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Interim esthetic restorations in conjunction with anterior implants.

This article describes 2 procedures that can be used to provide acceptable anterior esthetics from the time of extraction, through implant placement and uncovering, until the completed implant-supported and retained crown is inserted. The first procedure presents a simple treatment option to prevent esthetic embarrassment immediately after implant placement. The second procedure uses a claspless, acrylic resin temporary removable partial denture to overcome many of the esthetic problems attendant with immediate replacement.

Acrylic Resins↗

Follow-up study of dental students' esthetic perceptions of mild dental fluorosis.

OBJECTIVES: Several studies have assessed people's esthetic perceptions of dental fluorosis, suggesting that concerns may be greater than believed previously. Few studies have assessed dental students' perceptions and none has done so over time. The purpose of this paper is to report on changes in dental students' esthetic perceptions of dental fluorosis and other conditions. METHODS: Fourth-year dental students (n=45) completed questionnaires about computer-generated photographs of fluorosis and other conditions, using the same protocol as when they were entering dental students. Results were compared for each of the eight images at the individual level using paired statistical tests. RESULTS: Although many patterns were generally consistent, there were a substantial number of differences in results over time, concerning both the mild fluorosis and non-fluorosis images. In general, students tended to score both fluorosis and non-fluorosis images more favorably as fourth-year students. When rating images from very pleased (1) to very embarrassed (10), fourth-year students rated the images significantly more favorably than they had done as first-year students for normal/control, incisal third only dental fluorosis, and a more generalized, mild fluorosis. Similarly, with a visual analog scale from satisfactory (0) to unsatisfactory (69), fourth-year students reported significantly lower (more favorable) scores than they had done as first-year students for the normal/control, diastema/no fluorosis, more involved mild fluorosis, and incisal third only mild fluorosis. There were no obvious changes in the relative levels of favorable evaluation of fluorosis vs. the other conditions. CONCLUSIONS: Fourth-year dental students generally had more favorable esthetic perceptions of mild dental fluorosis and other conditions than they had reported as entering students.

Adult↗

Extraction vs nonextraction: arch widths and smile esthetics.

Dental casts of 30 patients treated with extraction and 30 patients without extraction of four first premolars were randomly selected to determine changes in arch width as a result of treatment. Arch widths were measured from the cusp tips of the canines, premolars, and molars. Posttreatment arch widths were also measured in the midline at a constant arch depth from the most labial surfaces of the incisors. Standardized frontal photographs of the face taken during smiling of 12 extraction- and 12 nonextraction-treated subjects were evaluated. Fifty laypersons judged the esthetics of the smiles. Intercanine width increased less than one mm in both groups, and there was no difference between the two groups. The interpremolar and intermolar distance in both arches decreased significantly from 0.53 to 0.95 mm in the extraction sample, whereas the interpremolar and intermolar widths increased significantly from 0.81 to 2.10 mm in the nonextraction sample. When arch widths of both groups were measured from the most labial surfaces of the teeth at a constant depth, the average arch width of both arches was significantly wider in the extraction sample (1.8 mm wider in the mandible and 1.7 mm wider in the maxilla). The mean esthetic score and the number of teeth displayed during a smile did not differ between the groups. The results indicate that arch width is not decreased at a constant arch depth because of extraction treatment, and smile esthetics are the same in both groups of patients.

Adolescent↗

The esthetic properties of lips: a comparison of models and nonmodels.

It is perceived that fuller lips are more attractive, and hence lip augmentation has become common in esthetic plastic surgery. Numerous materials have been used, including collagen, autologous adipocytes, and more recently Restylane; however, little data exist on what comprises esthetically beautiful lips. Photographs of 28 models from fashion magazines were scanned to obtain digital images. These were selected strictly, using only exactly anterior-facing pictures. Using image analysis software, a range of defined lengths, angles, the lip area, and perimeter were measured. Lengths were expressed as a ratio of the intercanthal distance. A group of 14 nonmodel hospital employees were used as controls, with images obtained using a digital camera, and the same measurements were calculated. Results were compared for the two groups, and statistical analysis was performed using the Student's t-test. Overall lip width was not significantly different between the two groups (models, 15.7 units; nonmodels, 15.9 units). Both upper- and lower-lip height was significantly greater in models than in nonmodels (models, 2.1 and 3.6 units; nonmodels, 1.6 and 2.7 units, respectively), as was the upper-lip height laterally at the point of the angle of cupid's bow. Correspondingly, the angles of both upper and lower lips were also greater in models (models, 30.0 degrees and 47.3 degrees; nonmodels, 23.2 degrees and 37.6 degrees, respectively). We have assumed the model group to have esthetically beautiful lips. Our quantitative measurements have confirmed that this population has fuller lips compared with nonmodel controls, as determined by the lip height and angles.

Cosmetic Techniques↗

Influence of sex on the perception of oral and smile esthetics with different gingival display and incisal plane inclination.

This study was designed to determine the esthetic perception of men and women to variations in upper and lower gingival display at smile and speech and to incisal plane tilting. Composed photographs of smile and speech with varying amounts of gingival exposure of the upper and lower teeth and gingiva at smile and at speech and with varying degrees of incisal plane tilting were rated for attractiveness by two groups of lay people. The images were presented as male or female images. A total of 300 questionnaires, including 7500 images, were evaluated by 100 subjects. The results showed that images were scored as less attractive as the amount of upper and lower gingival display was increased during smile and speech. The amount of gingival exposure graded in the esthetic range was up to one mm for the upper incisors and zero mm for the lower incisors. Incisal plane tilting was graded as unesthetic when above two degrees of deviation from the horizontal. Male and female evaluators scored images differently with upper gingival exposure. Female evaluators gave statistically significant higher scores than male evaluators to upper gingival exposure images at smile and speech of both males and females, suggesting that females are more tolerant of upper gingival exposure. Images were scored differently when presented as male or female images. Female images were scored lower by both male and female evaluators, suggesting that additional efforts should be taken in female patients to achieve an esthetic result.

Adult↗

Dental esthetic self-perception in young adults with and without previous orthodontic treatment.

The aim of this study was to determine which dental esthetic self-perception evaluation tool discriminated better between orthodontically treated or untreated Peruvian young adults. A total of 630 students were randomly chosen from the 2000 admitted in 2002 to a private university in Peru. Students undergoing active orthodontic treatment at the time of examination were excluded. Self-perceived dental esthetic appearance was evaluated through Standardized Continuum of Aesthetic Need, Oral Aesthetic Subjective Index Scale, and Visual Analogue Scale (VAS). A stepwise multivariate discriminant analysis was developed to classify orthodontic treatment according to the three evaluation tools. A total of 199 students (31.6%) reported a history of orthodontic treatment. Differences between orthodontically treated and untreated groups were found only for the mean VAS score (P < .001). Although three different approaches were used to evaluate dental esthetic self-perception, only VAS allowed the discrimination of the self-perceived dental appearance between orthodontically treated and untreated Peruvian university young adults. Similarities in the self-perceived dental appearance of treated and untreated groups reported in previous epidemiological studies could be explained because different evaluation instruments were used. Further studies are required to support current findings.

Adolescent↗

An interdisciplinary approach for improved esthetic results in the anterior maxilla.

This clinical report describes an interdisciplinary (orthodontic, periodontic, and prosthodontic) approach for the coordinated treatment of a patient diagnosed with peg-shaped maxillary lateral incisors, diastemata, short clinical crowns, excessive gingival display, and orthodontic malocclusion. The patient's specific esthetic expectations for the anterior maxilla were successfully met through phased treatment, including orthodontic tooth movement, provisional restorations, periodontal surgery for lengthening of the clinical crown, porcelain laminate veneers, and direct composite restorations. Such coordinated interdisciplinary evaluation and treatment are necessary for improved esthetic results in maxillary anterior areas esthetically compromised in several aspects.

Adult↗

Esthetic knowledge in family-centered nursing care of hospitalized children. 1972.

This article provides an analysis of esthetics, one type of nursing knowledge, in the context of the role of the nurse in family-centered nursing care of hospitalized children. Esthetic knowledge is explained through the analysis of vignettes from a clinical article. The components of the creative and expressive dimensions of esthetic knowledge are illustrated as are processes for assessing credibility or forming understanding. Finally, implications for nursing practice, education, and knowledge development are presented.

Child↗

Epididymal sparing bilateral simple orchiectomy with epididymoplasty: preservation of esthetics and body image.

PURPOSE: We report the surgical technique and results of epididymal sparing bilateral simple orchiectomy as an esthetic alternative to standard bilateral simple orchiectomy and luteinizing hormone releasing hormone (LH-RH) agonist injection therapy in patients with prostate cancer. MATERIALS AND METHODS: The study included 91 consecutive epididymal sparing bilateral simple orchiectomy (BSO) procedures that were performed at the Atlanta Veterans Affairs Medical Center during a 25-month period. All patients had pathologically confirmed prostate cancer. A total of 52 patients (57.1%) were receiving LH-RH agonist therapy prior to the procedure and the remaining 39 (42.9%) were not. All procedures were performed in an outpatient clinic setting using spermatic cord anesthesia block as the only method of anesthesia. In the 52 patients who were on LH-RH agonist therapy prior to the procedure the overall impression/satisfaction with the procedure was evaluated using a questionnaire. RESULTS: All 91 procedures were performed at the urology outpatient clinic using local anesthesia. Mean patient age was 74.2 years (range 44 to 86). Mean serum prostate specific antigen was 58.9 ng/ml. The mean time required to perform the spermatic cord anesthesia block was 3.9 minutes (range 2 to 6) and the volume of anesthetic solution was 18.9 ml per case (range 10 to 32). Despite significant difference in testicular size between patients receiving and not receiving LH/RH agonists there were no differences in anesthesia time or anesthetic volume (3.9 and 3.9 minutes, p = 0.97, and 18.6 and 19.4 ml, respectively, p = 0.47). Mean operative time for BSO excluding anesthesia time was 36.9 minutes (range 18 to 70). Mean operative time was similar in patients receiving and not receiving LH-RH agonists (36.2 and 37.8 minutes, respectively, p = 0.39). The procedure was well tolerated, as judged by the mean intraoperative pain score during BSO of 0.2 (range 0 to 3). The majority of patients (76 or 83.5%) were pain-free during the procedure. Pain scores were similar in patients who were and were not receiving LH-RH agonists during BSO (p = 0.97). There were no adverse events. Followup data were available on 26 of the 52 patients who were receiving LH-RH agonist therapy prior to the procedure. Of them 96.2% were satisfied with the results and 84.6% preferred the procedure over medical castration therapy with LH-RH agonist therapy. CONCLUSIONS: Epididymal sparing bilateral simple orchiectomy is a simple and safe procedure that can be conveniently performed in an outpatient clinic setting using pure local anesthesia. Preservation of the epididymis and subsequent epididymoplasty is effective for maintaining the esthetic appearance of the scrotum and patient satisfaction. The procedure offers patients the convenience of 1-time surgical therapy over lifelong medical injection therapy at a significantly lower cost and without significantly compromising the esthetic appearance of the scrotum.

Adult↗

An alveolar bone augmentation technique to improve esthetics in anterior ceramic FPDs: a clinical report.

This clinical report describes guided bone augmentation for treatment of a facial maxillary alveolar bone defect to enhance the esthetic result for an all-ceramic fixed partial denture (FPD). A combination of decalcified freeze dried bone allograft and resorbable human pericardium, in conjunction with cortical channel expansion, was used for the augmentation process to eliminate a secondary surgical procedure. Post-operative examinations showed improvement in the alveolar bone contour. The regeneration of the missing osseous structure was accomplished to support the future esthetic soft tissue contours. This osseous regenerative technique significantly increased the functional and esthetic outcome of the final FPD by restoring the alveolar ridge defect to its original dimension.

Absorbable Implants↗

Enhanced periodontal response and esthetics of implant-supported bridge by the use of galvanoforming technique: case report.

BACKGROUND: Galvanoforming restorations have been placed over the past 15 years successfully. They offer several advantages over alloy restorations, including enhanced response to the periodontal tissues, biocompatibility, and superior esthetics. PURPOSE: The purpose of this report is to show the use of the galvanoforming process in dental implant restorations to transfer the benefits of this technique. MATERIALS AND METHODS: Two standard Brånemark fixtures were placed submerged in the lower mandible for the restoration of a three-unit bridge. The impression was taken at fixture level, and two cast individual telescope abutments were inserted. The galvanoforming restoration was seated conventionally without any screw retention. RESULTS: An implant-supported galvanoforming bridge is functioning successfully. The use of biocompatible materials does not compromise the stability of the restoration; instead, the effect on the periodontal tissues is excellent, resulting in less plaque accumulation and bleeding on probing. Microgaps were avoided by conventional seating on the individual telescope gold abutments, revealing superior occlusal esthetics. CONCLUSIONS: This case report demonstrates the practicability of the biocompatible galvanoforming procedure for implant-supported restorations enhancing periodontal response and esthetics.

Biocompatible Materials↗

Preservation of esthetics with implant dentistry: a clinical report.

BACKGROUND: The replacement of single teeth with implants in the anterior maxilla poses a significant challenge to the clinician because of its esthetic implications. PURPOSE: The purpose of this article is to report a protocol in which single teeth are replaced by implants and temporarily restored without load, immediately after extraction. MATERIALS AND METHODS: Between June 2001 and July 2002, 16 cases were followed up in which this protocol was used. Briefly, the teeth are extracted with a Periotome (Friadent, Mannheim, Germany), using a flapless technique, the sockets are evaluated and débrided, an osteotomy is performed following the direction of the socket, and a tapered implant is placed using the alveolar crest as the landmark. A temporary abutment is immediately custom made, and a temporary crown is placed without loading. The 16 cases are summarized, and 4 of them are presented to illustrate this approach. RESULTS: All four cases have provided excellent esthetic results maintaining an ideal implant-to-supporting-tissue relationship. Furthermore, the overall time needed to restore the cases was considerably reduced when compared with time needed for the conventional approach. CONCLUSION: The four cases presented support the use of the described protocol in the placement of single implants in areas of the maxillary anterior region where esthetics is a high priority.

Adult↗

Smile-imaging: the key to more predictable dental esthetics.

Smile-imaging is a new concept in dentistry that offers an impressive level of predictable and successful esthetic results. It is useful in the diagnosis, communication, and treatment phases of esthetic cases regardless of the treatment plan. Smile-imaging builds esthetics into the case instead of adding them on at the end. It is available to any dentist without having to spend time learning a computer program or investing in equipment. Full-face pictures of the patient are all that are required from the dentist.

Esthetics, Dental↗

Changes in lip contour following treatment of maxillary protrusion with esthetic orthodontic appliances.

With the advent of acid etching techniques and the elimination of unesthetic band materials, direct bonding of orthodontic attachments kindled a desire for cosmetic appliances such as labial ceramic brackets and lingual orthodontics. Owing to the esthetic nature of our combination upper-lingual lower-ceramic orthodontic approach, adults who would have normally avoided orthodontic treatment are now seeking treatment. This study evaluated the cephalometric changes in the soft tissue lip profile following treatment of Class II Division 1 malocclusion with upper first bicuspid extractions with our esthetic orthodontic appliance approach. Serial lateral cephalograms (pretreatment and posttreatment) of 16 adult patients with a mean age of 22.1 +/- 3.2 years were studied. The mean upper incisor retraction, upper lip retraction, upper lip lengthening, and lower lip retraction were 5.75 +/- 1.91 mm, 2.8 +/- 1.4 mm, 1.5 +/- 0.6 mm, and 1.4 +/- 0.6 mm, respectively. All these changes were statistically significant (p < 0.01). The nasolabial angle increase of 10.8 +/- 3.0 degrees was also statistically significant (p < 0.01). The upper lip retraction to upper incisor retraction was 1:2.1, while the upper lip lengthening to upper incisor retraction was 1:3.8. The correlation coefficients (r) were 0.91 (p < 0.01) and 0.57 (p < 0.01), respectively. This study shows that significant esthetic changes in lip profile are possible with this cosmetic orthodontic appliance approach. The treatment results in this study appear comparable to those published with labial metal brackets. With very few exceptions, patients were able to adapt within 2 weeks, with almost no trauma to the tongue.

Adult↗

The role of high technology in maintaining esthetic restorations.

Computer technology has revolutionized the way the world does business, allowing us to work faster, smarter, and more efficiently than ever before. Within dentistry, that translates to x-rays that use significantly smaller amounts of ionizing radiation, automated periodontal charting and storage devices, and imaging systems. Perhaps the greatest bottom-line benefit, especially in esthetic dentistry, is that these state-of-the-art developments enable dentists and hygienists to more effectively communicate with patients. The future of any restoration is based on the patient's motivation and ability to maintain an efficient oral hygiene routine. Esthetic restorations demand more vigorous home care programs to maximize their esthetic and functional life expectancy. With computerized images on screen, patients can better visualize the treatment that has been done and come to a realization that the restoration's success rests squarely on their shoulders.

Computer Graphics↗

Treatment planning 2000: an esthetically oriented revision of the original implant protocol.

Soft and hard tissue ridge deformities are prevalent in areas of tooth loss and trauma and can compromise esthetic outcomes. Only a full understanding of the severity of the dimensional defects, the reconstructive techniques available, and the functional and esthetic needs of the final implant restoration will allow the design of a treatment approach that will achieve the desired outcome. This article emphasizes the synergistic relation of the osseous, gingival, and restorative triad in treatment planning. In addition, a systematic approach to the enhancement of this triad, in the partially edentulous patient, is outlined as part of a revised protocol for achieving optimal esthetics in implant therapy.

Dental Implantation↗

Soft tissue modeling for the esthetic single-tooth implant restoration.

The ability of the restorative dentist to understand and control the relation of the implant to its associated gingival tissues is extremely important in achieving the maximum esthetic result in the final restoration. The position of the gingival margin following stage-two surgery represents collapse of the gingival tissues until it finds support by the component against which it comes to rest. This component may be a healing abutment, final abutment, or provisional restoration, if placed at the same time of implant exposure. Generally, it will be a healing abutment. There is complex relation between implant position, gingival management at stage-one and stage-two surgery, the position of the gingival margin over the buccal surface of the implant compared to the adjacent natural teeth, component selection, and lip line esthetics. The therapist who understands these relations will know how to mold the gingival tissue around implants to maximize the esthetic result. This article focuses on these relations and the technique of tissue modeling with subgingival contours to create a restoration with the illusion of reality.

Dental Abutments↗

Rationalization of esthetic restorative dentistry based on biomimetics.

UNLABELLED: The exponential progressivism that characterizes the current decade often comes with substantial financial implications. Dental care is not spared by this phenomenon. However, new generations of concepts emerging from biomimetics provide the operator with the ability to restore the biomechanical, structural, and esthetic integrity of teeth. The development of adhesion and the evolution of porcelain veneers constitute striking examples of this nascent process. Indications for bonding porcelain are extending to more perilous situations (crown-fractured incisors, nonvital teeth), resulting in considerable improvements, comprising both the medical-biologic aspect (economy of sound tissues and maintenance of tooth vitality) and the socioeconomical context (decrease of costs compared to traditional and more invasive prosthetic treatments). CLINICAL SIGNIFICANCE: In the bonded porcelain veneer and its extensions, restorative dentistry has found new solutions for the anterior segment that balance the need for functional and esthetic reconstruction. The optimal stiffness of porcelain in thin section, the ideal surface characteristics, and the biomechanical continuum achieved through high performance bonding mean the crown of the tooth as a whole can support incisal or masticatory function. By the same token, the conduction of optical effects from within the tooth combined with the ideal surface features of the porcelain veneer make this restorative approach the ultimate in esthetic satisfaction, for both the practitioner and the patient.

Cuspid↗