International Journal of Esthetic Dentistry (EN), 01/2006

Erosion and surface wear result in the progressive thinning of enamel, ultimately generating increased crown flexibility and higher enamel surface strains. The restoration of tooth volume through the use of bonded porcelain veneers not only reestablishes the original and youthful appearance of the smile, but also allows biomimetic recovery of the crown. The driving force of this process should be the preservation of the remaining enamel. Traditional approaches to veneer preparation can lead to major dentin exposures. Enamel preservation can still be achieved with bonded porcelain veneer restorations, however, given a proper approach to tooth preparation. This article describes a treatment rationale that includes the use of a diagnostic template. This technique, presented here in a clinical case with moderate enamel loss, integrates an additive waxup and a direct intraoral acrylic mock-up. Using this strategy, clinicians should be able to perform tooth preparations that are both more accurate and also higher in quality in an extremely time-efficient fashion compared with traditional methods.

Images play a vital role in the publication and presentation of clinical and scientific work. Within clinical photography, color reproduction has always been a contentious issue. With the development of new technologies, the variables affecting color reproduction have changed, and photographers have moved away from film-based to digital photographic imaging systems. To develop an understanding of color, knowledge about the basic principles of light and vision is important. An object's color is determined by which wavelengths of light it reflects. Colors of light and colors of pigment behave differently. Due to technical limitations, monitors and printers are unable to reproduce all the colors we can see with our eyes, also called the LAB color space. In order to optimize the output of digital clinical images, color management solutions need to be integrated in the photographic workflow; however, their use is still limited in the medical field. As described in part 2 of this article, calibrating your computer monitor and using an 18% gray background card are easy ways to enable more consistent color reproduction for publication. In addition, some basic information about the various camera settings is given to facilitate the use of this new digital equipment in daily practice.

Use of traditional orthodontic measures in the periodontally compromised dentition can be problematic. This article describes a variation of the Grassline technique, in which the author uses adhesive bonding to harmoniously re-align malpositioned teeth. In this simple, easy-to-learn technique, a cotton thread is used to achieve orthodontic tooth movement. Initial contact with the saliva causes shrinkage of the thread, exercising a minor force that moves the teeth while allowing enough time for the tissues to regenerate. With this moderate, intermittent force, successful treatment is achieved with minimal risk. Moreover, this orthodontic technique has been associated with an increase in bone volume. This article presents this new technique and details methods for maintaining treatment success. The technique also is compared with an approach described in the literature. Two case reports are presented; the technique is employed in the first to close a diastema in a periodontally compromised dentition and in the second to correct the migration of maxillary and mandibular incisors. Photographs and radiographs show the esthetic improvement achieved in both cases using this technique.

This paper describes the rationale and procedures for noninvasive treatment of discolored nonvital teeth using the walking bleach technique. The limitations of this procedure and, in particular, the unpredictable color stability following nonvital bleaching are discussed and illustrated with two cases of rapid discoloration relapse. The possible reasons for treatment failure are examined and show that current knowledge regarding the origin and prevention of discoloration is limited.

Analysis of the facial features and lip movements in relation to teeth, achieved by evaluating the facial, dentolabial, and phonetic parameters, should be the first step in prosthetic rehabilitation. This article focuses on dentolabial analysis, presenting a systematic approach to evaluating the relationship between the teeth and the lips and lower third of the face. The parameters evaluated include tooth exposure, incisal edge position, smile width, labial corridor, interincisal line vs midline, and occlusal plane vs commissural line. Here two parameters of dentolabial analysis are explored in depth: incisal edge position (with regard to both incisal curve and incisal profile) and orientation of the incisal plane, which is a portion of the occlusal plane. Methods for identifying both parameters are outlined, and their role in the achieving successful esthetic results in prosthetic treatment is discussed.

In-office techniques for bleaching vital teeth are effective and expedient, but because they require the use of elevated concentrations of hydrogen peroxide-based agents, which are caustic and potentially toxic, they are found to be less appealing by practitioners compared with home whitening procedures. In this article we propose a new technique for in-office whitening of vital teeth using a 6% hydrogen peroxide paint-on whitening varnish, which enables the whitening procedure to be more economic and user-friendly, as well as less toxic and time consuming, compared with traditional in-office bleaching. A total of six patients with no caries or restorations in the maxillary and mandibular anterior teeth were selected for this study. Ten-minute applications of the painton whitening varnish were performed repeatedly with each patient for up to 1 hour and then repeated 1 week later. Initial shades were recorded with a Vita scale guide, and photographs were taken at the beginning and end of the study. A questionnaire assessing clinical parameters and patient satisfaction was performed. A change of 7 to 13 values on the Vita scale was observed in all cases. There were no reports of tooth sensitivity, and overall patient satisfaction was achieved. In-office bleaching with the use of paint-on varnishes seems to be effective, safe, and well accepted by patients, offering a viable alternative to high-peroxide-concentration in-office procedures.

In this two-part treatment planning series, the case of a 54-year-old woman with a failing four-unit fixed partial denture (FPD) is presented. In Part 1, pretreatment strategies, eg, use of intra- and extraoral photographs, analysis of periapical radiographs, and examination of occlusal and periodontal status, are discussed. The advantages and disadvantages of three treatment options-removable partial denture, toothsupported FPD, and implant-supported FPD-are presented. In Part 2, to be published in the next issue, the treatment selected will be revealed and the rationale governing the decision will be discussed.