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Helping patients improve their appearance with esthetic procedures can be very rewarding. Optimal esthetic results often require a multidisciplinary approach and sequenced care. Treatment planning with a team approach offers the potential for multiple perspectives and the best opportunity to achieve the optimal results.
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The need to respond to the ever-increasing patient demand for aesthetics, tissue maintenance, and cost efficiency has resulted in the evolution of techniques and materials that allow predictable restoration of teeth that would otherwise be compromised. The development of synthetic dental materials has allowed the incorporation of fiber-reinforced materials to replace metal splints. These contemporary materials provide increased flexural strength, as well as improved aesthetics, to the restoration. This article describes a conservative tooth splinting procedure using polyethylene fibers as reinforcement for both direct and indirect restorations.
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Glass-fiber-reinforced composite resin systems may be used as conservative alternatives to conventional fixed partial dentures (FPDs) for the replacement of a single missing tooth. This article describes a clinical technique and 4-year evaluation of an inlay bonded FPD. The patient presented with a missing maxillary right second premolar. A high-caries risk and moderate-to-advanced attachment loss around the abutment teeth, which were clinically stable, were noted. The patient had a strong desire to maintain his remaining dentition. Advantages of supragingival margins and minimal tooth structure removal made the bonded inlay bridge a viable alternative to a conventional FPD for this compromised restorative situation. The clinical performance of this glass-fiber-reinforced resin inlay FPD at the 4-year follow-up is provided. The restoration has served satisfactorily for more than 4 years and holds promise as a conservative, esthetic alternative to the conventional FPD in certain clinical cases.
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The objective of this study was to compare the apical leakage in root canal filled, apicectomised and retrogradely filled maxillary single rooted premolars with two canals of type II configuration. For this purpose the root canals of 51 maxillary type II premolars were shaped to size ISO #55, followed by a step-back preparation to size ISO #80. Subsequently, all teeth were obturated by means of lateral condensation and randomly divided into three groups, 17 teeth each. Group I was used as a control, whereas in group II and III an apicoectomy was performed. Retrograde glass ionomer restorations (Ketac Fil) were placed additionally in group III. The specimens were exposed to methylene blue for 24 hours, then cross-sectioned, and the deepness of dye penetration was measured. Data were analyzed and tested for significant differences between the various groups (Mann-Whitney test; alpha = 0.05). The teeth in group II showed the lowest mean dye penetration. The differences were statistically significant, if compared to group I (p < 0.001) and group III (p < 0.001). The dye penetration in group I was significantly lower than in group III (p = 0.024). In teeth with lateral canals, the mean dye penetration was higher (3,557 microns +/- 1,337 microns) than in teeth without lateral canals (3,096 microns +/- 1,931 microns). The teeth in group III showed a circular dye penetration in nearly all cases. For clinical purposes, the application of retrograde glass ionomer fillings must be considered very critically.
Prompted by increased patient requests for esthetic treatment, restorative clinicians have evaluated a variety of new materials and procedures. This study reports on 5 years' experience with In-Ceram Spinell all-ceramic crowns. A total of 40 anterior crowns were positioned in 13 patients from October 1995 to December 1998. The clinical examination was made following modified California Dental Association/Ryge criteria. Final evaluation was carried out in October 2000, for an observation period of 22 to 60 months (mean 50 months). Only one failure was recorded, and the fractured crown needed to be replaced; according to Kaplan-Meier analysis, the estimated success rate was 97.5%. A thorough description of the clinical procedures through which anterior teeth can be successfully treated with all-ceramic Spinell crowns is described.
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The plethora of base-mental alloys and metal-free restorations and ever rising cost of palladium alloys has given this full-feature PFM system a definite place in modern dentistry. Thanks to the minimum tooth reduction necessary, GES PureGold has a number of clinical and aesthetic advantages. The system's gold substructures are my choice because they provide natural color beneath ceramics, a high degree of biocompatibility, and exquisite marginal integrity.
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