Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

Unsplinted attachment systems for implant overdentures offer various benefits for edentulous patients, including cost-effectiveness, enhanced cleansability, and less need for manual dexterity. This article describes a facially driven digital workflow for fabricating a maxillary implant overdenture retained by conometric-style attachments (Atlantis® Conus) with a palateless design opposing an implant overdenture retained by standard attachments (LOCATOR®). This procedure provides a predictable and accurate technique to digitally scan the master casts with wax rims for articulation and to guide the digital teeth design set-up for a predictable esthetic outcome. The removable prosthesis workflow involves virtual teeth set-up, a 3D-printed trial denture, a milled definitive prosthesis, and intraoral pick-up for both unsplinted attachment systems. The clinical and laboratory steps are described.

Digital smile design allows dental providers to digitally strategize treatments prior to performing irreversible procedures. Through the integration of various digital records, a comprehensive digital replica of the patient can be produced in which crucial facets of the patient's oral health and smile are captured. This article discusses the benefits of digital smile design and identifies key smile design and facial harmony principles when designing a patient's smile. Such principles as central incisor ratio, recurring esthetic dental (RED) proportions, facial flow, axial angulations, and more are discussed.

The clinical quality and longevity of increasingly popular resin-bonded CAD/CAM ceramic restorations depends greatly on the strength and durability of the resin-ceramic bond. With a diverse array of ceramic materials available, the choice of ceramic bonding protocol is highly influenced by the specific ceramic's type and composition. Typically, this protocol encompasses a surface pretreatment step followed by the application of a priming agent. This article provides a comprehensive update on current resin-bonding protocols for the most commonly used CAD/CAM ceramics.

The benefits of transitioning from traditional analog workflows in dental practice to digital workflows are numerous and can be attained with wise choices and solid support. This transition begins with the integration of digital intraoral scanning into routine operations. The purpose of this article is to increase awareness of the clinical and management benefits of digital scanning and to aid clinicians in decision making regarding the incorporation of this technology into dental practice. Having a better understanding and appreciation of the implications for ease of use, accuracy, and enhanced success can help make digital scanning and workflow an attractive option.

Maxillary central incisors are critical to occlusal function, smile esthetics, and even one's self-image. Furthermore, their impaction at an early age could have harmful psychological consequences on the individual. Maxillary central incisors can be impacted due to early dentoalveolar trauma to the upper anterior region that displaces the incisor in formation and, in rare instances, tooth germs are deformed. The aftermath of trauma during primary dentition is seen later during mixed dentition. Other causes are either an impediment in the eruption pathway of the maxillary central incisor due to the presence of odontomas or supernumerary teeth, an insufficient eruption space, or, very rarely, syndromic and/or other general medical conditions. Diagnosis is completed through a detailed medical/dental history, clinical evaluation, and appropriate imaging. Arch width increase, space opening, removal of obstructions if present, suitable soft-tissue management, well-designed orthodontic traction mechanics, and long-term periodontal follow-up are all essential elements in resolving cases of impacted maxillary central incisors.

Background: An alveolar ridge preservation (ARP) procedure is commonly performed to preserve ridge width and height for optimal dental implant placement. Mixing different sources of bone grafts may help maximize their properties to obtain predictable ARP results.

Objective: The aim of this case series is to highlight the clinical and radiographic outcomes of a combined allograft and xenograft approach for a predictable ARP procedure.

Materials and methods: Eleven clinical cases that required tooth extraction and future implant placement were selected for this case series. All surgeries were performed by a single clinician in a private practice setting. All cases underwent an ARP procedure, which included atraumatic extraction, degranulation, assessment of the socket, and the use of a combination of allograft and xenograft fibers/granules in a 1:1 mixing approach. Based on the socket defect, either a type I or type III collagen membrane was used during the procedure. In all cases CBCT imaging was done prior to surgical implant placement, and digital implant planning was performed integrating interdisciplinary best practices. Implant placement was carried out using manufacturer's recommendations.

Results: Five male and five female patients were included in the study, with one of the male patients having two teeth extracted for a total of 11 cases. The reasons for teeth extraction included fracture, endodontic failure, periodontal infection, and subgingival decay. Healing was uneventful after the ARP procedure for all patients. A minimum of 120 days elapsed between ARP and the surgical implant procedure. Complete radiographic bone fill was observed in the CBCT image for all extraction sites, and no additional bone augmentation was needed at the time of implant placement.

Conclusion: This case series demonstrates that based on clinical and radiographic outcomes, a combination of allogenic and xenogenic bone substitute can be utilized to obtain predictable results following ARP. Future randomized controlled trials that can compare different ratios between the two biomaterials are indicated to guide clinicians in the mixing protocols and their outcomes.

All dental healthcare providers need to ensure patient and worker safety by maintaining excellent standards with regard to cleaning and disinfecting treatment rooms and reprocessing critical instruments. Especially in this day and age of heightened infection control concerns, proper cleaning and disinfection protocols are critically important to prevent cross-contamination and maintain hygienic conditions. This article reviews infection prevention strategies in the dental office, beginning with treatment room cleaning and disinfection, which includes maintenance of various types of surfaces and the use of barrier protection, and continuing to the disinfection and sterilization of dental instruments. The article also discusses methods for validating the sterilization process and proper instrument storage.

Surgical crown lengthening (SCL) is the treatment of choice to ensure healthy tissues when subgingival tooth defects encroach on the biologic width.1 However, restorative techniques employing adhesive dentistry may provide viable alternatives to or complement SCL in select cases without the repercussions of surgical bone removal and open interproximal spaces. One such clinical technique, deep margin elevation (DME), employs a direct restoration to relocate the cervical margin of small subgingival defects of posterior teeth supragingivally. The "elevated" margin simplifies impression-making and bonding of indirect restorations, especially inlays and onlays. Recent scientific systematic literature reviews indicate favorable clinical outcomes and suggest that DME restorations made with scrupulous care have high success rates and are compatible with periodontal health. Optimal working field isolation, meticulous placement of matrices, proper bonding and buildup procedure, as well as regular maintenance and follow-up are essential for success. This article provides an overview of this approach.

This clinical case study describes the smile restoration of a 33-year-old female patient who exhibited severe dental anxiety, multiple cavities, discoloration, and a fractured tooth. The patient's complex dental history and anxiety-driven treatment preferences posed challenges that were met with a minimally invasive strategy. The case involved meticulous diagnosis, leveraging advanced diagnostic wax-ups, and a comprehensive treatment plan. Esthetic zirconia material was utilized to enable the preservation of tooth structure while achieving visually appealing and functional outcomes, and CAD/CAM technology facilitated same-day restorations with superior marginal fit, aided by the precision of a digital intraoral scanner. The patient's dental anxiety strongly influenced the treatment approach, leading to the integration of smile enhancement alongside caries treatment. The use of a single cement and bond product simplified the final cementation process, while the versatility of the zirconia CAD/CAM material allowed for fabrication of various restoration types with minimal tooth reduction. This streamlined workflow expedited treatment, which was especially crucial for the anxious patient undergoing sedation.

While surgical guides have allowed for more highly accurate immediate implant placement in the esthetic zone, only a few techniques have been described to predictably position an immediate implant provisional. Even fewer techniques have addressed repositioning a patient's extracted tooth for use as the interim implant restoration. This article describes a workflow for the fabrication of a dual-purpose surgical guide that allows for guidance of implant placement as well as repositioning of a decoronated tooth that will serve as a provisional. While other provisional techniques aim to recreate proper gingival contour, the benefit of repositioning of the original tooth is the preservation of the existing gingival margin position and existing critical contour of the emergence profile.