Broadening the scope of dental education.
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This paper presents a technique for restoring maxillary posterior teeth with a combined composite resin and amalgam restoration when the preparation extends buccally into an esthetically critical area. This technique has two major advantages over traditional combined restorations: it requires only one clinical appointment, and it provides an esthetically acceptable result while maintaining the advantages of an amalgam restoration. A clinical assessment of 12 of these restorations, in vivo for 0.8 to 6.4 years, is presented. All but one restoration received a score of excellent or acceptable.
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Esthetic procedures that require alteration of healthy dental tissue should be explained to the patient. Our professional obligation is to inform the patient of the risk-reward of a dental treatment that does not correct or enhance dental health.
The contemporary practitioner is faced with a bewildering number of options from which to choose when selecting restorative materials. There are not only many different types of materials available, but also numerous options for any given group of materials. For example, many manufacturers offer their customers three or even four different dentin bonding agents. The sheer number of available products is in itself overwhelming. When coupled with aggressive marketing strategies, misinformation supplied by paid clinicians at many seminars and lectures, and infomercials disguised as scientific articles in many of the trade journals, it is little wonder that the average ethical practitioner is frustrated when attempting to make rational choices. Clinicians use information gleaned from a variety of sources to make these difficult decisions. This article will attempt to evaluate the validity of these sources and will provide a philosophical matrix to assist the practitioner in making rational decisions relative to materials selection.
The growing demand of patients for esthetic or metal-free restorations, together with the ongoing interest of the dental profession for tissue-preserving materials have led to the actual development of posterior adhesive restorations. It is now clearly established that a new biomimetic approach to restorative dentistry is possible through the structured use of "tooth-like" restorative materials (composite resins and porcelain) and the generation of a hard tissue bond (enamel and dentin bonding). Scientific studies and clinical experience have validated use of bonded tooth-colored restorations, and we may have entered the so-called "postamalgam era". These significant changes have already impacted daily general practice, including pediatric dentists in California, but it is now critical to assure that the corresponding evidence-based process is integrated to the predoctoral programs statewide and nationwide. This paper reviews the foundations of this evolution, based on maximum tissue preservation and sound biomechanics, the so-called "biomimetic principle". Using scientific evidence and clinical experience, a model for the adequate use of current restorative systems is presented. This work, illustrated with cases with up to 10 and 14 years' follow-up, sets the ground rules for the clinical performance of the posterior esthetic restoration. Important considerations about tooth preparation, matrix techniques, layering methods, immediate dentin sealing and base lining are presented.
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It can be challenging to reproduce the appropriate three-dimensional contours when the proximal walls of posterior teeth have been lost. This presentation will demonstrate the fundamentals required to achieve predictable success when placing direct posterior composites in these Class II sites. The keys to successful placement of resin materials (eg, adhesive technique, integration of form and function, color match) are covered herein. When placing a direct resin restoration, clinicians must have a sound understanding of tooth morphology, combined with the proper techniques, outlined in the clinical case, in order to obtain an acceptable aesthetic restoration.
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Aesthetic restorative resins have been characterised by clinical discolouration. New light-cured anterior and posterior resins are currently available to the profession and this study investigated the in vitro colour stability at 24 hours and 7 days of ten such resins in three different staining media. Disc specimens were prepared and stained at 37 degrees C and 100 per cent R. H. and then evaluated by double blind visual assessment. All the materials undergo some staining in coffee and red wine. Coca-Cola, however, does not cause any staining of the restorative resins. Adaptic II is the most stain-resistant material and most of the staining occurs within the first 24 hours after immersion in the staining media.
The try-in visit for restorative dentistry is one of many important steps toward excellence. Attention to detail in all parts of this visit outlined above will lead to fewer remakes and more satisfied patients and dentists.
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Porcelain is an outstanding material for tooth restoration with splendid cosmetic results. With the introduction of porcelain it is possible to restore teeth with minimal loss of healthy tissue. This results in strong and beautiful restorations.