High-tech special care dentistry: digital radiography in the operating room.
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Biomedical subjects
Publications and source records attributed to R E Rada.
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Teeth in the mandibular anterior region of the mouth, affected by years of periodontal disease and resultant bone loss, frequently require treatment for the patient to be able to chew comfortably and effectively. Often patients choose to keep compromised teeth, despite being presented with treatment options involving a fixed or removable prosthesis. In these situations, mechanical stabilization becomes necessary. Current treatment possibilities include bonding with resin composite or placement of a bonded metal mesh splint, a cast metal resin-bonded retainer, or a fiber-reinforced resin composite splint. Coupled with good oral hygiene practices, these mechanical stabilization techniques can provide increased oral comfort and improved function, especially for geriatric dental patients.
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Vital bleaching can be a relatively unpredictable treatment. Photographs of previous cases and cosmetic imaging, although useful, may lead to unrealistic expectations on the part of the patient. The high-tech mystique of computer imaging and viewing one's own teeth has a significant impact on the dental patient. Whether imaged by the dentist or an auxiliary, patients must be aware of alternatives that may exist both before and during treatment. Cosmetic imaging should be used as an adjunct to, not as the prime motivator for, treatment planning in bleaching cases. Excellent communication between the practitioner and patient is the most important factor in assuring positive bleaching results and patient satisfaction.
Minimizing the risk of bleeding as well as the risk of thromboembolism in dental patients being treated with anticoagulants is a common challenge for practitioners. This article features tips on evaluating and managing these patients.
The development of implants that are predictable and successful long-term replacements for missing teeth (as a result of disease or trauma) in both full and partially edentulous situations has led to their acceptance as part of mainstream restorative dental therapy. In partially edentulous cases, implants can be combined with various esthetic dental restorations. This article will describe a case in which optimum anterior esthetics were obtained using a combination of single-tooth implants and porcelain laminate veneers.
Strategic management of any business will enable it to prosper in challenging times of change. Strategic planning is not characteristically found only in large corporations. Indeed, small business, such as solo private practices, can gain much from the process. The successful practice is one that is proactive rather than reactive; it has learned to become the beneficiary of change, rather than its victim.
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Indirectly fabricated composite-resin inlay and onlay posterior restorations are becoming more popular. By utilizing a flexible die material, these restorations can be expeditiously completed by the dentist or by a well-trained dental auxiliary, often in one appointment.
The porcelain-fused-to-metal restoration is and will remain one of the most common restorations in dentistry. However, with the many variables that exist in fabrication and function of these restorations, there also is a potential for failure. This failure usually involves the porcelain portion of the restoration. A simple and predictable technique is extremely advantageous in prolonging the longevity of these restorations. A combination of metal preparation along with specific porcelain treatment will result in such a repair. The specific porcelain treatment involves a combination of hydrofluoric acid etching and a saline bonding agent. The technique has been used for numerous repairs with excellent success.
The consequences of disregarding the periodontal tissues through improper restoration design are illustrated. A geminated central incisor is aesthetically restored with a porcelain labial margin ceramometal crown and its normal counterpart with a porcelain laminate veneer to equalize proportions of the two teeth. Prior to restoration, the perio-prosthetic interdisciplinary approach is described in rehabilitation of the damaged periodontal tissues.
Placement of porcelain laminate veneers has become a relatively common procedure. Occasionally it is necessary to fabricate provisional restorations. For these situations, the use of self-curing acrylic resin and composite resin has been described in the literature. Extensive trimming and finishing procedures are often necessary, and, because of the inherent fragility of the materials, the provisional restorations are prone to breakage. To improve the technique, visible light-curing acrylic resin can be used to fabricate direct provisional restorations. The material is available in several shades, has excellent manipulative properties, and does not necessarily require a custom matrix, offering significant advantages over a composite resin or self-curing acrylic resin.
Amelogenesis imperfecta is an inherited disorder involving enamel formation that affects the appearance of the teeth to various degrees. Cosmetic rehabilitation of these patients has been open to a variety of treatment options. Complete-coverage restorations are often recommended. Patients are occasionally averse to this because of the extensive preparation of tooth structure or lack of financial means. In the past, conservative measures were inadequate because the lack of enamel bonding did not allow a durable restoration. Presently, with the use of glass-ionomer cements and dentinal adhesives, dentin-resin bond strengths are approaching those of etched enamel. This article discusses the use of glass-ionomer cement, dentinal priming agents, and etched enamel to create a strong bond between restorative material and tooth structure that provides not only satisfactory esthetics, but also a durable restoration.
Two cases of sickle cell crisis precipitated by periodontal infection are presented. Sickle cell anemia, causal factors in sickle cell crisis, and dental treatment considerations for crisis and noncrisis patients with sickle cell disease are discussed.
Esthetic restoration of the maxillary anterior dentition often requires an integrated perio-restorative team approach. Careful attention to treatment planning and treatment sequencing is essential in ensuring a desirable outcome and a satisfied patient. Detailed measurements, diagnostic wax-ups, surgical mock-ups, and stents all are effective communication tools which can be used to enhance interdisciplinary communication. These concepts and treatment modalities are illustrated in this case report.
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