The care of endodontically treated teeth has been one of the greatest challenges in restorative dentistry. Left unrestored, endodontically treated teeth have complications that include coronal leakage and subsequent reinfection of the root canal system. These teeth are at risk for fracture, since they become predisposed to structural compromise when compared to their properly restored counterparts. As demonstrated herein, caries, previous restorations, fractures, wear, erosion, and endodontic procedures each require careful consideration and timely tooth reconstruction to ensure a favorable prognosis.
The artistry involved in the development of natural-looking, aesthetic restorations has been recognized by dental professionals and patients alike, increasing the role of the laboratory technician in the overall treatment planning phase. While it is rare for patients to first present to the laboratory for treatment, proactive technicians can actively seek out patients and assist them in identifying the type of restorative care desired and provide a reference to a qualified clinician once a modality has been identified. The following case presentation details the laboratory sequence used in the fabrication of a low-fusing pressed ceramic restoration for a patient who presented to the laboratory for initial consultation and treatment planning.
Sophisticated patients want their dental concerns treated without appearing as if they have been restored. This case presentation describes the planning and treatment steps for the recreation of an aesthetic smile. The patient had dento-facial asymmetries and an elevated occlusal risk of fracture due to bruxism. Lithium disilicate glass ceramic in a pressed version with stocked veneering porcelain was selected as an ideal restorative material for natural aesthetics and to fulfill the strength requirements for the maxillary anterior restorations.
While the concept of minimally invasive dentistry has long been considered a rational, viable approach to restorative care, preparation design, material science, and long-term evidentiary support have only recently begun to provide the foundation necessary to support such treatment in the everyday practice. This article reviews the fundamental paradigm shift evidenced in contemporary prosthodontics as required to facilitate the emerging interest in delivering conservative restorative alternatives.
in the materials themselves, contain many variables and have consistently represented a challenge for both the restorative dentist and the dental laboratory. Many impressions are problematic (eg, unclear margin reproduction, distortion from improper handling prior to pouring, incomplete registration of finish lines, oral fluid contamination, tray movement during transfer) to some extent, and proper handling is fundamental to restorative success. Even when the practitioner correctly performs tooth preparation and forwards detailed impressions and bite registrations to the dental laboratory for restoration fabrication, additional chairtime can be required at the seating appointment for final adjustment of contacts and/or occlusion. In the author’s opinion, should chairside adjustment consume more than five minutes, then editorial commentary
Development of aesthetic restorations requires a careful, thorough, and concise team approach. The correct design of the gingival margin will significantly affect the overall appearance of the restorations, and the development of scalloped interdental papillae is equally paramount to restorative success. Tooth morphology can only be reestablished in a natural way when the soft tissue is compatible with aesthetic principles. Additional considerations that must be addressed during restorative fabrication include incisal edge position and development of an accurate shade match with the surrounding dentition. Thorough communication is, therefore, critical between the laboratory technician and the clinician in order to ensure development of a concise treatment plan that includes proper material selection, laboratory design, and clinical execution.
In recent orthodontic literature, the term "temporary anchorage devices (TADs)" has been used interchangeably with mini-implants for orthodontic anchorage. This article describes the use of TADs in conjunction with a tooth-borne segmental distraction osteogenesis device to treat mandibular anterior crowding with skeletal Class II and molar Class I relationships. The use of TADs prevents the rotation of the distracted segment, whereas the maxillary occlusal splint protects the distracted segment from anterior occlusal prematurities. The surgical and orthodontic rationales are also discussed.
While the need to maintain a dry operative field has traditionally caused complications during various soft tissue surgical procedures, the use of bipolar electrosurgical techniques can eliminate this need, thus increasing the clinician's ability to deliver predictable, long-term results. This case presentation describes how to determine the presence of passive eruption, treatment plan its correction, and surgically alter the gingiva to provide a more aesthetic smile. ncisal edge. * Be aware of how to surgically correct using bipolar electrosurgery.
Implant dentistry is changing. There are currently two types of computed tomogrophy (CT) scanners--multi-slice and cone beam--available to the dental professional. Computed tomography allows for proactive planning among the entire implant team and with the patient, a concept referred to as "collaborative accountability" In addition, CT surgical guidance that enhances accuracy and precision is available to ensure prosthetic outcomes. A logical and progressive approach is outlined that allows each clinician to assess how to embrace this paradigm shift in his or her clinical practice, and provide better and safer patient care.
