[Risk factors in dental implantology. The 5th Scientific Congress of the European Association for Osseointegration from 9 to 11 February 1996 in Paris].
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The fabrication of porcelain veneers in the laboratory presents many problems for the technician in the production of accurate margins and contacts, good aesthetics and, in some cases, function with the opposing dentition. Therefore, a simple, accurate and previously unpublished method of producing multiple contiguous veneers is described in this paper, involving the fabrication of six lower anterior porcelain veneers in a difficult case of tooth surface loss.
The success of free-hand bonding in anterior teeth depends on a harmonious integration of various elements, including a thorough understanding of natural function, aesthetics, characteristics of current materials, and restorative techniques. The selection of composite brands which offer a variety of shades and provide several opacities is mandatory. By utilizing an anatomic stratification with successive layers of dentin, enamel, and incisal composite, a natural-appearing aesthetic result can be achieved in a relatively simple and predictable manner. Attentive use of finishing methods is still necessary for surface quality and natural appearance of the final restoration. Direct composite bonding remains an adequate therapeutic modality in traditional Class III to Class V and localized cosmetic restorations. It can satisfy most aesthetic demands, and it offers an affordable alternative to more invasive procedures, such as veneers and crowns. The learning objective of this article is to review anterior free-hand bonding utilizing composite restorative materials.
Since the late 1950s, porcelain-fused-to-metal (PFM) restorations have remained a standard modality for rehabilitation of anterior dentition. This article discusses recent modifications to improve aesthetics, using clinical cases to present the multifaceted potential of this type of restoration. Color and contour are discussed. The use of a combination of laminate veneers and PFM restorations is presented in cases where the crown restorations of the adjacent teeth are not necessary, but color and contour require enhancement to achieve an aesthetic result. The learning objective of this article is to review the utilization of the improved porcelain laminates and the modified PFM crowns.
The use of all-ceramic systems has increased significantly during recent years, due to the improved strength and the introduction of a new generation of dental adhesive agents and resin cements. Both factors permit reliable and predictable results in single jacket crown restorations in the maxillary anterior region. Due to their natural appearance, the all-ceramic materials, especially the glass ceramics, blend harmoniously with the oral environment and are particularly appreciated where aesthetics is a priority. The learning objective of this article is to demonstrate a routine utilization of all-ceramic systems in the maxillary anterior region, preceded by a proper case selection. Two clinical cases are used to illustrate the preparation procedure, the importance of well-integrated provisional restorations, and the accuracy in transferring provisional information onto the final jacket crowns.
When the primary restorative objective is the reinstatement of vital natural tooth color, dark tetracycline-stained teeth still represent the ultimate challenge for ceramic laminate veneers. Masking severe stain with opaquing composite resins is a significant advancement; however, the procedure requires additional chairtime, is technique sensitive (to avoid excessive opacity), and involves removal of additional tooth structure. The learning objective of this article is to describe and compare two different methods for masking tetracycline-stained teeth. The article illustrates the natural tooth color derived from ceramic laminate veneers when bonded to opaque composite resins in the maxillary arch, and compares it to a new ceramic veneer formulation in the mandibular arch, which masks the stain, eliminates the need for subopaquing with composite resins, and resembles the qualities of natural tooth color.
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With the prognosis of dental implant replacement of missing teeth becoming better each year, practitioners are focusing their attention on the aesthetic aspects of implantology. However, improvement in aesthetics is only possible with the improvement in implant technology, surgical techniques and prosthodontic procedures. This study aimed at evaluating the effects of various physical and chemical agents on the implant surface; with the view of obtaining increased surface area and biocompatibility. The study found that the treatment of air-aluminum oxide blasted implants using a mixture of 30% HNO3-5% HF acids produced a surface which meets the consideration of aesthetics for implants placed in the anterior maxillary region.
The development of porcelain laminate veneers has added a new dimension to dentistry in the treatment of unsightly anterior teeth. It is a less invasive procedure than the conventional crown restoration in the treatment of aesthetic problems. This paper highlights some of the considerations in the successful use of porcelain veneers.
Matching the color of porcelain veneers to existing teeth has proved to be a challenge for the restorative dentist. The resulting color of a veneer depends upon several factors. This paper reviews a technique for making a test veneer to predict with accuracy the color of the result.
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With the continued increase in patient expectations for appearance-related restorations, the final result may be deficient in aesthetic qualities, such as color, contour, and shape. This is generally due to a breakdown in communication among the patient, dentist, and laboratory technician with regard to basic smile design principles prior to fabrication of the restoration. With the introduction of advanced porcelain systems (IPS Empress System, Ivoclar Williams, Amherst, NY), the clinician and technician can produce restorations that mimic the optical characteristics and color vitality of natural teeth. This article presents methods to improve communication, effectively evaluate smile design principles, and fabricate aesthetic all-ceramic restorations.
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Traditionally, the treatment of acid erosion lesions of the maxillary and mandibular dentition has been invasive, often utilizing full-coverage crown restorations. Intentional endodontic and post-and-core treatments have been used in the past to gain crown length for retention of cemented cast restorations. The learning objective of this article is to discuss the primary cause of acid erosion-bulimia nervosa-and present an alternative dental treatment modality. The alternative treatment uses conservative tooth preparation, dentin bonding technology, and pressed ceramic restorations, achieving aesthetic results. The indications and advantages are discussed, and a case report illustrates the clinical procedure. The importance of achieving the cessation of the purging habit as a prerequisite to dental treatment is emphasized.
Veneer restorations are well suited for conservative and aesthetic improvement of the anterior dentition. Laboratory fabricated porcelain and composite resin veneers present optimal aesthetics and durability. Although there are disadvantages associated with direct bonding, it provides control of color and contour for the operator, particularly in the case of a single anterior central incisor. Direct/indirect composite resin veneers utilize the advantages of both direct and indirect techniques in reconstruction of restorations with improved physical properties. The learning objective of this article is to review the available composite resins, opaquers, and tints, and present a step-by-step protocol for predictable restoration of discolored anterior dentition with direct/indirect heat-treated composite resin veneers in a single appointment. Patient evaluation, preoperative aesthetic considerations, selection of the restorative composite resins, and the clinical procedure are discussed.
Composite and ceramic restorations are well-accepted treatment modalities for anterior as well as posterior regions, and numerous systems are available. This article presents the historical development of tooth-colored restorations from their incipience in 1882 to the second generation laboratory composites of today. The causes of failures in the early ceramics are discussed, and the search to delineate the optimal qualities of ceramics is outlined, listing the improvements of each new generation. The inherent obstacle of ceramic brittleness is reviewed along with the specific requirements of preparation. The learning objective of this article is to present the development of tooth-colored restorations in a concise form and indicate the characteristics of the materials currently available.