The European journal of esthetic dentistry : official journal of the European Academy of Esthetic Dentistry最新文献

In this two-part case presentation, the benchmarks of our treatment planning principles are briefly explained and their application is discussed in the case of a 35-year old patient with multiple failing restorations and an esthetic complaint regarding the maxillary anterior teeth. In this first part, the four principles are proposed, the patient's main problems are presented and three treatment options are discussed. In the second part, the treatment choice will be disclosed as well as the decision making process, the respective diagnostic procedures involved, and finally the sequential treatment. The aim of these articles is to stimulate the debate and to promote therapeutic choices that take into account evolution of contemporary dental medicine.

Background: Research into bleaching focuses on new products in order to minimize undesirable effects. This study evaluated the bleaching effectiveness of a new enzymatic-activated dentifrice.

Materials and methods: A total of 20 volunteers were bleached with a dentifrice containing 5% lactoperoxidase and 3% carbamide peroxide applied three times a day for two minutes over 21 days. Color was recorded before and after the treatment using a spectrophotometer. CIELAB differences were calculated before and after treatment using the paired t test (P < 0.05).

Results: Lightness was significantly higher after treatment (P < 0.001), ΔE was 5.14. The maxillary central incisors showed greater lightness than the laterals and canines, both before and after treatment, and a greater tendency towards green and blue; the same occurred in the mandibular central incisors in comparison to the canines and laterals.

Conclusions: The use of brush-applied enzyme-activated carbamide peroxide at low concentrations with short exposure time is effective for whitening teeth.

Clinical implications: Enzymatic dental bleaching is able to increase the efficiency of low concentration peroxides, reducing the potential risk of peroxides on oral tissues.

The necessity of surgical root coverage is often encountered in daily clinical practice, mainly because of esthetic reasons. Despite the variety of available surgical techniques, delicate clinical scenarios may require refined surgical therapy approaches. The presented double sliding flap technique is designed to meet the special requirements encountered in the often-fragile incisal mandibular area. This surgical approach combines two laterally repositioned flaps with the dissection of the frenulum, to cover two deep neighboring recessions in the area of the central incisors. Providing that correct indication and adequate surgical tissue handling are used, this complex and advanced technique may have the potential to achieve complete longterm root coverage and an esthetically satisfying treatment outcome.

Many treatment options are currently available for single tooth replacement, such as metal-ceramic, all-ceramic, direct or indirect fiber-reinforced composite fixed dental prostheses (FDPs) or implants. Inlay-retained FDPs could be indicated especially when adjacent teeth have preexisting restorations and where implant placement is not possible or not indicated. In such cases, indication of both metal-ceramic and fiber-reinforced composite FDPs has certain disadvantages. This paper describes the use of all-ceramic inlay-retained FDPs with zirconia frameworks, veneered with a press-on technique. The retainer margins were made of pressed ceramic to make adhesive luting possible. In deep cavities, a full contour press-on ceramic all around the retainers increased the available surface area for the adhesive approach.

The objective of this in vitro study was to evaluate the kinetics of hydrogen peroxide (HP) release from five different bleaching products: VivaStyle® 10% fitted tray gel, VivaStyle® 30% in-office bleaching gel, VivaStyle® Paint-On Plus paint-on bleaching varnish, Opalescence PF® 10% carbamide peroxide gel and Trèswhite Supreme™ 10% HP gel. Each product was firstly titrated for its HP content by a described method. HP release kinetics was assessed by a modified spectrophotometric technique. One sample t test was performed to test for differences between the manufacturers' claimed HP concentrations and the titrated HP content in the whitening products. Analysis of variance plus Tamhane's post hoc tests and Pearson correlation analysis were used as appropriate. Values of P < 0.05 were taken as significant. Titrated HP revealed an increased content when compared to the manufacturer's specifications for all the products tested (P < 0.05), although only products from one manufacturer produced significantly higher results. All products presented a significant (P < 0.05) and sustained release of HP. However, the product with paint-on cellulose-based matrix resulted in significantly (P < 0.05) faster kinetics when compared to other products tested. These results are consistent with manufacturers' reduced recommended application times. The results of this study suggest that modifying the matrix composition may be a viable alternative to HP concentration increase, since this may result in faster release kinetics without exposure to high HP concentrations.

Porcelain laminate veneer restorations are much thinner than other types of restorations such as crowns or onlays. Within the range of 0.3 to 1.5 mm, it is not an easy task for the clinician to provide the appropriate clearance for the ideal restoration and, concurrently, for the dental technician to predictably create a piece of imitated nature. The advantages of enamel preservation and the principle of nil nocere imply removing as little tooth structure as possible for the purpose of maintaining tooth health, its mechanical strength and ensure the treatment's long-term predictability. There has to be a balance between the requirements of reduction clearance, which will enable the technician to achieve the desired esthetic result, and the minimally invasive principles of dentistry. With laminate veneer cases, there might be areas of variable ceramic thickness that can create esthetic problems. These will be hard to correct during cementation and will also be clearly visible to the patient. Clinical cases are presented here to outline this type of problem.

Purpose: The presence of a treatable gingival recession in teeth ready for crown preparation requires a combined restorative-periodontal effort to achieve all biologic and esthetic goals. This needs an ideal artificial crown proportion and a harmonious gingival architecture. Traditionally, a root coverage procedure is initially performed followed by final crown preparation and cementation. However, during the prosthetic phase, irritation to the grafted delicate tissue may be followed by recession and exposed crown margins. To minimize prosthetic irritations, the "crown-then-graft approach" (CTGA) is suggested in which the root coverage procedure is performed after final crown preparation.

Methods: After definitive crown preparation and impression taking of the left maxillary incisor, an acrylic crown with flat marginal profiles was temporarily cemented into the patient's mouth. Root coverage procedures were implemented using a combined connective tissue graft and a coronally advanced flap. No additional tooth preparation and impression taking were performed. After 6 months, a final crown, fabricated from the previous impressions, was cemented.

Results: Initially, the grafted tissue margins completely covered the root and 1-2 mm of the temporary crown margins. At 12 months post-surgery and 6 months post-definitive crown cementation, the gingival margins slowly receded, reaching the ideal position. Complete root coverage was maintained for the next 5 years.

Conclusions: The CTGA may minimize tissue irritation after root coverage in teeth designed for combined crown preparation and root coverage procedure, and may account for long-term marginal tissue stabilization.

External beauty is a complex construct that influences lives and may be impacted by dentists. Beauty is not easily quantified, but one cited anthropometric of beauty is the ratio phi, the number 1.618033(...). This study examined phi as a measure of female frontal facial beauty in classic Western art, using pre- Renaissance (N = 30), and Renaissance (N = 30) artwork. Four horizontal and five vertical ratios were determined in the works of art, which were then compared with the phi ratio. All horizontal ratios for both pre-Renaissance and Renaissance artwork were similar to each other, but did not contain the phi ratio (P < 0.001). Nevertheless, all vertical ratios for pre-Renaissance and Renaissance art-work did contain the phi ratio within their confidence intervals with the exception of the vertical ratio, "intereye point to soft tissue menton/ intereye point to stomion", that was found to be less than phi in the Renaissance group. The study provides evidence of the presence of the phi ratio in vertical aspect of females in artwork from pre-Renaissance through the Renaissance demonstrating consistent temporal preferences. Therefore, the phi ratio seems to be an important consideration in altering vertical facial dimensions in full mouth rehabilitation and reconstructive orthognathic surgery involving females.

This study presents a technique for improving implant placements. As is widely known, a correct positioning is essential in restoration-driven implants, as well as in tilted implants in order to obtain satisfactory final functional and esthetic results. To this end, some authors have emphasized the importance of using a diagnostic and/or surgical guide to plan the exact implant position. In practice, one of the clinical problems faced is how to check the accuracy of the template prior to initiating the surgical phase. A simple method called the "S-Technique" is proposed in order to evaluate and to change, if necessary, the projected position of the implants by way of metal rods as radiopaque markers. This device is easy to produce and is cost-saving to the clinician and, therefore, to the patient. Furthermore, in specific patients, this method could also decrease the need for computerized tomography scans and/or radiographs, thus reducing health risks for the patient.