International Journal of Esthetic Dentistry (EN), 02/2017

Direct composite resin restorations have been recognized for their valuable clinical service and respect of intact hard tissue. The cost-effectiveness and inherent minimally invasive approach of resin-based materials means that they are also gaining popularity for use in computer-aided design/computer-aided manufacture (CAD/CAM) procedures. Several cases from the student clinics at the Herman Ostrow School of Dentistry of USC are presented that could have been resolved either with direct composite resin restorations or with indirect porcelain veneers. A novel semi-indirect CAD/CAM approach, characterized by its absolute noninvasiveness and simplicity, was chosen instead. The bilaminar restoration consists of a customized histoanatomical CAD/CAM dentin base (incisoproximal cutback), and a generic enamel skin. The patients can be treated either in one clinical session (semi-directly) or in two clinical sessions (semi-indirectly). The purpose of this article is to present another tool from the anterior restorative armamentarium to bridge the gap between direct and indirect techniques.

Ceramic laminate veneer restorations are indicated in several clinical situations. Indirect restorations are usually chosen if the less-invasive options - bleaching, resin infiltration, or composite resin restorations - are not possible, or when it is too difficult to achieve an esthetically pleasing result in the long term. Bonded indirect partial restorations are highly dependent on their adhesive interface, as these thin restorations have a relatively low cohesive strength. Therefore, preservation of sound enamel, conditioning of the restorations and of the substrate, and luting procedures are of paramount importance for a successful outcome. Even when utmost care is taken during every step of the procedure, failures such as fractures, chipping, or marginal discoloration and defects sometimes occur. Only very few of these cases of failure are presented or are a subject of interest. In this case presentation, a fracture repair is performed using an infiltration technique with a resin composite material.

It is often presumed that, since its introduction in 1864, the use of rubber dam in multiple dental procedures has increased. However, its use is not as widespread as one might expect. There still seem to be many obstacles that prevent clinicians from adopting it as a standard of care. Furthermore, it appears very difficult to scientifically prove the impact of its use on the final outcome of a given procedure. The fundamental idea of isolating the operatory field and preventing contamination is simple; the practical execution of it is more demanding. In this article, the authors not only focus on the essential criteria for predictable isolation, they also present an isolation strategy that can be translated into a step-by-step procedure. It is suggested that by adopting this strategy, clinicians can eliminate the most commonly experienced obstacles and optimize the full potential of isolation, even in extremely difficult clinical situations.

Contemporary dental patients present with high expectations and demand seamless optical integration of restorative interventions. As a result, clinicians and technicians are required to develop methodologies that remain practical yet increase the accuracy and objectivity of shade analysis and estimation. There have been significant advances in digital technologies over the past 20 years, with digital photography being at the forefront. Digital photography has made an immediate and profound impact on applied clinical dentistry, primarily due to instantaneous image visualization and distribution. However, standardization protocols in terms of image acquisition and objective analysis remain equivocal. By utilizing reflective cross-polarized light digital photography with a standardized white balance gray reference card serving as the known reference, in conjunction with a specific digital single-lens reflex (DSLR) camera profile and digital photographic processing software working in the CIE L*a*b* (1976) color space, one can achieve standardized image acquisition and subsequent objective image analysis. The goal of this systematic approach is to identify the most efficient and effective means to generate consistent and optimum visual integration and restorative outcomes through numerical quantification, in order to enable clinicians and technicians to work predictably even when they are in different geographic locations.

The aim of this article is to identify the indications for adhesively cemented restorations and to provide a correct step-by-step protocol for clinicians. New cavity preparation principles are based on morphological considerations in terms of geometry (maximum profile line and inclination of cusp lines), and structure (dentin concavity and enamel convexity). In this article, we discuss previous preparation concepts that were not designed purely for adhesive restorations and were therefore not conservative enough or suitable for adhesive procedures. The novel cavity shape consists of continuous inclined plane cavity margins (hollow chamfer or concave bevel) on axial walls, whenever they are coronal to the equatorial tooth line. A 1.2 mm-thick butt-joint preparation is performed in the interproximal box and on the axial walls when the margins are apical to the equatorial line. The occlusal surface is anatomically prepared, free of slots and angles. The author's suggestion is to avoid shoulder finish line preparation around cusps, occlusal slots, and pins, as they are less conservative, incompatible with adhesive procedures, and involve unnecessary dentin exposure. The clinical advantages of this new "anatomic" preparation design are 1) improving adhesion quality (optimizing the cutting of enamel prisms, and increasing the available enamel surface); 2) minimizing dentin exposure; 3) maximizing hard tissue preservation (the cavity being designed for cementation with reinforced composite resins, improvement of flow, and removal of excess material); 4) optimization of esthetic integration due to the inclined plane design, which permits a better blending at the transition area between tooth and restoration. These preparation principles may be effectively used for all adhesively cemented restorations, both according to traditional concepts (inlay, onlay, overlay) and new ones (additional overlay, occlusal-veneer, overlay-veneer, long-wrap overlay, adhesive crown). Thus, a balance between restoration and prosthodontics is created, which is characterized by a more conservative approach.

Objective: The aim of this study was to investigate the accuracy of digital measuring tools to measure the position of gingival zeniths and to assess its reproducibility between different examiners. Materials and methods: A total of 108 subjects were photographed at the Louisiana State University School of Dentistry. The settings, positioning of the digital camera, and subjects' Frankfurt levels were standardized. A photograph was taken of the six anterior maxillary teeth of each subject, and their corresponding free gingival margins. Digital caliper measurements were taken intraorally from the zenith to the incisal edge of the right maxillary central incisor. A reference line was drawn across the screen on each image at the level of the zenith of tooth 8. Three calibrated examiners then measured the distance from the reference line to the zeniths of the other five anterior maxillary teeth. Results/conclusions: There was no statistically significant difference between the examiners regarding any of the measurements. Central incisors were at the same level in 84.24% of the subjects, and lateral incisors were within 0.5 mm of central incisors in only 58% of the subjects. Canine zeniths were within 0.5 mm of each other in 43% of the subjects. Only 28% of the subjects presented with zeniths of tooth 6 to tooth 11 within 0.5 mm of each other. Lateral incisors were at or beneath the line drawn from central incisors to cuspids in 90.8% of the subjects. Standardized digital photography taken with the aid of a stadiometer and used to evaluate esthetic parameters allowed for reproducible measurements.

Purpose: This article describes the use of rapid prototyping (RP) for diagnosis, planning, and execution of the reconstruction of hard and soft tissue in socket defects using immediate dentoalveolar restoration (IDR). Summary: In cases of tissue loss in anterior dental areas, esthetic rehabilitation poses a major challenge with respect to treatment planning with the goal of long-term tissue maintenance. The IDR technique consists of immediate reconstruction in a single procedure of bone and soft tissue around implants placed immediately after extraction, and prosthetic rehabilitation. As this procedure is immediate and flapless, the correct diagnosis of tissue loss and correct graft adaptation are mandatory. RP can increase the precision of the procedure, as demonstrated using a clinical case characterized by total loss of the buccal bone wall and gingival recession. The results were evaluated by clinical assessment, photography, radiography, cone beam computed tomography (CBCT), and prototyping. Conclusion: The application of RP facilitated the execution of IDR as it enabled more accurate diagnosis of the socket defect and more precise adaptation of the tissue graft. A clinical study should be conducted to evaluate the effects of RP on the clinical results of the IDR technique.