International Journal of Esthetic Dentistry (EN), 04/2006

This case report presents the clinical and technical protocol involved in treating a 32- year-old patient whose teeth and dental appearance were severely compromised as a result of bulimia nervosa. Patients suffering from this disorder have a high incidence of erosion of dentin and enamel, which over time may cause loss of vertical dimension. This has an impact on the patient's overall appearance, with effects such as sunken lips, lack of support, and creases at the corners of the mouth.

Esthetic dentistry is characterized primarily by the smile. The goal in the creation of esthetic dental restorations is to simulate, or improve upon, the appearance of the natural dentition. However, it is important to note that the smile is just one element of the face, which serves as the primary means of emotional expression. Therefore, successful esthetic restorations must integrate harmoniously with the whole of the face, not just with the surrounding teeth. This requires a full understanding of each patient's unique personality-the psychology of dental esthetics. This article will discuss esthetic psychology and the process by which our creative thought and understanding of a patient takes concrete, physical form in the creation of dental restorations. The integration of dental restorations with the face using both shape and color will be addressed; specifically, the intricate movement of the facial muscles will be explored, as will the ways in which color is perceived in the brain, both of which are key considerations for proper esthetic restorations.

The attainment of primary wound closure is one of the major determining factors of success in oral surgery. Especially when dealing with regenerative or augmentative procedures, healing in a submerged environment is crucial to achieving the desired treatment result. In this context, the use of a microsurgical approach and layered suturing techniques is of utmost importance for precise and meticulous wound closure. However, microsurgical wound closure using both mattress sutures and interrupted sutures is very time consuming and may be detrimental to wound healing because of trauma and extended surgical time. The double-sling suture, a modified suture technique that combines two interrupted sutures that have different bite sizes and engage different tissue layers, is able to predictably and efficiently close the surgical site for improved wound healing. This article describes this new technique and presents two case examples.

The chance for a successful restorative outcome is improved when the clinician, the laboratory technician, and the patient agree on the design and appearance of the planned dental prosthesis as early as possible. A try-in of a planned dental restoration in the patient's mouth provides the parties involved in treatment planning with the ability to determine treatment goals together. The following article describes the use of a novel light-curing hybrid wax, a resinlike material that allows natural-looking, fracture-proof esthetic try-in restorations. Corrections can be made chairside by adding or removing material. The material is suitable for all indications involving fixed or removable dentures. Moreover, as the material can be burned without producing residues, it can be used directly in other applications such as pressable ceramics, ceramics pressed to metal, and casting techniques. A clinical case demonstrating the use of the hybrid wax is also presented.

Accurate shade analysis and communication represent one of the biggest challenges in restorative and esthetic dentistry today, especially in light of the rapidly increasing array of ceramic materials available. Traditional methods of shade analysis have relied upon the use of conventional shade guides or, more recently, digital shade measurement. In this article, the author examines the advantages and disadvantages of traditional shade analysis; reviews principles for optimizing the evaluation process, including information regarding the scientific basis of general color science, optics, and aspects of material science; and proposes a six-step approach to shade analysis in which less emphasis is placed on shade guide samples in favor of natural internal structures and surface properties and their replication in different dentin, enamel, transparent, and colored translucent, as well as fluorescent and opalescent, ceramics.

This two-part treatment series describes the examination, planning, and prosthetic treatment of a 17-year-old female patient whose maxillary central incisors were traumatically lost at the age of 9 years. The first part presented analysis of function and esthetics, and the advantages and disadvantages of the different prosthodontic treatment options were discussed. In this second part of the article, treatment selection, along with the rationale for the decision, the sequence of treatment steps, and the final result are revealed.