There is no question that dental implants have been the most influential change in dentistry during the last half-century. In general, they are well-proven and highly useful. However, the diameter of standard implants (approximately 3.75 mm), along with the frequent need to graft bone to allow for their placement, have limited their use for those who most need implants. The introduction, approval and continuing observation of success of smaller-diameter mini-implants have stimulated use of implants in situations in which standard-sized implants could not have been used without grafting. The result has been more patients who have been served successfully at reduced cost with minimized pain and trauma--patients who could not have been treated with implants otherwise. Continuing research is needed for further verification of the acceptability of mini-implants.
In-office CAD/CAM is a reality. It allows fabrication of tooth-colored inlays and onlays, crowns and veneers in one appointment. It is especially well-suited to dentists who accomplish many single-tooth or single-quadrant restorations. As with any new technology, its cost is high, but using it can be financially feasible. Clinical and basic science investigations have resulted in positive findings on the concept. There are some significant advantages and several disadvantages. In-office CAD/CAM works well for many dentists, but practitioners should evaluate it carefully before accepting it, as it is not for everybody.
Ceramic veneers are extremely popular and have been used for many years. In spite of their phenomenal success, they offer numerous challenges during service. In this column, I have identified and discussed several degenerative situations commonly observed, and I have described methods of preventing or reducing the problems. When properly placed, ceramic veneers are among the most beautiful and long-lasting of all dental restorations.
During the past few decades, life expectancy has increased significantly. As a result, mature patients often have receding gingival tissues, physical and mental debilitation, less energy and motivation, and the resultant Class V carious lesions. In this article, I suggest the use of high-level fluoride in toothpastes, remineralizing pastes and high-level fluoride gels for topical application in trays to reduce the progression of caries. To accompany fluoride therapy, high-fluoride-releasing restorative materials are indicated for Class V carious lesions. Adequate caries-preventive and restorative concepts for mature patients require planning, patient education and close patient supervision.
Several forms of restorative techniques are used for posterior teeth. They vary significantly in cost and longevity. The following restorative concepts are the most commonly used: amalgam, resin-based composite, PFM, cast gold alloy restorations and all-ceramic restorations. I suggest that patients be informed about the potential longevity of restorative treatment for posterior teeth as they make decisions about treatment for their oral restorative needs.
The dental laboratory industry appears to need immediate change to face many challenges, the four most significant of which are described in this column and in our column in May JADA. The first article on this subject described the current challenges facing the laboratory industry, as determined by conference attendees representing all aspects of the dental industry and related professions. This article reports on the suggestions made by attendees of this conference to solve the identified challenges.
There is an obvious tendency in dental practice to place more full crowns than may be necessary. This article has discussed some of the reasons for this increased use of full crowns, and for a reduction in the use of full crowns. I have supported the desirability of placing more conservative restorations, and I have discussed the financial and longevity implications offered by more conservative restorative dentistry.
Undoubtedly, the four challenges facing dental technology we have described in this article are not the only ones, but they are the major ones as identified by the participants in the Dental Technology Summit. The attendees conducted active discussion on all of these points and developed potential solutions. It was gratifying to see the various political and organizational factions agree on the challenges, and the participants felt at the conclusion of the conference that the described challenges are, in fact, those that need immediate attention. We will discuss suggested potential solutions in a column in the June issue of JADA.
Digital photography almost has overtaken the conventional photographic film industry. Most professional photographers are using either digital photography alone or a combination of digital and conventional film photography. The trend toward digital photography is not likely to change. Using digital photography in the dental office is fast, easy and highly useful for documenting treatment, carrying out patient education and accomplishing clinical research. Supervision and use of this new technology can be delegated to staff members, and it will provide many benefits to dentists and patients.
American dentists should be pleased with the level of care they provide to their patients in the area of fixed prosthodontics. The American public is served with good, competent care at a moderate cost. However, this article has addressed the potential for increasing the quality level of care, increasing the speed of treatment and maintaining the moderate cost by delegating some of the clinical tasks to qualified staff members. In my opinion and experience, these results are achievable by delegating up to one-half of the time involved in fixed prosthodontic clinical tasks to qualified, educated, supervised non-dentist staff members, where such delegation is legal.
Many mechanical methods have been suggested to increase retention for restorations and crowns. Also, there have been numerous suggestions about the use of bonding agents for retention. Failure of bonding agents often is noted in practice when intracoronal restorations come out or when veneers fall off during service. Similarly, buildups for crown preparations or posts and cores occasionally come out during service. Questions often are asked about when bonding agents should be used, when mechanical retention should be used or when both are desirable. In this article, I discuss the various types of mechanical retentive methods available and make suggestions about the use of bonding agents. Dr. Christensen is co-founder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 3D, Provo, Utah 84604. He has a master’s degree in restorative dentistry and a doctorate in education and psychology. He is board-certified in prosthodontics. Address reprint requests to Dr. Christensen.
In the approximately 25 years that dental restorative resins have been cured by light, there has been constant evolution of and improvement in the curing devices and the resins they cure. During the past decade, curing lights have become very effective. Dentists who have functional halogen, fast halogen or PAC lights may wish to compare their current lights with the new generation of LED lights that are dominating the commercial dental advertising at this time. If the new LED lights offer more than the current light they are using, they might consider changing to an LED. If their current light offers about the same characteristics as the LED light being considered, I do not recommend changing. I anticipate that continued upgrading and improvement in LED lights eventually will make this concept the most used method for curing restorative resin.
Use of post-and-core restorations has changed markedly in the past several decades. Current use and research supports techniques using tooth-colored, fiber-reinforced resin-based composite posts or titanium alloy posts cemented with resin cement, followed by resin-based composite build-ups. Although fiber-reinforced resin-based composite posts appear to be very promising, long-term clinical observation is needed. I have made suggestions about when to use posts, what type of post to use and how to use them.
Fixed prosthodontic therapy continues to be a major part of dental services in the United States, and because of the aging population and the relative affluence of typical Americans, it is apparent that this involvement will not decrease in the foreseeable future. The average quality level of fixed prosthodontics in the United States is good, and with the help of third-party payment programs, many Americans are taking advantage of the availability of crowns and bridges. Dr. Christensen is co-founder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 3D, Provo, Utah 84604. He has a master’s degree in restorative dentistry and a doctorate in education and psychology. He is board-certified in prosthodontics. Address reprint requests to Dr. Christensen.
It is not difficult to observe and record patient occlusal characteristics before starting simple or complex occlusal rehabilitations. If this is done, and if the subsequently placed crowns and fixed prostheses are constructed in observation of similar characteristics, clinical success usually is the result. Deviations from the suggestion to duplicate the "normal" occlusion should be made when the original natural occlusion had caused overt pathosis, or when all teeth or one arch of the teeth is being restored at one time. If this is the case, centric relation occlusion is more reproducible and easier to develop than occlusion with a shift from centric relation to centric occlusion. Peculiar requests of patients relative to occlusal positioning, or routine dependence on various devices to predetermine occlusal characteristics for rehabilitation (as is currently popular in some groups), should be considered, but they should be tempered with careful observation of preoperative occlusal characteristics.
"Oral rehabilitation" is a phrase that is used to encompass several levels of oral therapy. Usually, dentists think of an oral rehabilitation as meaning restoration of all of the teeth in a given mouth. However, when only the defective teeth in any mouth are restored, that too could be defined as an oral rehabilitation. The advent of esthetic dentistry has encouraged oral rehabilitation for esthetic reasons only. This article suggests that such oral rehabilitations should be preceded by thorough informed consent and education about other, more conservative, therapies. Patients should have full knowledge that such rehabilitations are not required, and that they may require frequent re-treatment at significant cost. Qualified specialists or experienced general dentists are capable of treating all levels of oral rehabilitation, and completion of courses at specific commercial institutes is not necessary.
Digital radiography in dentistry has been around for more than a decade, and it has improved significantly during that time. However, the majority of practitioners in the United States have not abandoned conventional radiography, and many question the need to change to digital radiography. Is it finally time to move to this form of recording radiographic images? In this column, I will present a candid view of this technology and make a few personal conclusions about the state of the art in digital radiography. Dr. Christensen is co-founder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 3D, Provo, Utah 84604. He has a master’s degree in restorative dentistry and a doctorate in education and psychology. He is board-certified in prosthodontics. Address reprint requests to Dr. Christensen.
A difficult clinical situation encountered all too often by restorative dentists is the restoration of one single upper or lower anterior tooth with a crown or resin-based composite. If all of the anterior teeth in one arch need to be restored, the development of an acceptable esthetic result is relatively easy, because all of the restored teeth match one another. However, restoration of a single anterior tooth is a genuine esthetic challenge. Most mature dentists would agree that they have restored only a few single teeth to a near-perfect level in their entire careers. Dr. Christensen is co-founder and senior consultant of Clinical Research Associates, 3707 N. Canyon Road, Suite No. 3D, Provo, Utah 84604. He has a master's degree in restorative dentistry and a doctorate in education and psychology. He is board-certified in prosthodontics. Address reprint requests to Dr. Christensen.
Dental CE is mandatory for ongoing competency in dental practice. There are numerous methods of obtaining CE, some of which are highly successful and others that are of minimal value. In this article, I have described and prioritized the various methods of obtaining CE according to their effectiveness as I perceive it. CE in dentistry can be enjoyable, will allow dentists to serve their patients at a higher level of competency and will keep practitioners mentally stimulated as they learn new concepts and techniques.
