Periodontal and restorative considerations of molar uprighting

The sequelae to the loss of a tooth are both numerous and varied. Furthermore, the ramifications of tooth loss increase in severity with time. Consequently, corrective therapeutic measures can become complex both in the diagnosis and treatment of these situations. As the demand for more predictable treatment results grows, the requirements for more efficacious treatment modalities grow as well. Therefore, the need for interdisciplinary treatment within the various areas of dentistry to assist in the complex rehabilitation becomes very important. The purpose of this article is to examine the various benefits of molar uprighting from periodontal, orthodontic, and restorative viewpoints, and to suggest a classification whereby the clinician is directed toward a multidisciplinary treatment approach.     

Esthetic dentistry in the twenty-first century. Healthy beauty

The goal of esthetic dentistry in the twenty-first century is to attain healthy beauty by harmonizing morphology and function. Morphologic beauty is achieved by using restorative techniques such as ceramo-metal restoration, all-ceramic restoration, laminate veneer, bleaching, and the treatment of malocclusion. Functional beauty is obtained by facilitating the primary functions of the stomatognathic organ, namely, mastication, speech, and craniomandibular stability. In the next century, esthetic dentistry must combine the present focus of morphologic beauty with the goals of functional beauty to attain true, healthy beauty.     

Root surface treatment with glass ionomers and resin composites

Recommendations for restorative treatments of root surfaces are made difficult by a lack of information on the etiology of root conditions and on the clinical performance of available materials used to treat these conditions. Resin composite and glass ionomer materials are popular restorative materials because they are esthetic and can bond to tooth structure. However, the role each can play in restoration of root surface lesions is not well documented. This article presents a rationale for using these materials for a number of restorative situations.     

Improving outcomes using dental implants: integrating improvements in clinical practice

Modern restorative dentistry is confronted with many challenges related to implant use in the craniofacial region, such as attempting to place implants in esthetically critical sites or anatomically limiting regions of the jaw. To assure a successful implant placement that is satisfactory to both the patient and the dentist, four key areas need to be improved: diagnostic procedures, surgical procedures and outcomes, esthetic results, and prosthetic complications. This article discusses how an integrated approach to these areas can improve clinical practice.     

Pre-hospitalization management of evolving myocardial infarction. 2d conference of south-eastern region emergency medicine experts

Since the development of advanced adhesive technology, the use of amalgam has declined significantly. The search for amalgam substitutes, i.e., restorative materials which maintain similar clinical function and cost-effectiveness as amalgam, has so far been unsuccessful. It has also become evident that a considerable confusion prevails regarding the objectives of restorative procedures. In absence of national and international standards, the products--the restorations--are assessed according to varied criteria. In placing restorations, three objectives are attained, at most: a) tooth preservation, b) tooth preservation and function, and c) tooth preservation, function, and imperceptible restitution. The learning objective of this article is to discuss the positive effects that could be attained by defining the standards, terminology, and the quality assessment criteria for operative dentistry in regard to the patients and the dental profession.     

Conventional endodontics and the operating microscope

Patients are increasingly wishing to undergo conventional endodontic treatment rather than to risk the loss of a tooth. Endodontic treatment in teeth that have been previously restored with extensive intracoronal or extracoronal restorations are often difficult to treat. The orientation of the root canals to the crown of the tooth may be lost, and this may often be compounded by the deposition of reparative dentin in the pulp chamber. The operating microscope allows better visualization of the working field, ensuring that the anatomy of the tooth is more readily inspected. This greatly enhances the clinician's ability to locate extra root canals and therefore increase the likelihood of a successful outcome. It should not be forgotten that the operating microscope also has a place in other fields of dentistry, especially restorative dentistry, and is an asset to both the specialist and the generalist.     

Cosmetics and the esthetic patient and laboratory communication

With increasing consumer awareness of the innovative procedures available for cosmetic dentistry, this area of practice is growing rapidly and has become an excellent source for patient referrals. Unfortunately, it can also be a large source of stress for the practitioner. Esthetics has been described by The Pocket Oxford Dictionary as "the philosophy of beautiful"; its perception varies from individual to individual. In the field of dentistry, there are criteria which define one tooth as being more esthetic than another and one individual's smile as more pleasing than another. However, that which is esthetically pleasing to the clinician may not be esthetically pleasing to the patient.     

Diagnosis and treatment planning for implant dentistry

Dental implants are well-established in dentistry and allow the restorative dentist to offer patients the best that dentistry has to offer. Through examination, radiographs, and study models, the restorative dentist and implant surgeon can develop a treatment plan. Comprehensive diagnosis and treatment planning involve much more than a clinical exam--they require an investigation involving past, present and future dental therapy.     

Glial tumor cell proliferation and immune response in the brain

Absence of the maxillary lateral incisor creates an aesthetic problem which can be managed in various ways. The condition requires careful treatment planning and a consideration of the options and outcomes following either space closure or prosthetic replacement. Recent developments in restorative dentistry have warranted a re-evaluation of the approach to this clinical situation. Factors relating both to the patient and to the teeth, including the presenting malocclusion and the effect on the occlusion, are considered. This review considers the possible options: no treatment; orthodontic space closure with canine modification; space maintenance and replacement of the missing tooth with denture, bridge (adhesive and conventional), or implant.     

The effect of core translucency on the aesthetics of all-ceramic restorations

Recent advances in ceramic technology have revolutionized aesthetic dentistry. When treating a single anterior tooth in need of a full-coverage restoration, a multitude of options in restorative materials and techniques is available to the clinician. The learning objective of this article is to present and evaluate a selection of all-ceramic dental materials currently available for aesthetic full-coverage crown restorations. When selecting an all-ceramic system, there are several major factors to consider, including the inherent translucency of the ceramic material and of the adjacent dentition, the color of the prepared tooth, and the forces anticipated in that region. Preparation and restoration of discolored and nondiscolored tooth structure are reviewed. The techniques presented can be utilized to obtain predictable results in the anterior region for aesthetic all-ceramic full-coverage restorations.     

Restorative dentistry. Crown therapy

Not one post, core, margin, impression material, cement, or final restoration can be used in all clinical situations. This article does not discuss the merits and shortcomings of the numerous restorative concepts and techniques that exist, but rather has concentrated on those that the author believes are valid and applicable today. If one third or more of the anatomic crown remains, or if this is achieved by crown lengthening, a post may not be necessary; however, a crown restoration should definitely be considered. Veterinary dentistry cannot limit those variables that occur daily in clinical practice. Veterinarians must learn to work with these variables and spend less time trying to find the one that applies to all cases. When the basic concepts of how to retain the various restorative components and how to protect remaining tooth structure are understood, the ability to answer numerous questions that arise during the restorative process is facilitated and results in final restorations that are based on sound design principles.     

The use of cantilever bridges

Replacement of missing teeth with fixed bridgework often involves producing full crown retainers on teeth on both sides of an edentulous space. Unfortunately, this approach can result in the destruction of much healthy tooth tissue, and the clinician must balance the benefits of replacing missing teeth with the amount of tooth preparation required. Current thinking in restorative dentistry places the preservation of tooth tissue at a premium, and most practitioners are happy to use techniques that embrace this philosophy. Because of this, cantilever bridges have an increasing role in dental practice, where the replacement for a missing tooth or teeth has one or more abutments on only one side of the edentulous space, being unsupported at the other. Cantilever bridges fall into several types, depending on the number of abutments and types of retainers. This article describes the various cantilever bridge designs, considers the biomechanics of these restorations, and provides guidelines for their clinical use.     

Lipid peroxidation in patients with ischemic heart disease, hyperlipidemia and/or hypertension while polyunsaturated omega-3 fatty acids of plant and animal origin were in their diet

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.     

Problems in restorative dentistry: who copes with them?

The views of general dental practitioners, practising in part of the Yorkshire Region, as to how they would cope with a variety of restorative problems were sought using a questionnaire. If advice or advice and treatment were to be requested from a consultant in restorative dentistry, the questionnaire was designed to discover whether the distance from a hospital created a barrier to the preferred course of action. Only one-third of the dentists were happy to treat a troublesome complete denture case, provide a replacement obturator or look after a natural dentition with considerable periodontal problems. Travel constraints were particularly apparent when it came to seeking help for the elderly edentulous patient. The results of the study indicate that in the Yorkshire Region, there is a high level of demand for consultant advice and treatment for a number of common restorative problems.     

Middle digestive cancers in Texas Hispanics: a New World syndrome?

The aim of the study was to evaluate the esthetic performance of direct composite additions in correcting tooth form and position at 5 years. Composite additions were directly placed using the acid-etch technique and enamel bonding on 87 intact maxillary anterior teeth in 23 young patients (12-19 years old). The restorations were made by one operator using an ultrafine midway-filled densified restorative composite. Color slides were made at baseline and 5 years. At the 5-year recall, esthetic performance was assessed clinically by two evaluators at chair-side in subterms of color match, translucency/opacity, surface roughness, and anatomical form. Five additional examiners scored esthetics on the 5-year slides. Of the restorations, 89% were still esthetically satisfactory after 5 years of clinical service. The remaining restorations needed replacement, mainly because of severe loss of anatomical form, to a lesser degree because of severe color mismatch. Central incisors and small unilateral restorations generally showed the best results concerning color match (68% and 74%, respectively) and surface smoothness (84% and 100%, respectively). The slide scores on color match and translucency/opacity were generally similar or somewhat better than the direct clinical scores; however, the difference were not statistically significant (P > 0.05). As far as surface roughness is concerned, the results were significantly better (P < 0.05) when recorded indirectly than by direct clinical evaluation. In conclusion, direct composite additions are a valuable and effective procedure for esthetic and conservative treatment of malformed and misaligned anterior teeth. Loss of anatomical form due to wear points to a shortcoming of the composite material used, with which a durable esthetic result cannot always be guaranteed in the long term.     

Making a clinical decision for vital tooth bleaching: at-home or in-office?

The dramatic increase in public demand for esthetic dentistry and tooth bleaching has encouraged development and resulted in new products and eltasdeltaues. Vital tooth bleaching, including in-office bleaching and at-home bleaching, has been adopted as an effective and safe method for whitening natural dentition. Although most dentists prefer at-home bleaching, nearly one third use in-office bleaching. Continuous improvements in bleaching products and delivery systems have made in-office bleaching more practical and predictable. This article discusses the practical applications of vital tooth bleaching, as well as the advantages and disadvantages of each method.     

Advanced adhesive restorations: the post-amalgam age

Due to patient demand for biocompatible, safe, and tooth-colored restorations, the use of amalgam as a restorative material has been declining. Currently, the profession of operative dentistry is in a state of transition from the amalgam age to the post-amalgam age. The learning objective of this article is to discuss the current state of the art of tooth-colored restoratives--amalgam substitutes and amalgam alternatives--used either as direct or laboratory fabricated restorations nationally and internationally. Adhesive dentistry is discussed in detail, with tooth preparation as the key element. The challenges facing the clinician during the transition period include clinician education, restorative concepts and teaching competence, costs, prevention, and maintenance.     

Adhesive systems for tooth-colored restorations. A review

The quality, longevity and the esthetic appearance of tooth-colored restorations are primarily dependent upon the integrity of the bond of the restoration with the enamel and dentin. Consequently, the enamel and dentin adhesives which are increasingly combined in the so-called adhesive systems play key roles in restorative dentistry. This paper describes the components, the clinical technique, the importance of the systems and the relevant adhesive mechanisms.     

Advanced marketing strategies to build the esthetic dental practice

Esthetic dentistry is truly a major part of the future of the fee-for-service practice. There are still many patients who seek high-quality elective care and these individuals need to be swayed to make an initial appointment with you. Whether you reach them through your present patients or through outreach to the community, the important key is your method of handling each of these patients as they join your practice. Customer service needs to be stronger and more obvious than ever before in order to differentiate your practice from others and to attract more referrals. The days of waiting for patients to arrive have clearly come to an end. Managed care and a decline in the need for traditional services has eroded a significant component of the dental market. When you combine that with the realization that only 50% of the population visits the dentist even once a year (and far less in many countries outside the United States), then it becomes obvious that the total available market for the elective services of esthetic dentistry has declined. Esthetic dentistry programs must be better defined, with an ongoing focus to educate present patients and to attract new patients. As I state in my seminars, I firmly believe that any practice today can still be highly successful. I do not feel that I will be making that statement three to five years from now. The time to begin positioning your practice for future growth of esthetic dentistry is now. As managed-care programs increase, it will become more difficult to turn around a declining practice. Having a quality marketing program already in place will make the difference for your esthetic practice. The new patient phone call is critical. It is there that you will begin to help patients understand fully the overall attitude and policies of your office. Successful management of new patients is to win their trust by giving them ultimate customer service while convincing them to fit your present system and schedule. When a new patient calls the practice, you want to get them scheduled within a reasonable time frame while their motivation is still positive. Remember, you only get one first chance to make a great impression. Each office should decide which questions are appropriate to ask. The front desk coordinator should ask these questions calmly and clearly so that the new patient has an opportunity to answer them without feeling that they are going through the inquisition. At the same time, the more information you have about this patient, the easier it will be to gain treatment acceptance because of your understanding of the new patient's needs. Many offices will ask new patients how they came to choose their particular office. Since many practices gain new patients from existing patients, it is appropriate to know when this has occurred and properly thank the referral patient. By thanking the patient who referred the new patient, you will encourage further referrals.