, gingival, or osseous tissues would be jeopardized by the conventional restorative intercession. The incorporation of accepted and routine procedures of acid etching and direct bonding of orthodontic appliances to the surfaces of the adult dentition to reposition malposed teeth offers the clinician a magnificent alternative or adjunct to the conventional dental material forms of treatment. This article will present several patient treatments that incorporated the use of acid etching and direct bonding of orthodontic appliances to the surfaces of the patient's teeth for the purposes of repositioning the teeth with or without the need for restorative interventions.
Accidents occur in life and when they affect the dentition, whether natural, artificial, or a combination, they can result in a feeling of dread and despair in the patient. The thought of appearing not only in public with business and social acquaintances, but also in private with family members can be reprehensible. This article discusses the use of visible light-cured denture base materials that can be used to alleviate the fear these patients display in being exposed to socio-esthetic intercourse when becoming suddenly partially edentate. The method of use and three patients' photographic essay presentations are discussed.
The great technologic strides of the past have transformed medicine and dentistry from a primitive craft into a modern science. Although the past century has witnessed great advances in the evolution of esthetic dentistry, it is fitting to pay tribute to the ancient practitioners of this craft, who formed a basis for its present progress.
Combining harmonious proportions of final restorations with periodontal health and stability surrounding these restorations is a basic fundamental in esthetic dentistry. However, when one can adversely affect the other, a clinical dilemma arises. This article describes a case with unfavorable proportions that may be worsened due to an existing unfavorable preparation design. A simple approach for diagnosis and treatment of such a situation is presented.
Esthetic dentistry offers a myriad of opportunities for older adults wishing to improve their smile, oral function, and self-esteem. The challenge for dental professionals is to maintain oral health throughout the patient's lifetime, even through periods of dependence that may include residence in a nursing home. Dental professionals will have increasing opportunities to share their knowledge and expertise about the relation between oral health and overall health, with a variety of health professionals who care for the aging population.
Computer imaging can be helpful in demonstrating to patients the potential outcome of esthetic dental procedures. The current clinical study assesses the effectiveness of computer imaging by comparing the reactions of patient and dentist to conventional consultations versus the use of computer imaging. The responses from 35 subjects show that computer imaging consultations are more effective in helping patients decide to accept treatment. Patient satisfaction was higher (93.75%) with computer consultations than with conventional methods (83.3%). Computer imaging consultations were easier to conduct but significantly (p < .05) more time consuming.
Many contemporary restorative procedures are primarily esthetically driven, and patients have high expectations. It is imperative for the restorative dentist to understand patients' desires and expectations prior to initiating irreversible therapy. It is equally important for patients to understand the anatomic and technical limitations inherent with restorative therapy.
UNLABELLED: A car accident victim can lose not only anterior teeth but also the soft- and hard-tissue support for these teeth. This article describes a step-by-step approach to the treatment protocol for an accident victim in whom anterior teeth and the supporting tissues have been lost. The protocol is systematic and can be used for most accident cases, where the functional and esthetic demands are very high. CLINICAL SIGNIFICANCE: This article demonstrates how excellent teamwork among the dentist, implant surgeon, and laboratory technician can result in a well-conceived and successful restoration following traumatic injury of the dentition.