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With the arrival of the new dentin-enamel adhesives, the dentist is able to bond many different materials to the tooth. The esthetic inlays or onlays may thus be made out of various materials such as composite or ceramics with long term success. This article is an attempt to detail all the clinical procedures necessary to succeed such restorations.
Rapid orthodontic root extrusion is an esthetic technique for clinical crown lengthening. Associated with periodontal surgery, it exposes subgingival lesions and preserves an harmonious gingivo-osseous morphology. This conservative technique is easy to apply by the general dentist as it requires non specialised material.
Nowadays, free revascularized myocutaneous and osteomyocutaneous flaps are available as grafts of high biological value, which allow functional and esthetic rehabilitation after tumor resection and trauma. The use of these flaps however must be considered carefully, since these techniques require a good general physical condition of the patient for extensive surgery and a considerable operation time. Therefore we consider these flaps as adequate solely in cases of poor recipient site conditions after previous irradiation or chronic infection, in cases of extensive scar formation and in large bone and soft tissue defects. In these cases revascularized grafts from the iliac crest have proven to be useful in mandibular reconstruction while scapular grafts has been useful in restorations of the midface.
The surge of interest in the use of tooth-colored restorative materials and systems in recent years has been attributed partly to rapid developments in dental materials science and also to patient demand and operator interest. When overall dental appearance is considered, several factors are of significance, including tooth color, shape, and position; restoration quality; and the general arrangement of the dentition, especially of the anterior teeth. Each factor may be considered individually, but all components together act in concert to produce the final esthetic effect. However, although the clinician must be mindful of the patient's desires for a favorable cosmetic result, materials and techniques must be carefully selected, and restorations should be sufficient to withstand the forces of occlusion and mastication and provide long-term function.
Limitations in position, quality, or dimension of bone often require that implants be placed in a nonideal axial inclination. Use of preangulated abutments may be the method of choice when anatomic limitations preclude the axial placement of an implant. This paper discusses the indications for and advantages of the use of preangulated abutments to fulfill esthetic and functional objectives.
The esthetic influence of gingival architecture on symmetry and tooth length as they relate to the "smile line" can be altered through periodontal surgical techniques. An internal bevel gingivectomy can be utilized, with some modifications in technique, to increase the beauty of a smile. The practitioner can influence the appearance of the smile by correcting tooth length problems as they relate to upper lip line and correction of right-to-left asymmetries. The surgical techniques are described in detail for various clinical situations.
Unimagined only a few years ago, high-technology tools for the dental practice are now widely available. Ranging from video cameras to computer-enhanced diagnostics that fabricate porcelain restorations on site, these new technologies have many applications in esthetic dentistry. Because they make it easier to communicate to patients what can realistically be achieved, high-technology tools tend to involve the patient more in treatment planning and thus may help prevent disappointing outcomes.
In the past 50 years, advances in restorative dental procedures have made it possible for dentists to achieve better esthetic and functional results for their patients than ever before. Removable prosthodontics has been practiced in much the same way that is has been for many years. Since the introduction of root-form osseointegrated implants, there is a renewed interest in the edentulous and partially edentulous patient. To give the patient all possible treatment options, implants must be considered, but they must not replace sound prosthodontic principles. Presurgical prosthodontics in the form of provisional restorations and stents are necessary for correct implant placement. Overdentures, bar partial dentures, and soft liners are sound treatment alternatives. Review of the work of Dr. Earl Pound is the best source for the development of correct complete dentures.
An attractive smile has always been the focal point of a person's attention to improving esthetic appearance and thus self-esteem. It is the contrasts of shape, color, line, and texture that enable us to differentiate one tooth from another, the teeth from the gums, and the smile from the face To understand why a smile with dentition in harmony is considered beautiful, clinical examples are presented to illustrate how to apply visual perception to the dental environment. These simple principles of visualization and treatment can be successfully applied to enhance the smile of any patient.
Porcelain veneers have become an important treatment modality in most clinicians' armamentarium. Their proven reliability for correcting otherwise unesthetic situations, such as diastemas, malalignment, or misshapen or discolored teeth, combined with their conservative preparation requirements, have made porcelain veneers popular. The use of porcelain veneers to correct occlusal deficiencies or to reestablish the correct guidance during excursive movements is often overlooked. This article describes the use of porcelain laminate veneers to combine optimal esthetics with the establishment of a more favorable occlusal balance.
The field of cosmetic dentistry is in a state of constant change. Clinicians must stay up-to-date with new developments in materials and techniques. This article discusses the use of several new materials that provide a highly esthetic result. In addition, a predictable diastema closure technique is discussed.
This article describes the treatment of a 10 year-old patient with complete root resorption of the maxillary permanent incisor following avulsion and replantation 4 years earlier. The remaining natural crown was used to immediately solve the esthetic problem created by its extraction. The crown was attached with an orthodontic wire and composite resin to adjacent teeth. This temporary treatment does not elicit any damage to adjacent teeth, and can be easily removed. Therefore, it does not affect any plans that might be considered in the future as the permanent treatment.
Single-tooth replacement in contemporary dentistry is often accomplished with an osseointegrated implant-supported restoration. To accomplish this in an esthetically acceptable manner requires a thorough course of treatment, including diagnosis, treatment planning, surgery and restorative and preventive care. This article discusses surgical considerations that are applicable before implant placement, as well as at the time of stage I and II surgery. Furthermore, the interrelationship between the tissues and the restoration is addressed. Preservation of the result by preventive-care protocol is shown to be essential.
This article has described application of bonding procedures for adults in everyday practice. Depending on the materials and the technique employed, one can achieve satisfactory bonding. The techniques used to debond orthodontic brackets safely have been described. The bonded retainer, particularly in the mandibular arch, can easily be applied using the technique described. These retainers offer an advantage because of the high patient acceptance owing to convenience and esthetic reasons. Bonding on porcelain veneers and gold crowns has been described. Although silane pretreatment to the porcelain surface yields satisfactory results, the technique for bonding to gold has not yet been fully perfected.
Direct bonding is the most commonly-used treatment for the conservative esthetic restoration of anterior teeth. Class IV defects deserve special attention because of their high incidence in anterior teeth. One of the major challenges for the practitioner treating defects in this category is disguising the fracture line, through the correct use of masking and restorative resins, to make the restoration imperceptible to the eye. This paper discusses the morphologic, histologic, and optical characteristics, as well as the polychromy of sound natural teeth, and the way they correlate with composite restoratives.
Splinting is a well-accepted clinical treatment that has been us many years to control irreversible tooth mobilities through mechanical stabilization. With contemporary demands for quality-of-life dentistry, extracoronal or unesthetic splints can fall short of patient expectations. This article examines the rationale and technique for placing an intracoronal esthetic splint when full coverage restorations are no indicated or desired. This type of splint using bondable ceramic ropes is imperceptible both visually and to the patient's tongue, lips, and cheeks proprioceptively.
Restitution of the complex central sulcular portion of teeth is extremely difficult when direct tooth-colored restorative materials are used, because sculpturing of the solid polymerized mass is accomplished mechanically with burs. When the initial carious lesion presents within a shell of undermined yet intact enamel, the preoperative occlusal morphology provides an ideal index of the esthetic and functional anatomy. The preoperative occlusal morphology is recorded in a transparent registration material, and then the registration is used as an index to reproduce the preoperative occlusal morphology in the final incremental restorative layer. Photopolymerization of the restoration is initiated through the translucent index and completed with surface approximation of the light source once the index has been removed.
The current abundance of posterior esthetic restorative materials and techniques may be confusing. This paper describes a simple and logical global concept that assists clinicians in choosing the appropriate therapeutic modality according to well-defined clinical criteria. Practical considerations about cavity preparation, base-lining, filling, luting, and finishing procedures are reviewed.