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PubMed2002

Esthetic treatment planning: the grid analysis system.

UNLABELLED: It is sometimes difficult to identify esthetic problems let alone pre-visualize an esthetic end-result. The Esthetic Grid Analysis is a system for analyzing the basic problems that detract from the concept of an attractive smile. A photograph is taken of the anterior teeth with the lips retracted. The upper and lower frame of the photograph is aligned parallel with the interpupillary line, assuming that the interpupillary line is parallel with the horizon. Where this is not the case, the vertical margins of the photograph are aligned parallel with the facial midline. Through orienting the photograph to the facial guidelines and incorporating the idealized positions of the incisal plane, highest lipline, midline axis, and proportionate contact areas, a grid is formed. The grid built from these components provides a method of demonstrating deviations from an esthetic arrangement of anterior teeth. CLINICAL SIGNIFICANCE: Integrating facial guidelines with the dental composition using a grid highlights deviations from the ideal. It thereby assists in the treatment planning process by communicating esthetic problems to the patient, laboratory personnel, and other specialists.

Adult↗
PubMed2002

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Dental Materials↗
PubMed2003

Perioesthetic approach to the diagnosis and treatment of carious and noncarious cervical lesions: Part II.

UNLABELLED: Several classes of tooth-colored materials are available for restoring carious and noncarious cervical lesions. Included are the composite resins, which can be bonded into the cervical area to provide predictable form, function, and esthetics. Part I of this two-part report reviewed the etiology of noncarious cervical lesions and provided a series of clinical case reports showing the importance of the periodontal aspect of lesion management. In part II we present information about adhesive preparation design and esthetic restoration of the noncarious cervical lesion. CLINICAL SIGNIFICANCE: When used with proper attention to preparation design and restoration placement and finishing, resin composites can be used to successfully restore form, function, and esthetics to defective cervical areas of teeth.

Dental Caries↗
PubMed2004

Direct composite resin restorations: a review of some clinical procedures to achieve predictable results in posterior teeth.

UNLABELLED: The interest of patients in having tooth-colored restorations and the development of techniques and materials that make these restorations easier have contributed to make the esthetic restoration of posterior teeth popular. The direct use of composites in posterior teeth is a technique-sensitive procedure. Some difficulties, nevertheless, can be overcome or at least minimized by a heedful clinician by paying thorough attention to the various stages of the restorative technique. The present article seeks to review some concepts about this adhesive restorative procedure and to illustrate the possibilities of the technique with clinical reports. CLINICAL SIGNIFICANCE: The direct posterior composite restorative technique offers the possibility of closely matching the natural optical characteristics of the lost tooth structure. Aimed at showing the potential of this technique, this article presents two step-by-step case reports and also reviews some concepts related to these clinical procedures.

Adult↗
PubMed1986

Factors affecting the cost of fissure sealants: a dental insurer's perspective.

The slow adoption of sealants into dental practice is attributed partly to the fact that few prepayment plans pay for sealants. An important concern of insurers is how a sealants benefit will affect premiums. In this analysis, caries rates for various surfaces and teeth, failure rates for both sealants and amalgam restorations, fees and copayments, interest rates, reimbursement policies for replacement and repair, and the passage of time were studied to assess the cost to an insurer of amalgam restorations versus sealants. The results indicate: Sealants as a covered benefit for molars may not cause premiums to increase if fees and copayment levels are properly balanced. If caries in children continues to decline, however, higher premiums may be required if a sealant benefit is provided. Sealants as a covered benefit for bicuspids are likely to require higher premiums. The level of dental caries in the population should be monitored closely, because a further substantial decline in caries prevalence could diminish the economic argument for sealants.

Bicuspid↗
PubMed1992

Comparison of number and mean charge between dental sealants and one-surface restorations.

An important concern of the insurer is how sealants, if a covered benefit, will affect the premium. Important factors that may have an influence on determining the premium include the decline in caries rate coupled with the long-term cost to an insurer for sealants vs one-surface restorations. In this study of more than 1 million dentally insured children (aged 5-15), the mean charge ($) for sealants and one-surface restorations was determined, along with the frequency of these procedures, by patient age. For this group of children, 43 percent of one-surface restorations occurred between ages 12-14, whereas 32 percent of the patients received sealants at either 7 or 8 years of age. States varied substantially in the number of sealants as a percentage of the number of restorations. Only three states had more sealants placed than one-surface, posterior restorations. Three states had an annual increase in the ratio of sealant to restoration charge, while 13 states had an annual decrease. With the exclusion of a few states with a minimum number of sealants and restorations in 1988, the highest ratio of the cost of sealants to the cost of one-surface restorations was observed in New York (.60) and New Jersey (.56) and the lowest observed in Kansas and Utah (.37). The ratios for both New York and New Jersey were lower in 1988 than in the previous two years. The ratio of the number of one-surface, posterior restorations to the population served was approximately the same for each NIDR region in the contiguous United States. Alaska and Hawaii had a higher proportion.

Adolescent↗
PubMed2006

The cost-effectiveness of large amalgam and crown restorations over a 10-year period.

OBJECTIVE: To assist clinical decision making for an individual patient or on a community level, this study was done to determine the differences in costs and effectiveness of large amalgams and crowns over 5 and 10 years when catastrophic subsequent treatment (root canal therapy or extraction) was the outcome. METHODS: Administrative data for patients seen at the University of Iowa, College of Dentistry for 1735 large amalgam and crown restorations in 1987 or 1988 were used. Annual costs and effectiveness values were calculated. Costs of initial treatment (large amalgam or crown), and future treatments were determined, averaged and discounted. The effectiveness measure was defined as the number of years a tooth remained in a state free of catastrophic subsequent treatment. Years free of catastrophic treatment were averaged, and discounted. The years free of catastrophic treatment accounted for individuals who dropped out or withdrew from the study. RESULTS: Teeth with crowns had higher effectiveness values at a much higher cost than teeth restored with large amalgams. The cost of an addition year free of catastrophic treatment for crowns was 1088.41 dollars at 5 years and 500.10 dollars at 10 years. Teeth in women had more favorable cost-effectiveness ratios than those in men, and teeth in the maxillary arch had more favorable cost-effectiveness ratios than teeth in the mandibular arch. CONCLUSIONS: Neither the large amalgam or crown restoration had both the lowest cost and the highest effectiveness. The higher incremental cost-effectiveness ratio for crowns should be considered when making treatment decisions between large amalgam and crown restorations.

Adult↗
PubMed1975

Composite resin restorations. A three-year clinical assessment of four materials.

The clinical characteristics of four composite resins were assessed over a period or up to three years. Two hundred and sixty nine restorations of composite resins placed in anterior teeth were subjected to 380 examinations during a three year study. The restorations had been placed in the mouth of patients aged 11 to more than 51 years by a variety of operators and the clinical characteristics observed. An increase in defects and deficiencies occurred at the progressive examinations.

Adolescent↗
PubMed1977

Incisal angle adhesive resins: a two-year clinical survey of three materials.

Three composite resin materials gave reasonable results in the short-term, provided that they were placed and finished correctly. This would be easier to do with the small incisal fractures. Although slightly more defects became apparent with time, most could be corrected without the replacement of the restorations.

Acid Etching, Dental↗
PubMed1979

The quantitative measurement of the opacity of aesthetic dental filling materials.

A method is described for measuring the opacity of anesthetic dental filling materials using a goniophotometer. Procedures are given for converting measured opacity values to those referred to a 70% reflectance background (C0.7 values) as required by existing specifications. The conversion is involved, and, since most available white surfaces have reflectance of about 80%, it is recommended that in future specifications opacity be recorded as C0.8 values. Opacity values for 28 materials are reported. It was found that the opacity of dental cement decreases for several days following preparation and that powder/liquid ratio has little effect, while pigmentation has a marked effect on opacity.

Acrylic Resins↗
PubMed1980

Ethical and legal considerations associated with clinical field trials.

As members of a hypothetical review board, we have evaluated the protocol of a clinical caries trial following the recommendations proposed by the National Commission. The potential risks to the subjects were described as well as the potential benefits that both the participants and society might derive from the study. A new element of the institutional review process was the determination of the scientific validity of the study. The Commission was cautious in indicating that, while such a review should be conducted, studies of marginal scientific importance might be allowed, as long as the risks were minimal. Clinical studies of cariostatic agents traditionally use children as subjects. The rights of children as research subjects were addressed in detail by the Commission. Its recommendation that "assent" of the children be secured is significant. Nevertheless, the Commission distinguished between consent and assent. Consent of parents must be actively secured while assent of the children is acquired by their passive acquiescence to participation. We have raised questions at a practical level throughout this presentation in order to stimulate discussion. These questions, however, do not have simple answers. In the time remaining, we trust the complex issues involved will be discussed further.

Child↗