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Esthetic dentistry comprises one of the most rapidly growing segments of our profession, and patients receiving this type of treatment are often maintained on an alternating schedule. Improper maintenance care can quickly destroy many of these restorations. This article will serve as a resource for dental professionals who wish to offer these special patients customized maintenance care.
The increase in the demands made by patients for esthetic or metal-free restorations, together with the ever-growing interest shown by the dental profession for tooth-colored materials and techniques, led to the current development of posterior adhesive restorations. This paper reviews critical elements such as adhesion to dental hard tissues as well as current properties of bases/liners, filling materials, and luting materials. A rationale for the successful use of currently available restorative systems is presented.
Achievement of an esthetic single-tooth restoration in the anterior segment is a difficult task for the restorative dentist. A case is described in which two congenitally missing maxillary lateral incisors were replaced with single-tooth implants. A new technique was used to restore the teeth provisionally with a polyethylene ribbon and resin replacement. Light-cured staining systems for acrylic resins and ceramics were employed to customize both the provisional and final restorations.
Provisional restorations represent a key element in the realization of extensive esthetic rehabilitations. In particular, they provide indispensible diagnostic information contribute significantly to adjacent soft tissue conditioning, and ensure the patient's comfort during the intermediate phase of treatment. The-treatment outcome strongly depends on the treatment approach chosen. This article describes a treatment rationale comprising the use of a diagnostic template. This type of work strategy, documented with clinical cases, integrates diagnostic waxups and indirect provisional restorations using simplified and efficient fabrication techniques.
A bone-splitting technique used for anterior single-tooth replacement was evaluated in 54 patients and 68 sites. The cumulative rate of implant survival was 93.7% (SE 4.6%) after more than 4 years. The decrease in marginal bone height ranged from 0.8 to 1.3 mm. Some reaction of the bone levels around the adjacent teeth should be anticipated (0.3 to 0.5 mm). It was concluded that the bone-splitting procedure is a safe and predictable technique when performed carefully on selected patients and with the proper instrumentation. The procedure seeks to reconstruct the labial contour of the alveolar process, which is a prerequisite for optimal and lasting implant esthetics.
Esthetically correct treatment of a localized alveolar ridge defect is a frequent prosthetic challenge. Such defects can be overcome not only by a variety of prosthetic means, but also by several periodontal surgical techniques, notably soft tissue augmentations. Preoperative classification of the localized alveolar ridge defect can be greatly useful in evaluating the prognosis and technical difficulties involved. A semiquantitative classification, dependent on the severity of vertical and horizontal dimensional loss, is proposed to supplement the recognized qualitative classification of a ridge defect. Various methods of soft tissue augmentation are evaluated, based on initial volumetric measurements. The roll flap technique is proposed when the problem is related to ridge quality (single-tooth defect with little horizontal and vertical loss). Larger defects in which a volumetric problem must be solved are corrected through the subepithelial connective tissue technique. Additional mucogingival problems (eg, insufficient gingival width, high frenum, gingival scarring, or tattoo) should not be corrected simultaneously with augmentation procedures. In these cases, the onlay transplant technique is favored.
This report describes a young patient with fusion of a maxillary central incisor to a supernumerary tooth. Treatment involved extraction of the fused tooth and orthodontic movement of the lateral incisor to occupy the position of the extracted tooth. A resin composite laminate veneer was placed on the lateral incisor to simulate the appearance of a central incisor. Five years of follow-up revealed that treatment had successfully restored esthetics and function.
It is well known that guided soft tissue healing with a provisional restoration is essential to obtain optimal anterior esthetics in the implant prosthesis. What is not well known is how to transfer a record of beautiful anatomically healed tissue to the laboratory. With the advent of emergence profile healing abutments and corresponding impression copings, there has been a dramatic improvement over the original 4.0-mm diameter design. This is a great improvement, however, it still does not accurately transfer a record of anatomically healed tissue, which is often triangularly shaped, to the laboratory, because the impression coping is a round cylinder. This article explains how to fabricate a "custom impression coping" that is an exact record of anatomically healed tissue for accurate duplication. This technique is significant because it allows an even closer replication of the natural dentition.
Custom cast metal post and cores used to retain all-ceramic restorations are indicated in endodontically treated teeth when little clinical crown remains. The metal cores of these post and core restorations block light transmission and create a graying effect when used in support of all-ceramic restorations. This article describes a technique to minimize this effect using custom cast porcelain-fused-to-metal post and cores to achieve a more natural esthetic result.
The restorative dentist treats patients with needs that often transcend dental disciplines. This dentist will be responsible for long-term dental maintenance and should logically oversee interdisciplinary reconstruction. This case report demonstrates an integrated treatment approach and 5-year retrospective study involving a patient with maxillary anterior excess, pronounced overjet, and advanced periodontitis. Extraction and radical alveolectomy with removable prosthesis is often considered in such cases; however, results are often less than optimum function, esthetics, and general oral health. In this case, a previously undescribed anterior maxillary rotating segmental ostectomy was integrated with restorative, periodontal, and removable full and partial denture procedures.
Using composite resins in posterior esthetic restorations has become more acceptable in recent years as a result of improvements in materials. For this reason, innovative products such as Luciwedge and the SuperMat System have gained the attention of many practitioners. SuperMat, an improved translucent matrix, offers a new approach to matrices for use with multimaterial fillings. It makes the procedure easier and offers many other advantages, particularly in composite-compomer restorations.
As generations proceed to reinvent themselves in an effort to achieve and maintain youth, cosmetic dentistry faces one of its greatest and most persistent challenges: the restoration of an aging smile. Although the need for this restorative therapy has not yet been adequately studied, the momentum continues to build as aging teeth exhibit physical characteristics that affect their function as well as appearance. This review presents the most common factors influencing the esthetics of anterior tooth aging: coloration; wear and the effects of erosion, attrition, abrasion, and abfraction; and position of teeth relative to each other and surrounding tissues. While dental science seeks to understand how well age-specific restorative procedures can affect patients, the question of the necessity of this therapy remains. Should a healthy smile require treatment? Only time will reveal at what cost and to what extent a younger appearance plays a role in dental science.
A patient presented with two osseointegrated implants placed in a ridge deformity that had resulted from a traumatic injury during an automobile accident. The implant placement and subsequent restorative dentistry resulted in a poor esthetic result and difficult maintenance. Treatment included multiple soft tissue grafts to submerge the implants and augment the ridge. The patient was then restored with a conventional fixed partial denture.
This article reviews plastic surgery literature to help identify and manage the risk presented by patients interested in elective esthetic dentistry whose physiologic profile would compromise the success of the procedure. A questionnaire, designed to help identify patients with problematic physiologic profiles, is presented. In addition, risk management techniques adapted from the plastic surgery literature are reviewed.
A new testing apparatus for the measurement of frictional properties was designed and the frictional coefficients were obtained and compared with each other in various combinations of brackets and orthodontic wires, including esthetic fiber-reinforced plastic (FRP) wire that was especially designed and manufactured. Three kinds of wires (stainless steel, nickel-titanium, and FRP) and four brackets (single-crystal alumina, polycrystalline alumina, polycarbonate, and stainless steel) were used. The testing was done under dry and wet conditions. The friction testing equipment was designed to attach the bracket to a C-shaped bar suspended with a variable mass, and sliding along a fixed wire. The transition between static and dynamic friction was measured as a breakaway force, with the use of a universal test machine. In addition to material properties, this testing fixture eliminates geometrical factors, such as the rotational moment at the edge of the bracket slot, deflection of the orthodontic wire, and tension of the ligature wire. Nearly ideal frictional properties between materials are obtained. The frictional properties of FRP wire were similar to those of metal wires on all brackets, except the polycrystalline alumina bracket. The frictional coefficient between the polycrystalline ceramic bracket and FRP wire was larger than that of other combinations. There was little difference in frictional coefficients between dry and wet conditions.
OBJECTIVES: Assuming that color changes after aging are related to changes in translucency of materials, the purpose of the present study was to determine the correlation between the changes in color and the changes in scattering and absorption properties after accelerated aging with representative dental esthetic restorative materials: glass ionomer, resin-modified glass ionomer, compomer, and resin composite. METHODS: Color was measured according to the CIELAB color scale in the transmittance and reflectance modes and used to calculate changes in color (deltaE*(ab)), color coordinates (deltaL*, delta a*, and delta b*), translucency parameter (deltaTP), scattering coefficient (deltaS), absorption coefficient (deltaK), and light reflectivity (deltaRI) after accelerated aging. Simple correlations between each pair of the changes in optical values were calculated, and multiple regression analysis was used to determine the parameters influencing the changes in color and color coordinates (p = 0.05). RESULTS: In the resin composite and compomer, deltaS, deltaK, and deltaRI values were approximately zero, whereas deltaS was as high as 8.9 in the glass ionomer. For most comparisons, correlation coefficient (r) was between 0.700 and 0.997. DeltaL* was found to have a major influence on color changes, and deltaS, deltaTP, and deltaRI influenced deltaL*. Therefore, changes in scattering and absorption properties, after aging, were closely correlated with changes in color and color coordinates, especially in glass ionomer-based filling materials.
With reconstructive microsurgical techniques, some previously hopelessly mutilated hands have become reconstructable. The functional and esthetic results of such hands can be improved to an acceptable degree with through prereconstruction evaluation and planning. This case report demonstrates the approach to reconstruction of a mutilated hand using the following: a pedicle groin flap for soft tissue reconstruction of the first web space and the amputation stump of the thumb; a combined second and third toe transfer for reconstruction of opposable fingers at the amputated index and middle finger stumps; a single second toe for reconstruction of the thumb, and an iliac osteocutaneous flap for reconstruction of the ulnar border of the palm.
Conventional techniques in facial esthetic surgery are based on skin and flap elevation by sharp surgical dissection. The hydrodissection technique of local anesthetic administration facilitates creation of an atraumatic field for subcutaneous flap preparation. Its application in face- and necklifting procedures is described.